ST. ANTHONY'S MEMORIAL HOSPITAL - Price Transparency,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, Site,Svc_Cd,HCPC/Cpt_Cd,CDM_Svc_Descr,Rev_Cd, Quantity/Units , Hospital_gross_Charge , Self_Pay_Chg , Minimum_Negotiated_Chg , Maximum_Negotiated_Chg , AETNA , AETNA HSHS , AETNA MEDICARE , BC EXCHANGE , BC MEDICARE , BCBS OF ILLINOIS PPO , BLUE CROSS BLUE SHIELD IL HMO , BLUE CROSS BLUE SHIELD IPA IL , BLUE CROSS SIHCA , CHOICE CARE , CIGNA , CLEAR SPRING HEALTH MEDICARE ADV , CONSOCIATE GROUP ," ESSENCE, L.L.P. ", FIRST HEALTH NETWORK , HEALTH ALLIANCE KINGERY , HEALTH ALLIANCE MEDICAL PLAN EXCHANGE ," HEALTH ALLIANCE MEDICAL PLANS, INC. ", HEALTH ALLIANCE MEDICARE , HEALTH ALLIANCE PPO , HEALTH PARTNERS MEDICARE , HEALTHLINK , HEALTHLINK CASINO QUEEN , HEALTHLINK PPO , HFN , HOPETRUST , HUMANA , HUMANA MEDICARE , ILLINOIS BREAST AND CERVICAL CANCER PROGRAM , LIVE360 HSHS HEALTHY PLAN , LIVE360 MEDICARE COST PLAN , LIVE360 NON HSHS HEALTHY PLAN , MOLINA MEDICAID , MOLINA MEDICARE , MULTIPLAN , NAPHCARE , PHYSICIANS HEALTH ASSOCIATION OF IL BCBS HMO , PLAIN CHURCH MEDICAL GROUP , PROVIDER NETWORK OF AMERICA , SAE MEMORIAL HOSPICE , UHC CATERPILLAR , UNITED HEALTH ALL PAYOR , UNITED HEALTH CARE MEDICARE , WELLFIRST ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),12000001,N/A,HC DAILY SERVICE GENERAL,120,1 ,$923.00 ,$599.95 ,$400.58 ,$923.00 ,$687.64 ,$604.57 , Inpt Medicare ,$486.42 , Inpt Medicare ,$582.41 ,$582.41 ,$582.41 ,$582.41 ,$830.70 ,$692.25 , Inpt Medicare +1% ,$784.55 , Inpt Medicare ,$692.25 ,$692.25 ,$784.55 ,$784.55 , Inpt Medicare ,$784.55 , Inpt Medicare ,$692.25 ,$692.25 ,$692.25 ,$830.70 , Medicare +150% ,$830.70 , Inpt Medicare , N/A ,$604.57 , Inpt Medicare ,$400.58 , Inpt Medicaid +5% , Inpt Medicare +5% ,$830.70 , Inpt Medicare +100% ,$582.41 ,$553.80 ,$830.70 , Inpt Medicare ,$830.70 ,$830.70 , Inpt Medicare ,$599.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),12000006,N/A,HC DAILY SERVICE W/TELEMETRY,120,1 ,"$1,301.00 ",$845.65 ,$564.63 ,"$1,301.00 ",$969.25 ,$852.16 , Inpt Medicare ,$685.63 , Inpt Medicare ,$820.93 ,$820.93 ,$820.93 ,$820.93 ,"$1,170.90 ",$975.75 , Inpt Medicare +1% ,"$1,105.85 ", Inpt Medicare ,$975.75 ,$975.75 ,"$1,105.85 ","$1,105.85 ", Inpt Medicare ,"$1,105.85 ", Inpt Medicare ,$975.75 ,$975.75 ,$975.75 ,"$1,170.90 ", Medicare +150% ,"$1,170.90 ", Inpt Medicare , N/A ,$852.16 , Inpt Medicare ,$564.63 , Inpt Medicaid +5% , Inpt Medicare +5% ,"$1,170.90 ", Inpt Medicare +100% ,$820.93 ,$780.60 ,"$1,170.90 ", Inpt Medicare ,"$1,170.90 ","$1,170.90 ", Inpt Medicare ,$845.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),12200001,N/A,HC DAILY SERVICE OBSTETRICS,122,1 ,$923.00 ,$599.95 ,$400.58 ,$923.00 ,$687.64 ,$604.57 , Inpt Medicare ,$486.42 , Inpt Medicare ,$582.41 ,$582.41 ,$582.41 ,$582.41 ,$830.70 ,$692.25 , Inpt Medicare +1% ,$784.55 , Inpt Medicare ,$692.25 ,$692.25 ,$784.55 ,$784.55 , Inpt Medicare ,$784.55 , Inpt Medicare ,$692.25 ,$692.25 ,$692.25 ,$830.70 , Medicare +150% ,$830.70 , Inpt Medicare , N/A ,$604.57 , Inpt Medicare ,$400.58 , Inpt Medicaid +5% , Inpt Medicare +5% ,$830.70 , Inpt Medicare +100% ,$582.41 ,$553.80 ,$830.70 , Inpt Medicare ,$830.70 ,$830.70 , Inpt Medicare ,$599.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),17100001,N/A,HC DAILY INFANT SERVICE LEV 1,171,1 ,$790.00 ,$513.50 ,$342.86 ,$790.00 ,$588.55 ,$517.45 , Inpt Medicare ,$416.33 , Inpt Medicare ,$498.49 ,$498.49 ,$498.49 ,$498.49 ,$711.00 ,$592.50 , Inpt Medicare +1% ,$671.50 , Inpt Medicare ,$592.50 ,$592.50 ,$671.50 ,$671.50 , Inpt Medicare ,$671.50 , Inpt Medicare ,$592.50 ,$592.50 ,$592.50 ,$711.00 , Medicare +150% ,$711.00 , Inpt Medicare , N/A ,$517.45 , Inpt Medicare ,$342.86 , Inpt Medicaid +5% , Inpt Medicare +5% ,$711.00 , Inpt Medicare +100% ,$498.49 ,$474.00 ,$711.00 , Inpt Medicare ,$711.00 ,$711.00 , Inpt Medicare ,$513.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),17200002,N/A,HC DAILY INFANT SERVICE LEV 2,172,1 ,"$1,312.00 ",$852.80 ,$569.41 ,"$1,312.00 ",$977.44 ,$859.36 , Inpt Medicare ,$691.42 , Inpt Medicare ,$827.87 ,$827.87 ,$827.87 ,$827.87 ,"$1,180.80 ",$984.00 , Inpt Medicare +1% ,"$1,115.20 ", Inpt Medicare ,$984.00 ,$984.00 ,"$1,115.20 ","$1,115.20 ", Inpt Medicare ,"$1,115.20 ", Inpt Medicare ,$984.00 ,$984.00 ,$984.00 ,"$1,180.80 ", Medicare +150% ,"$1,180.80 ", Inpt Medicare , N/A ,$859.36 , Inpt Medicare ,$569.41 , Inpt Medicaid +5% , Inpt Medicare +5% ,"$1,180.80 ", Inpt Medicare +100% ,$827.87 ,$787.20 ,"$1,180.80 ", Inpt Medicare ,"$1,180.80 ","$1,180.80 ", Inpt Medicare ,$852.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),20000001,N/A,HC DAILY SERVICE ICU,200,1 ,"$1,905.00 ","$1,238.25 ",$826.77 ,"$1,905.00 ","$1,419.23 ","$1,247.78 ", Inpt Medicare ,"$1,003.94 ", Inpt Medicare ,"$1,202.06 ","$1,202.06 ","$1,202.06 ","$1,202.06 ","$1,714.50 ","$1,428.75 ", Inpt Medicare +1% ,"$1,619.25 ", Inpt Medicare ,"$1,428.75 ","$1,428.75 ","$1,619.25 ","$1,619.25 ", Inpt Medicare ,"$1,619.25 ", Inpt Medicare ,"$1,428.75 ","$1,428.75 ","$1,428.75 ","$1,714.50 ", Medicare +150% ,"$1,714.50 ", Inpt Medicare , N/A ,"$1,247.78 ", Inpt Medicare ,$826.77 , Inpt Medicaid +5% , Inpt Medicare +5% ,"$1,714.50 ", Inpt Medicare +100% ,"$1,202.06 ","$1,143.00 ","$1,714.50 ", Inpt Medicare ,"$1,714.50 ","$1,714.50 ", Inpt Medicare ,"$1,238.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),26000000,96360,HC HYDRATION THERAPY 1ST HOUR,260,1 ,$486.00 ,$315.90 ,$206.87 ,$486.00 ,$362.07 ,$318.33 ,$206.87 ,$256.12 ,$206.87 ,$306.67 ,$306.67 ,$306.67 ,$306.67 ,$437.40 ,$364.50 ,$206.87 ,$427.68 ,$206.87 ,$364.50 ,$364.50 ,$413.10 ,$413.10 ,$206.87 ,$413.10 ,$206.87 ,$383.94 ,$383.94 ,$383.94 ,$437.40 ,$486.00 ,$437.40 ,$206.87 ,$486.00 ,$318.33 ,$206.87 ,$210.92 , N/A ,$216.53 ,$437.40 ,$448.32 ,$306.67 ,$291.60 ,$437.40 ,$206.87 ,$437.40 ,$437.40 ,$206.87 ,$315.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),26000001,96361,HC HYDRATION THERAPY EA ADDL HR,260,1 ,$174.00 ,$113.10 ,$40.66 ,$174.00 ,$129.63 ,$113.97 ,$40.66 ,$91.70 ,$40.66 ,$109.79 ,$109.79 ,$109.79 ,$109.79 ,$156.60 ,$130.50 ,$40.66 ,$153.12 ,$40.66 ,$130.50 ,$130.50 ,$147.90 ,$147.90 ,$40.66 ,$147.90 ,$40.66 ,$137.46 ,$137.46 ,$137.46 ,$156.60 ,$97.61 ,$156.60 ,$40.66 ,$174.00 ,$113.97 ,$40.66 ,$75.52 , N/A ,$42.56 ,$156.60 ,$88.12 ,$109.79 ,$104.40 ,$156.60 ,$40.66 ,$156.60 ,$156.60 ,$40.66 ,$113.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),26000002,96365,HC INFUSION THERAPY 1ST HOUR,260,1 ,$550.00 ,$357.50 ,$206.87 ,$550.00 ,$409.75 ,$360.25 ,$206.87 ,$289.85 ,$206.87 ,$347.05 ,$347.05 ,$347.05 ,$347.05 ,$495.00 ,$412.50 ,$206.87 ,$484.00 ,$206.87 ,$412.50 ,$412.50 ,$467.50 ,$467.50 ,$206.87 ,$467.50 ,$206.87 ,$434.50 ,$434.50 ,$434.50 ,$495.00 ,$496.61 ,$495.00 ,$206.87 ,$550.00 ,$360.25 ,$206.87 ,$238.70 , N/A ,$216.53 ,$495.00 ,$448.32 ,$347.05 ,$330.00 ,$495.00 ,$206.87 ,$495.00 ,$495.00 ,$206.87 ,$357.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),26000003,96366,HC INFUSION THERAPY EA ADDL HR,260,1 ,$115.00 ,$74.75 ,$40.66 ,$115.00 ,$85.68 ,$75.33 ,$40.66 ,$60.61 ,$40.66 ,$72.57 ,$72.57 ,$72.57 ,$72.57 ,$103.50 ,$86.25 ,$40.66 ,$101.20 ,$40.66 ,$86.25 ,$86.25 ,$97.75 ,$97.75 ,$40.66 ,$97.75 ,$40.66 ,$90.85 ,$90.85 ,$90.85 ,$103.50 ,$97.61 ,$103.50 ,$40.66 ,$115.00 ,$75.33 ,$40.66 ,$49.91 , N/A ,$42.56 ,$103.50 ,$88.12 ,$72.57 ,$69.00 ,$103.50 ,$40.66 ,$103.50 ,$103.50 ,$40.66 ,$74.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),26000004,96367,HC IV INF ADDL SEQ INIT HR,260,1 ,$81.00 ,$52.65 ,$35.15 ,$136.52 ,$60.35 ,$53.06 ,$63.00 ,$42.69 ,$63.00 ,$51.11 ,$51.11 ,$51.11 ,$51.11 ,$72.90 ,$60.75 ,$63.00 ,$71.28 ,$63.00 ,$60.75 ,$60.75 ,$68.85 ,$68.85 ,$63.00 ,$68.85 ,$63.00 ,$63.99 ,$63.99 ,$63.99 ,$72.90 ,$81.00 ,$72.90 ,$63.00 ,$81.00 ,$53.06 ,$63.00 ,$35.15 , N/A ,$65.94 ,$72.90 ,$136.52 ,$51.11 ,$48.60 ,$72.90 ,$63.00 ,$72.90 ,$72.90 ,$63.00 ,$52.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),26000005,96368,HC INFUS CONCURRENT,260,1 ,$122.00 ,$79.30 ,$52.95 ,$122.00 ,$90.89 ,$79.91 , N/A ,$64.29 , N/A ,$76.98 ,$76.98 ,$76.98 ,$76.98 ,$109.80 ,$91.50 , N/A ,$107.36 , N/A ,$91.50 ,$91.50 ,$103.70 ,$103.70 , N/A ,$103.70 , N/A ,$96.38 ,$96.38 ,$96.38 ,$109.80 , N/A ,$109.80 , N/A ,$122.00 ,$79.91 , N/A ,$52.95 , N/A , N/A ,$109.80 , N/A ,$76.98 ,$73.20 ,$109.80 , N/A ,$109.80 ,$109.80 , N/A ,$79.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),26000006,96360,HC HYDRATION THERAPY 1ST HOUR,260,1 ,$486.00 ,$315.90 ,$206.87 ,$486.00 ,$362.07 ,$318.33 ,$206.87 ,$256.12 ,$206.87 ,$306.67 ,$306.67 ,$306.67 ,$306.67 ,$437.40 ,$364.50 ,$206.87 ,$427.68 ,$206.87 ,$364.50 ,$364.50 ,$413.10 ,$413.10 ,$206.87 ,$413.10 ,$206.87 ,$383.94 ,$383.94 ,$383.94 ,$437.40 ,$486.00 ,$437.40 ,$206.87 ,$486.00 ,$318.33 ,$206.87 ,$210.92 , N/A ,$216.53 ,$437.40 ,$448.32 ,$306.67 ,$291.60 ,$437.40 ,$206.87 ,$437.40 ,$437.40 ,$206.87 ,$315.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27000013,N/A,HC PUMP BREAST,270,1 ,$411.21 ,$267.29 ,$178.47 ,$411.21 ,$306.35 ,$269.34 , N/A ,$216.71 , N/A ,$259.47 ,$259.47 ,$259.47 ,$259.47 ,$370.09 ,$308.41 , N/A ,$361.86 , N/A ,$308.41 ,$308.41 ,$349.53 ,$349.53 , N/A ,$349.53 , N/A ,$324.86 ,$324.86 ,$324.86 ,$370.09 , N/A ,$370.09 , N/A ,$411.21 ,$269.34 , N/A ,$178.47 , N/A , N/A ,$370.09 , N/A ,$259.47 ,$246.73 ,$370.09 , N/A ,$370.09 ,$370.09 , N/A ,$267.29 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27000015,N/A,HC SET IV EXTENSION,270,1 ,$5.63 ,$3.66 ,$2.44 ,$5.63 ,$4.19 ,$3.69 , N/A ,$2.97 , N/A ,$3.55 ,$3.55 ,$3.55 ,$3.55 ,$5.07 ,$4.22 , N/A ,$4.95 , N/A ,$4.22 ,$4.22 ,$4.79 ,$4.79 , N/A ,$4.79 , N/A ,$4.45 ,$4.45 ,$4.45 ,$5.07 , N/A ,$5.07 , N/A ,$5.63 ,$3.69 , N/A ,$2.44 , N/A , N/A ,$5.07 , N/A ,$3.55 ,$3.38 ,$5.07 , N/A ,$5.07 ,$5.07 , N/A ,$3.66 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27000017,N/A,HC SYSTEM DRAINAGE,270,1 ,$73.62 ,$47.85 ,$31.95 ,$73.62 ,$54.85 ,$48.22 , N/A ,$38.80 , N/A ,$46.45 ,$46.45 ,$46.45 ,$46.45 ,$66.26 ,$55.22 , N/A ,$64.79 , N/A ,$55.22 ,$55.22 ,$62.58 ,$62.58 , N/A ,$62.58 , N/A ,$58.16 ,$58.16 ,$58.16 ,$66.26 , N/A ,$66.26 , N/A ,$73.62 ,$48.22 , N/A ,$31.95 , N/A , N/A ,$66.26 , N/A ,$46.45 ,$44.17 ,$66.26 , N/A ,$66.26 ,$66.26 , N/A ,$47.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27000021,N/A,HC TRAY ARTHROGRAM,270,1 ,$102.21 ,$66.44 ,$44.36 ,$102.21 ,$76.15 ,$66.95 , N/A ,$53.86 , N/A ,$64.49 ,$64.49 ,$64.49 ,$64.49 ,$91.99 ,$76.66 , N/A ,$89.94 , N/A ,$76.66 ,$76.66 ,$86.88 ,$86.88 , N/A ,$86.88 , N/A ,$80.75 ,$80.75 ,$80.75 ,$91.99 , N/A ,$91.99 , N/A ,$102.21 ,$66.95 , N/A ,$44.36 , N/A , N/A ,$91.99 , N/A ,$64.49 ,$61.33 ,$91.99 , N/A ,$91.99 ,$91.99 , N/A ,$66.44 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27000024,N/A,HC TRAY SPINAL ANESTHESIA,272,1 ,$204.76 ,$133.09 ,$88.87 ,$204.76 ,$152.55 ,$134.12 , N/A ,$107.91 , N/A ,$129.20 ,$129.20 ,$129.20 ,$129.20 ,$184.28 ,$153.57 , N/A ,$180.19 , N/A ,$153.57 ,$153.57 ,$174.05 ,$174.05 , N/A ,$174.05 , N/A ,$161.76 ,$161.76 ,$161.76 ,$184.28 , N/A ,$184.28 , N/A ,$204.76 ,$134.12 , N/A ,$88.87 , N/A , N/A ,$184.28 , N/A ,$129.20 ,$122.86 ,$184.28 , N/A ,$184.28 ,$184.28 , N/A ,$133.09 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27000047,N/A,HC PAD CARDIAC MONITOR,270,1 ,$54.88 ,$35.67 ,$23.82 ,$54.88 ,$40.89 ,$35.95 , N/A ,$28.92 , N/A ,$34.63 ,$34.63 ,$34.63 ,$34.63 ,$49.39 ,$41.16 , N/A ,$48.29 , N/A ,$41.16 ,$41.16 ,$46.65 ,$46.65 , N/A ,$46.65 , N/A ,$43.36 ,$43.36 ,$43.36 ,$49.39 , N/A ,$49.39 , N/A ,$54.88 ,$35.95 , N/A ,$23.82 , N/A , N/A ,$49.39 , N/A ,$34.63 ,$32.93 ,$49.39 , N/A ,$49.39 ,$49.39 , N/A ,$35.67 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27000073,N/A,HC DETECTOR CARBON DIOXIDE,270,1 ,$94.94 ,$61.71 ,$41.20 ,$94.94 ,$70.73 ,$62.19 , N/A ,$50.03 , N/A ,$59.91 ,$59.91 ,$59.91 ,$59.91 ,$85.45 ,$71.21 , N/A ,$83.55 , N/A ,$71.21 ,$71.21 ,$80.70 ,$80.70 , N/A ,$80.70 , N/A ,$75.00 ,$75.00 ,$75.00 ,$85.45 , N/A ,$85.45 , N/A ,$94.94 ,$62.19 , N/A ,$41.20 , N/A , N/A ,$85.45 , N/A ,$59.91 ,$56.96 ,$85.45 , N/A ,$85.45 ,$85.45 , N/A ,$61.71 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27000077,N/A,HC TUBING CONNECTING,270,1 ,$32.66 ,$21.23 ,$14.17 ,$32.66 ,$24.33 ,$21.39 , N/A ,$17.21 , N/A ,$20.61 ,$20.61 ,$20.61 ,$20.61 ,$29.39 ,$24.50 , N/A ,$28.74 , N/A ,$24.50 ,$24.50 ,$27.76 ,$27.76 , N/A ,$27.76 , N/A ,$25.80 ,$25.80 ,$25.80 ,$29.39 , N/A ,$29.39 , N/A ,$32.66 ,$21.39 , N/A ,$14.17 , N/A , N/A ,$29.39 , N/A ,$20.61 ,$19.60 ,$29.39 , N/A ,$29.39 ,$29.39 , N/A ,$21.23 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27000093,N/A,HC MATTRESS WARMING,270,1 ,$193.21 ,$125.59 ,$83.85 ,$193.21 ,$143.94 ,$126.55 , N/A ,$101.82 , N/A ,$121.92 ,$121.92 ,$121.92 ,$121.92 ,$173.89 ,$144.91 , N/A ,$170.02 , N/A ,$144.91 ,$144.91 ,$164.23 ,$164.23 , N/A ,$164.23 , N/A ,$152.64 ,$152.64 ,$152.64 ,$173.89 , N/A ,$173.89 , N/A ,$193.21 ,$126.55 , N/A ,$83.85 , N/A , N/A ,$173.89 , N/A ,$121.92 ,$115.93 ,$173.89 , N/A ,$173.89 ,$173.89 , N/A ,$125.59 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27000104,N/A,HC POLAR CARE CUBE,270,1 ,$180.63 ,$117.41 ,$78.39 ,$180.63 ,$134.57 ,$118.31 , N/A ,$95.19 , N/A ,$113.98 ,$113.98 ,$113.98 ,$113.98 ,$162.57 ,$135.47 , N/A ,$158.95 , N/A ,$135.47 ,$135.47 ,$153.54 ,$153.54 , N/A ,$153.54 , N/A ,$142.70 ,$142.70 ,$142.70 ,$162.57 , N/A ,$162.57 , N/A ,$180.63 ,$118.31 , N/A ,$78.39 , N/A , N/A ,$162.57 , N/A ,$113.98 ,$108.38 ,$162.57 , N/A ,$162.57 ,$162.57 , N/A ,$117.41 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27000105,N/A,HC COLD PACK HALF SIZE,270,1 ,$18.82 ,$12.23 ,$8.17 ,$18.82 ,$14.02 ,$12.33 , N/A ,$9.92 , N/A ,$11.88 ,$11.88 ,$11.88 ,$11.88 ,$16.94 ,$14.12 , N/A ,$16.56 , N/A ,$14.12 ,$14.12 ,$16.00 ,$16.00 , N/A ,$16.00 , N/A ,$14.87 ,$14.87 ,$14.87 ,$16.94 , N/A ,$16.94 , N/A ,$18.82 ,$12.33 , N/A ,$8.17 , N/A , N/A ,$16.94 , N/A ,$11.88 ,$11.29 ,$16.94 , N/A ,$16.94 ,$16.94 , N/A ,$12.23 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27000110,N/A,HC BASIC MATERNITY KIT,270,1 ,$41.79 ,$27.16 ,$18.14 ,$41.79 ,$31.13 ,$27.37 , N/A ,$22.02 , N/A ,$26.37 ,$26.37 ,$26.37 ,$26.37 ,$37.61 ,$31.34 , N/A ,$36.78 , N/A ,$31.34 ,$31.34 ,$35.52 ,$35.52 , N/A ,$35.52 , N/A ,$33.01 ,$33.01 ,$33.01 ,$37.61 , N/A ,$37.61 , N/A ,$41.79 ,$27.37 , N/A ,$18.14 , N/A , N/A ,$37.61 , N/A ,$26.37 ,$25.07 ,$37.61 , N/A ,$37.61 ,$37.61 , N/A ,$27.16 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27000116,N/A,HC MATERNITY SURGERY KIT,270,1 ,$30.00 ,$19.50 ,$13.02 ,$30.00 ,$22.35 ,$19.65 , N/A ,$15.81 , N/A ,$18.93 ,$18.93 ,$18.93 ,$18.93 ,$27.00 ,$22.50 , N/A ,$26.40 , N/A ,$22.50 ,$22.50 ,$25.50 ,$25.50 , N/A ,$25.50 , N/A ,$23.70 ,$23.70 ,$23.70 ,$27.00 , N/A ,$27.00 , N/A ,$30.00 ,$19.65 , N/A ,$13.02 , N/A , N/A ,$27.00 , N/A ,$18.93 ,$18.00 ,$27.00 , N/A ,$27.00 ,$27.00 , N/A ,$19.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27000117,N/A,HC NEWBORN SURGERY KIT,270,1 ,$30.00 ,$19.50 ,$13.02 ,$30.00 ,$22.35 ,$19.65 , N/A ,$15.81 , N/A ,$18.93 ,$18.93 ,$18.93 ,$18.93 ,$27.00 ,$22.50 , N/A ,$26.40 , N/A ,$22.50 ,$22.50 ,$25.50 ,$25.50 , N/A ,$25.50 , N/A ,$23.70 ,$23.70 ,$23.70 ,$27.00 , N/A ,$27.00 , N/A ,$30.00 ,$19.65 , N/A ,$13.02 , N/A , N/A ,$27.00 , N/A ,$18.93 ,$18.00 ,$27.00 , N/A ,$27.00 ,$27.00 , N/A ,$19.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27000118,N/A,HC EPIDURAL TRAY PAINBLOCK,270,1 ,$30.00 ,$19.50 ,$13.02 ,$30.00 ,$22.35 ,$19.65 , N/A ,$15.81 , N/A ,$18.93 ,$18.93 ,$18.93 ,$18.93 ,$27.00 ,$22.50 , N/A ,$26.40 , N/A ,$22.50 ,$22.50 ,$25.50 ,$25.50 , N/A ,$25.50 , N/A ,$23.70 ,$23.70 ,$23.70 ,$27.00 , N/A ,$27.00 , N/A ,$30.00 ,$19.65 , N/A ,$13.02 , N/A , N/A ,$27.00 , N/A ,$18.93 ,$18.00 ,$27.00 , N/A ,$27.00 ,$27.00 , N/A ,$19.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27000119,N/A,HC BIOPSY SURGERY TRAY,270,1 ,$30.00 ,$19.50 ,$13.02 ,$30.00 ,$22.35 ,$19.65 , N/A ,$15.81 , N/A ,$18.93 ,$18.93 ,$18.93 ,$18.93 ,$27.00 ,$22.50 , N/A ,$26.40 , N/A ,$22.50 ,$22.50 ,$25.50 ,$25.50 , N/A ,$25.50 , N/A ,$23.70 ,$23.70 ,$23.70 ,$27.00 , N/A ,$27.00 , N/A ,$30.00 ,$19.65 , N/A ,$13.02 , N/A , N/A ,$27.00 , N/A ,$18.93 ,$18.00 ,$27.00 , N/A ,$27.00 ,$27.00 , N/A ,$19.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100005,N/A,HC AIR SHIELDS WARMER,271,1 ,$38.47 ,$25.01 ,$16.70 ,$38.47 ,$28.66 ,$25.20 , N/A ,$20.27 , N/A ,$24.27 ,$24.27 ,$24.27 ,$24.27 ,$34.62 ,$28.85 , N/A ,$33.85 , N/A ,$28.85 ,$28.85 ,$32.70 ,$32.70 , N/A ,$32.70 , N/A ,$30.39 ,$30.39 ,$30.39 ,$34.62 , N/A ,$34.62 , N/A ,$38.47 ,$25.20 , N/A ,$16.70 , N/A , N/A ,$34.62 , N/A ,$24.27 ,$23.08 ,$34.62 , N/A ,$34.62 ,$34.62 , N/A ,$25.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100080,N/A,HC LARYNGEAL MASK AIRWAY,272,1 ,$145.09 ,$94.31 ,$62.97 ,$145.09 ,$108.09 ,$95.03 , N/A ,$76.46 , N/A ,$91.55 ,$91.55 ,$91.55 ,$91.55 ,$130.58 ,$108.82 , N/A ,$127.68 , N/A ,$108.82 ,$108.82 ,$123.33 ,$123.33 , N/A ,$123.33 , N/A ,$114.62 ,$114.62 ,$114.62 ,$130.58 , N/A ,$130.58 , N/A ,$145.09 ,$95.03 , N/A ,$62.97 , N/A , N/A ,$130.58 , N/A ,$91.55 ,$87.05 ,$130.58 , N/A ,$130.58 ,$130.58 , N/A ,$94.31 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100107,N/A,HC OXYGEN HOURLY,271,1 ,$17.04 ,$11.08 ,$7.40 ,$17.04 ,$12.69 ,$11.16 , N/A ,$8.98 , N/A ,$10.75 ,$10.75 ,$10.75 ,$10.75 ,$15.34 ,$12.78 , N/A ,$15.00 , N/A ,$12.78 ,$12.78 ,$14.48 ,$14.48 , N/A ,$14.48 , N/A ,$13.46 ,$13.46 ,$13.46 ,$15.34 , N/A ,$15.34 , N/A ,$17.04 ,$11.16 , N/A ,$7.40 , N/A , N/A ,$15.34 , N/A ,$10.75 ,$10.22 ,$15.34 , N/A ,$15.34 ,$15.34 , N/A ,$11.08 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100114,N/A,HC PEAK FLOWMETER,271,1 ,$61.77 ,$40.15 ,$26.81 ,$61.77 ,$46.02 ,$40.46 , N/A ,$32.55 , N/A ,$38.98 ,$38.98 ,$38.98 ,$38.98 ,$55.59 ,$46.33 , N/A ,$54.36 , N/A ,$46.33 ,$46.33 ,$52.50 ,$52.50 , N/A ,$52.50 , N/A ,$48.80 ,$48.80 ,$48.80 ,$55.59 , N/A ,$55.59 , N/A ,$61.77 ,$40.46 , N/A ,$26.81 , N/A , N/A ,$55.59 , N/A ,$38.98 ,$37.06 ,$55.59 , N/A ,$55.59 ,$55.59 , N/A ,$40.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100155,N/A,HC THERABAND PER FOOT,271,1 ,$8.68 ,$5.64 ,$3.77 ,$8.68 ,$6.47 ,$5.69 , N/A ,$4.57 , N/A ,$5.48 ,$5.48 ,$5.48 ,$5.48 ,$7.81 ,$6.51 , N/A ,$7.64 , N/A ,$6.51 ,$6.51 ,$7.38 ,$7.38 , N/A ,$7.38 , N/A ,$6.86 ,$6.86 ,$6.86 ,$7.81 , N/A ,$7.81 , N/A ,$8.68 ,$5.69 , N/A ,$3.77 , N/A , N/A ,$7.81 , N/A ,$5.48 ,$5.21 ,$7.81 , N/A ,$7.81 ,$7.81 , N/A ,$5.64 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100188,N/A,HC SLING ARM,271,1 ,$37.33 ,$24.26 ,$16.20 ,$37.33 ,$27.81 ,$24.45 , N/A ,$19.67 , N/A ,$23.56 ,$23.56 ,$23.56 ,$23.56 ,$33.60 ,$28.00 , N/A ,$32.85 , N/A ,$28.00 ,$28.00 ,$31.73 ,$31.73 , N/A ,$31.73 , N/A ,$29.49 ,$29.49 ,$29.49 ,$33.60 , N/A ,$33.60 , N/A ,$37.33 ,$24.45 , N/A ,$16.20 , N/A , N/A ,$33.60 , N/A ,$23.56 ,$22.40 ,$33.60 , N/A ,$33.60 ,$33.60 , N/A ,$24.26 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100189,E0190,HC PILLOW ABDUCTION HIP,271,1 ,$182.92 ,$118.90 ,$79.39 ,$182.92 ,$136.28 ,$119.81 , N/A ,$96.40 , N/A ,$115.42 ,$115.42 ,$115.42 ,$115.42 ,$164.63 ,$137.19 , N/A ,$160.97 , N/A ,$137.19 ,$137.19 ,$155.48 ,$155.48 , N/A ,$155.48 , N/A ,$144.51 ,$144.51 ,$144.51 ,$164.63 , N/A ,$164.63 , N/A ,$182.92 ,$119.81 , N/A ,$79.39 , N/A , N/A ,$164.63 , N/A ,$115.42 ,$109.75 ,$164.63 , N/A ,$164.63 ,$164.63 , N/A ,$118.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100196,N/A,HC SENSOR BIS,271,1 ,$163.28 ,$106.13 ,$70.86 ,$163.28 ,$121.64 ,$106.95 , N/A ,$86.05 , N/A ,$103.03 ,$103.03 ,$103.03 ,$103.03 ,$146.95 ,$122.46 , N/A ,$143.69 , N/A ,$122.46 ,$122.46 ,$138.79 ,$138.79 , N/A ,$138.79 , N/A ,$128.99 ,$128.99 ,$128.99 ,$146.95 , N/A ,$146.95 , N/A ,$163.28 ,$106.95 , N/A ,$70.86 , N/A , N/A ,$146.95 , N/A ,$103.03 ,$97.97 ,$146.95 , N/A ,$146.95 ,$146.95 , N/A ,$106.13 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100201,N/A,HC CANNULA NASAL OXYGEN,271,1 ,$22.00 ,$14.30 ,$9.55 ,$22.00 ,$16.39 ,$14.41 , N/A ,$11.59 , N/A ,$13.88 ,$13.88 ,$13.88 ,$13.88 ,$19.80 ,$16.50 , N/A ,$19.36 , N/A ,$16.50 ,$16.50 ,$18.70 ,$18.70 , N/A ,$18.70 , N/A ,$17.38 ,$17.38 ,$17.38 ,$19.80 , N/A ,$19.80 , N/A ,$22.00 ,$14.41 , N/A ,$9.55 , N/A , N/A ,$19.80 , N/A ,$13.88 ,$13.20 ,$19.80 , N/A ,$19.80 ,$19.80 , N/A ,$14.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100204,N/A,HC CIRCUIT BREATHING,271,1 ,$58.83 ,$38.24 ,$25.53 ,$58.83 ,$43.83 ,$38.53 , N/A ,$31.00 , N/A ,$37.12 ,$37.12 ,$37.12 ,$37.12 ,$52.95 ,$44.12 , N/A ,$51.77 , N/A ,$44.12 ,$44.12 ,$50.01 ,$50.01 , N/A ,$50.01 , N/A ,$46.48 ,$46.48 ,$46.48 ,$52.95 , N/A ,$52.95 , N/A ,$58.83 ,$38.53 , N/A ,$25.53 , N/A , N/A ,$52.95 , N/A ,$37.12 ,$35.30 ,$52.95 , N/A ,$52.95 ,$52.95 , N/A ,$38.24 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100206,N/A,HC CUSHION CHAIR,271,1 ,$28.00 ,$18.20 ,$12.15 ,$28.00 ,$20.86 ,$18.34 , N/A ,$14.76 , N/A ,$17.67 ,$17.67 ,$17.67 ,$17.67 ,$25.20 ,$21.00 , N/A ,$24.64 , N/A ,$21.00 ,$21.00 ,$23.80 ,$23.80 , N/A ,$23.80 , N/A ,$22.12 ,$22.12 ,$22.12 ,$25.20 , N/A ,$25.20 , N/A ,$28.00 ,$18.34 , N/A ,$12.15 , N/A , N/A ,$25.20 , N/A ,$17.67 ,$16.80 ,$25.20 , N/A ,$25.20 ,$25.20 , N/A ,$18.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100209,N/A,HC ENEMA BAG,271,1 ,$9.52 ,$6.19 ,$4.13 ,$9.52 ,$7.09 ,$6.24 , N/A ,$5.02 , N/A ,$6.01 ,$6.01 ,$6.01 ,$6.01 ,$8.57 ,$7.14 , N/A ,$8.38 , N/A ,$7.14 ,$7.14 ,$8.09 ,$8.09 , N/A ,$8.09 , N/A ,$7.52 ,$7.52 ,$7.52 ,$8.57 , N/A ,$8.57 , N/A ,$9.52 ,$6.24 , N/A ,$4.13 , N/A , N/A ,$8.57 , N/A ,$6.01 ,$5.71 ,$8.57 , N/A ,$8.57 ,$8.57 , N/A ,$6.19 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100210,N/A,HC KIT CANISTER SUCTION,271,1 ,$10.70 ,$6.96 ,$4.64 ,$10.70 ,$7.97 ,$7.01 , N/A ,$5.64 , N/A ,$6.75 ,$6.75 ,$6.75 ,$6.75 ,$9.63 ,$8.03 , N/A ,$9.42 , N/A ,$8.03 ,$8.03 ,$9.10 ,$9.10 , N/A ,$9.10 , N/A ,$8.45 ,$8.45 ,$8.45 ,$9.63 , N/A ,$9.63 , N/A ,$10.70 ,$7.01 , N/A ,$4.64 , N/A , N/A ,$9.63 , N/A ,$6.75 ,$6.42 ,$9.63 , N/A ,$9.63 ,$9.63 , N/A ,$6.96 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100211,N/A,HC PAD DEFIBRILLATOR,271,1 ,$222.76 ,$144.79 ,$96.68 ,$222.76 ,$165.96 ,$145.91 , N/A ,$117.39 , N/A ,$140.56 ,$140.56 ,$140.56 ,$140.56 ,$200.48 ,$167.07 , N/A ,$196.03 , N/A ,$167.07 ,$167.07 ,$189.35 ,$189.35 , N/A ,$189.35 , N/A ,$175.98 ,$175.98 ,$175.98 ,$200.48 , N/A ,$200.48 , N/A ,$222.76 ,$145.91 , N/A ,$96.68 , N/A , N/A ,$200.48 , N/A ,$140.56 ,$133.66 ,$200.48 , N/A ,$200.48 ,$200.48 , N/A ,$144.79 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100216,N/A,HC SET FLUID WARMER,271,1 ,$103.00 ,$66.95 ,$44.70 ,$103.00 ,$76.74 ,$67.47 , N/A ,$54.28 , N/A ,$64.99 ,$64.99 ,$64.99 ,$64.99 ,$92.70 ,$77.25 , N/A ,$90.64 , N/A ,$77.25 ,$77.25 ,$87.55 ,$87.55 , N/A ,$87.55 , N/A ,$81.37 ,$81.37 ,$81.37 ,$92.70 , N/A ,$92.70 , N/A ,$103.00 ,$67.47 , N/A ,$44.70 , N/A , N/A ,$92.70 , N/A ,$64.99 ,$61.80 ,$92.70 , N/A ,$92.70 ,$92.70 , N/A ,$66.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100218,N/A,HC SET IV BLOOD ADMINISTRATION,271,1 ,$27.00 ,$17.55 ,$11.72 ,$27.00 ,$20.12 ,$17.69 , N/A ,$14.23 , N/A ,$17.04 ,$17.04 ,$17.04 ,$17.04 ,$24.30 ,$20.25 , N/A ,$23.76 , N/A ,$20.25 ,$20.25 ,$22.95 ,$22.95 , N/A ,$22.95 , N/A ,$21.33 ,$21.33 ,$21.33 ,$24.30 , N/A ,$24.30 , N/A ,$27.00 ,$17.69 , N/A ,$11.72 , N/A , N/A ,$24.30 , N/A ,$17.04 ,$16.20 ,$24.30 , N/A ,$24.30 ,$24.30 , N/A ,$17.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100235,N/A,HC MASK OXYGEN,271,1 ,$33.01 ,$21.46 ,$14.33 ,$33.01 ,$24.59 ,$21.62 , N/A ,$17.40 , N/A ,$20.83 ,$20.83 ,$20.83 ,$20.83 ,$29.71 ,$24.76 , N/A ,$29.05 , N/A ,$24.76 ,$24.76 ,$28.06 ,$28.06 , N/A ,$28.06 , N/A ,$26.08 ,$26.08 ,$26.08 ,$29.71 , N/A ,$29.71 , N/A ,$33.01 ,$21.62 , N/A ,$14.33 , N/A , N/A ,$29.71 , N/A ,$20.83 ,$19.81 ,$29.71 , N/A ,$29.71 ,$29.71 , N/A ,$21.46 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100252,N/A,HC SITZ BATH,271,1 ,$35.95 ,$23.37 ,$15.60 ,$35.95 ,$26.78 ,$23.55 , N/A ,$18.95 , N/A ,$22.68 ,$22.68 ,$22.68 ,$22.68 ,$32.36 ,$26.96 , N/A ,$31.64 , N/A ,$26.96 ,$26.96 ,$30.56 ,$30.56 , N/A ,$30.56 , N/A ,$28.40 ,$28.40 ,$28.40 ,$32.36 , N/A ,$32.36 , N/A ,$35.95 ,$23.55 , N/A ,$15.60 , N/A , N/A ,$32.36 , N/A ,$22.68 ,$21.57 ,$32.36 , N/A ,$32.36 ,$32.36 , N/A ,$23.37 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100256,N/A,HC ELECTRODE FETAL SCALP,271,1 ,$18.63 ,$12.11 ,$8.09 ,$18.63 ,$13.88 ,$12.20 , N/A ,$9.82 , N/A ,$11.76 ,$11.76 ,$11.76 ,$11.76 ,$16.77 ,$13.97 , N/A ,$16.39 , N/A ,$13.97 ,$13.97 ,$15.84 ,$15.84 , N/A ,$15.84 , N/A ,$14.72 ,$14.72 ,$14.72 ,$16.77 , N/A ,$16.77 , N/A ,$18.63 ,$12.20 , N/A ,$8.09 , N/A , N/A ,$16.77 , N/A ,$11.76 ,$11.18 ,$16.77 , N/A ,$16.77 ,$16.77 , N/A ,$12.11 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100258,N/A,HC KIT RT OXYGEN SUPPLY,271,1 ,$98.28 ,$63.88 ,$42.65 ,$98.28 ,$73.22 ,$64.37 , N/A ,$51.79 , N/A ,$62.01 ,$62.01 ,$62.01 ,$62.01 ,$88.45 ,$73.71 , N/A ,$86.49 , N/A ,$73.71 ,$73.71 ,$83.54 ,$83.54 , N/A ,$83.54 , N/A ,$77.64 ,$77.64 ,$77.64 ,$88.45 , N/A ,$88.45 , N/A ,$98.28 ,$64.37 , N/A ,$42.65 , N/A , N/A ,$88.45 , N/A ,$62.01 ,$58.97 ,$88.45 , N/A ,$88.45 ,$88.45 , N/A ,$63.88 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100259,N/A,HC LINER SUCTION CANISTER,271,1 ,$15.80 ,$10.27 ,$6.86 ,$15.80 ,$11.77 ,$10.35 , N/A ,$8.33 , N/A ,$9.97 ,$9.97 ,$9.97 ,$9.97 ,$14.22 ,$11.85 , N/A ,$13.90 , N/A ,$11.85 ,$11.85 ,$13.43 ,$13.43 , N/A ,$13.43 , N/A ,$12.48 ,$12.48 ,$12.48 ,$14.22 , N/A ,$14.22 , N/A ,$15.80 ,$10.35 , N/A ,$6.86 , N/A , N/A ,$14.22 , N/A ,$9.97 ,$9.48 ,$14.22 , N/A ,$14.22 ,$14.22 , N/A ,$10.27 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100267,N/A,HC SLEEVE SCD FOOT,271,1 ,$36.00 ,$23.40 ,$15.62 ,$36.00 ,$26.82 ,$23.58 , N/A ,$18.97 , N/A ,$22.72 ,$22.72 ,$22.72 ,$22.72 ,$32.40 ,$27.00 , N/A ,$31.68 , N/A ,$27.00 ,$27.00 ,$30.60 ,$30.60 , N/A ,$30.60 , N/A ,$28.44 ,$28.44 ,$28.44 ,$32.40 , N/A ,$32.40 , N/A ,$36.00 ,$23.58 , N/A ,$15.62 , N/A , N/A ,$32.40 , N/A ,$22.72 ,$21.60 ,$32.40 , N/A ,$32.40 ,$32.40 , N/A ,$23.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100269,N/A,HC SUSPENSORY/SUPPORT SCROTAL,271,1 ,$70.74 ,$45.98 ,$30.70 ,$70.74 ,$52.70 ,$46.33 , N/A ,$37.28 , N/A ,$44.64 ,$44.64 ,$44.64 ,$44.64 ,$63.67 ,$53.06 , N/A ,$62.25 , N/A ,$53.06 ,$53.06 ,$60.13 ,$60.13 , N/A ,$60.13 , N/A ,$55.88 ,$55.88 ,$55.88 ,$63.67 , N/A ,$63.67 , N/A ,$70.74 ,$46.33 , N/A ,$30.70 , N/A , N/A ,$63.67 , N/A ,$44.64 ,$42.44 ,$63.67 , N/A ,$63.67 ,$63.67 , N/A ,$45.98 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100277,N/A,HC BAG WASTE,271,1 ,$59.96 ,$38.97 ,$26.02 ,$59.96 ,$44.67 ,$39.27 , N/A ,$31.60 , N/A ,$37.83 ,$37.83 ,$37.83 ,$37.83 ,$53.96 ,$44.97 , N/A ,$52.76 , N/A ,$44.97 ,$44.97 ,$50.97 ,$50.97 , N/A ,$50.97 , N/A ,$47.37 ,$47.37 ,$47.37 ,$53.96 , N/A ,$53.96 , N/A ,$59.96 ,$39.27 , N/A ,$26.02 , N/A , N/A ,$53.96 , N/A ,$37.83 ,$35.98 ,$53.96 , N/A ,$53.96 ,$53.96 , N/A ,$38.97 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100282,N/A,HC PACK HOT/ COLD SMALL,271,1 ,$11.03 ,$7.17 ,$4.79 ,$11.03 ,$8.22 ,$7.22 , N/A ,$5.81 , N/A ,$6.96 ,$6.96 ,$6.96 ,$6.96 ,$9.93 ,$8.27 , N/A ,$9.71 , N/A ,$8.27 ,$8.27 ,$9.38 ,$9.38 , N/A ,$9.38 , N/A ,$8.71 ,$8.71 ,$8.71 ,$9.93 , N/A ,$9.93 , N/A ,$11.03 ,$7.22 , N/A ,$4.79 , N/A , N/A ,$9.93 , N/A ,$6.96 ,$6.62 ,$9.93 , N/A ,$9.93 ,$9.93 , N/A ,$7.17 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100325,N/A,HC SPACER MDI,271,1 ,$38.20 ,$24.83 ,$16.58 ,$38.20 ,$28.46 ,$25.02 , N/A ,$20.13 , N/A ,$24.10 ,$24.10 ,$24.10 ,$24.10 ,$34.38 ,$28.65 , N/A ,$33.62 , N/A ,$28.65 ,$28.65 ,$32.47 ,$32.47 , N/A ,$32.47 , N/A ,$30.18 ,$30.18 ,$30.18 ,$34.38 , N/A ,$34.38 , N/A ,$38.20 ,$25.02 , N/A ,$16.58 , N/A , N/A ,$34.38 , N/A ,$24.10 ,$22.92 ,$34.38 , N/A ,$34.38 ,$34.38 , N/A ,$24.83 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100482,N/A,HC SHEET PATIENT TRANSFER,271,1 ,$10.95 ,$7.12 ,$4.75 ,$10.95 ,$8.16 ,$7.17 , N/A ,$5.77 , N/A ,$6.91 ,$6.91 ,$6.91 ,$6.91 ,$9.86 ,$8.21 , N/A ,$9.64 , N/A ,$8.21 ,$8.21 ,$9.31 ,$9.31 , N/A ,$9.31 , N/A ,$8.65 ,$8.65 ,$8.65 ,$9.86 , N/A ,$9.86 , N/A ,$10.95 ,$7.17 , N/A ,$4.75 , N/A , N/A ,$9.86 , N/A ,$6.91 ,$6.57 ,$9.86 , N/A ,$9.86 ,$9.86 , N/A ,$7.12 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100483,N/A,HC BOTTLE HUMIDITY,271,1 ,$16.48 ,$10.71 ,$7.15 ,$16.48 ,$12.28 ,$10.79 , N/A ,$8.69 , N/A ,$10.40 ,$10.40 ,$10.40 ,$10.40 ,$14.83 ,$12.36 , N/A ,$14.50 , N/A ,$12.36 ,$12.36 ,$14.01 ,$14.01 , N/A ,$14.01 , N/A ,$13.02 ,$13.02 ,$13.02 ,$14.83 , N/A ,$14.83 , N/A ,$16.48 ,$10.79 , N/A ,$7.15 , N/A , N/A ,$14.83 , N/A ,$10.40 ,$9.89 ,$14.83 , N/A ,$14.83 ,$14.83 , N/A ,$10.71 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100487,N/A,HC MASK VENTILATION,271,1 ,$9.62 ,$6.25 ,$4.18 ,$9.62 ,$7.17 ,$6.30 , N/A ,$5.07 , N/A ,$6.07 ,$6.07 ,$6.07 ,$6.07 ,$8.66 ,$7.22 , N/A ,$8.47 , N/A ,$7.22 ,$7.22 ,$8.18 ,$8.18 , N/A ,$8.18 , N/A ,$7.60 ,$7.60 ,$7.60 ,$8.66 , N/A ,$8.66 , N/A ,$9.62 ,$6.30 , N/A ,$4.18 , N/A , N/A ,$8.66 , N/A ,$6.07 ,$5.77 ,$8.66 , N/A ,$8.66 ,$8.66 , N/A ,$6.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100489,N/A,HC MASK RESPIRATOR,271,1 ,$169.85 ,$110.40 ,$73.71 ,$169.85 ,$126.54 ,$111.25 , N/A ,$89.51 , N/A ,$107.18 ,$107.18 ,$107.18 ,$107.18 ,$152.87 ,$127.39 , N/A ,$149.47 , N/A ,$127.39 ,$127.39 ,$144.37 ,$144.37 , N/A ,$144.37 , N/A ,$134.18 ,$134.18 ,$134.18 ,$152.87 , N/A ,$152.87 , N/A ,$169.85 ,$111.25 , N/A ,$73.71 , N/A , N/A ,$152.87 , N/A ,$107.18 ,$101.91 ,$152.87 , N/A ,$152.87 ,$152.87 , N/A ,$110.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100490,N/A,HC PAD KNEE ELASTIC,271,1 ,$531.81 ,$345.68 ,$230.81 ,$531.81 ,$396.20 ,$348.34 , N/A ,$280.26 , N/A ,$335.57 ,$335.57 ,$335.57 ,$335.57 ,$478.63 ,$398.86 , N/A ,$467.99 , N/A ,$398.86 ,$398.86 ,$452.04 ,$452.04 , N/A ,$452.04 , N/A ,$420.13 ,$420.13 ,$420.13 ,$478.63 , N/A ,$478.63 , N/A ,$531.81 ,$348.34 , N/A ,$230.81 , N/A , N/A ,$478.63 , N/A ,$335.57 ,$319.09 ,$478.63 , N/A ,$478.63 ,$478.63 , N/A ,$345.68 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100492,N/A,HC PULLEY OVERDOOR,271,1 ,$20.12 ,$13.08 ,$8.73 ,$20.12 ,$14.99 ,$13.18 , N/A ,$10.60 , N/A ,$12.70 ,$12.70 ,$12.70 ,$12.70 ,$18.11 ,$15.09 , N/A ,$17.71 , N/A ,$15.09 ,$15.09 ,$17.10 ,$17.10 , N/A ,$17.10 , N/A ,$15.89 ,$15.89 ,$15.89 ,$18.11 , N/A ,$18.11 , N/A ,$20.12 ,$13.18 , N/A ,$8.73 , N/A , N/A ,$18.11 , N/A ,$12.70 ,$12.07 ,$18.11 , N/A ,$18.11 ,$18.11 , N/A ,$13.08 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100493,N/A,HC PAD SENSOR,271,1 ,$75.45 ,$49.04 ,$32.75 ,$75.45 ,$56.21 ,$49.42 , N/A ,$39.76 , N/A ,$47.61 ,$47.61 ,$47.61 ,$47.61 ,$67.91 ,$56.59 , N/A ,$66.40 , N/A ,$56.59 ,$56.59 ,$64.13 ,$64.13 , N/A ,$64.13 , N/A ,$59.61 ,$59.61 ,$59.61 ,$67.91 , N/A ,$67.91 , N/A ,$75.45 ,$49.42 , N/A ,$32.75 , N/A , N/A ,$67.91 , N/A ,$47.61 ,$45.27 ,$67.91 , N/A ,$67.91 ,$67.91 , N/A ,$49.04 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100519,N/A,HC SYSTEM MONITR NOVII PTCH,271,1 ,$116.85 ,$75.95 ,$50.71 ,$116.85 ,$87.05 ,$76.54 , N/A ,$61.58 , N/A ,$73.73 ,$73.73 ,$73.73 ,$73.73 ,$105.17 ,$87.64 , N/A ,$102.83 , N/A ,$87.64 ,$87.64 ,$99.32 ,$99.32 , N/A ,$99.32 , N/A ,$92.31 ,$92.31 ,$92.31 ,$105.17 , N/A ,$105.17 , N/A ,$116.85 ,$76.54 , N/A ,$50.71 , N/A , N/A ,$105.17 , N/A ,$73.73 ,$70.11 ,$105.17 , N/A ,$105.17 ,$105.17 , N/A ,$75.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100520,N/A,HC DISPOSABLE EXPIRATORY VALVE,271,1 ,$45.63 ,$29.66 ,$19.80 ,$45.63 ,$33.99 ,$29.89 , N/A ,$24.05 , N/A ,$28.79 ,$28.79 ,$28.79 ,$28.79 ,$41.07 ,$34.22 , N/A ,$40.15 , N/A ,$34.22 ,$34.22 ,$38.79 ,$38.79 , N/A ,$38.79 , N/A ,$36.05 ,$36.05 ,$36.05 ,$41.07 , N/A ,$41.07 , N/A ,$45.63 ,$29.89 , N/A ,$19.80 , N/A , N/A ,$41.07 , N/A ,$28.79 ,$27.38 ,$41.07 , N/A ,$41.07 ,$41.07 , N/A ,$29.66 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100521,N/A,HC FLOW SENSOR,271,1 ,$62.16 ,$40.40 ,$26.98 ,$62.16 ,$46.31 ,$40.71 , N/A ,$32.76 , N/A ,$39.22 ,$39.22 ,$39.22 ,$39.22 ,$55.94 ,$46.62 , N/A ,$54.70 , N/A ,$46.62 ,$46.62 ,$52.84 ,$52.84 , N/A ,$52.84 , N/A ,$49.11 ,$49.11 ,$49.11 ,$55.94 , N/A ,$55.94 , N/A ,$62.16 ,$40.71 , N/A ,$26.98 , N/A , N/A ,$55.94 , N/A ,$39.22 ,$37.30 ,$55.94 , N/A ,$55.94 ,$55.94 , N/A ,$40.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27100522,N/A,HC ENDOGATOR PVC TUBE CO2 CONNECTOR,272,1 ,$56.40 ,$36.66 ,$24.48 ,$56.40 ,$42.02 ,$36.94 , N/A ,$29.72 , N/A ,$35.59 ,$35.59 ,$35.59 ,$35.59 ,$50.76 ,$42.30 , N/A ,$49.63 , N/A ,$42.30 ,$42.30 ,$47.94 ,$47.94 , N/A ,$47.94 , N/A ,$44.56 ,$44.56 ,$44.56 ,$50.76 , N/A ,$50.76 , N/A ,$56.40 ,$36.94 , N/A ,$24.48 , N/A , N/A ,$50.76 , N/A ,$35.59 ,$33.84 ,$50.76 , N/A ,$50.76 ,$50.76 , N/A ,$36.66 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200029,C1726,HC DILATOR BALLOON,272,1 ,$16.29 ,$10.59 ,$7.07 ,$16.29 ,$12.14 ,$10.67 , N/A ,$8.58 , N/A ,$10.28 ,$10.28 ,$10.28 ,$10.28 ,$14.66 ,$12.22 , N/A ,$14.34 , N/A ,$12.22 ,$12.22 ,$13.85 ,$13.85 , N/A ,$13.85 , N/A ,$12.87 ,$12.87 ,$12.87 ,$14.66 , N/A ,$14.66 , N/A ,$16.29 ,$10.67 , N/A ,$7.07 , N/A , N/A ,$14.66 , N/A ,$10.28 ,$9.77 ,$14.66 , N/A ,$14.66 ,$14.66 , N/A ,$10.59 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200075,C1758,HC CATHETER URETERAL,272,1 ,$139.01 ,$90.36 ,$60.33 ,$139.01 ,$103.56 ,$91.05 , N/A ,$73.26 , N/A ,$87.72 ,$87.72 ,$87.72 ,$87.72 ,$125.11 ,$104.26 , N/A ,$122.33 , N/A ,$104.26 ,$104.26 ,$118.16 ,$118.16 , N/A ,$118.16 , N/A ,$109.82 ,$109.82 ,$109.82 ,$125.11 , N/A ,$125.11 , N/A ,$139.01 ,$91.05 , N/A ,$60.33 , N/A , N/A ,$125.11 , N/A ,$87.72 ,$83.41 ,$125.11 , N/A ,$125.11 ,$125.11 , N/A ,$90.36 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200078,C1765,HC INTERCEED ADHESION BARRIER,272,1 ,"$2,162.26 ","$1,405.47 ",$938.42 ,"$2,162.26 ","$1,610.88 ","$1,416.28 ", N/A ,"$1,139.51 ", N/A ,"$1,364.39 ","$1,364.39 ","$1,364.39 ","$1,364.39 ","$1,946.03 ","$1,621.70 ", N/A ,"$1,902.79 ", N/A ,"$1,621.70 ","$1,621.70 ","$1,837.92 ","$1,837.92 ", N/A ,"$1,837.92 ", N/A ,"$1,708.19 ","$1,708.19 ","$1,708.19 ","$1,946.03 ", N/A ,"$1,946.03 ", N/A ,"$2,162.26 ","$1,416.28 ", N/A ,$938.42 , N/A , N/A ,"$1,946.03 ", N/A ,"$1,364.39 ","$1,297.36 ","$1,946.03 ", N/A ,"$1,946.03 ","$1,946.03 ", N/A ,"$1,405.47 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200100,C1769,HC GUIDEWIRE - STIFF,272,1 ,$111.75 ,$72.64 ,$48.50 ,$111.75 ,$83.25 ,$73.20 , N/A ,$58.89 , N/A ,$70.51 ,$70.51 ,$70.51 ,$70.51 ,$100.58 ,$83.81 , N/A ,$98.34 , N/A ,$83.81 ,$83.81 ,$94.99 ,$94.99 , N/A ,$94.99 , N/A ,$88.28 ,$88.28 ,$88.28 ,$100.58 , N/A ,$100.58 , N/A ,$111.75 ,$73.20 , N/A ,$48.50 , N/A , N/A ,$100.58 , N/A ,$70.51 ,$67.05 ,$100.58 , N/A ,$100.58 ,$100.58 , N/A ,$72.64 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200189,N/A,HC 12 FR ESOPHAGEAL STEHOSCOPE,272,1 ,$28.00 ,$18.20 ,$12.15 ,$28.00 ,$20.86 ,$18.34 , N/A ,$14.76 , N/A ,$17.67 ,$17.67 ,$17.67 ,$17.67 ,$25.20 ,$21.00 , N/A ,$24.64 , N/A ,$21.00 ,$21.00 ,$23.80 ,$23.80 , N/A ,$23.80 , N/A ,$22.12 ,$22.12 ,$22.12 ,$25.20 , N/A ,$25.20 , N/A ,$28.00 ,$18.34 , N/A ,$12.15 , N/A , N/A ,$25.20 , N/A ,$17.67 ,$16.80 ,$25.20 , N/A ,$25.20 ,$25.20 , N/A ,$18.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200200,N/A,HC ABDOMINAL BINDERS,272,1 ,$105.50 ,$68.58 ,$45.79 ,$105.50 ,$78.60 ,$69.10 , N/A ,$55.60 , N/A ,$66.57 ,$66.57 ,$66.57 ,$66.57 ,$94.95 ,$79.13 , N/A ,$92.84 , N/A ,$79.13 ,$79.13 ,$89.68 ,$89.68 , N/A ,$89.68 , N/A ,$83.35 ,$83.35 ,$83.35 ,$94.95 , N/A ,$94.95 , N/A ,$105.50 ,$69.10 , N/A ,$45.79 , N/A , N/A ,$94.95 , N/A ,$66.57 ,$63.30 ,$94.95 , N/A ,$94.95 ,$94.95 , N/A ,$68.58 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200226,N/A,HC ADHESIVE DERMABOND,272,1 ,$59.30 ,$38.55 ,$25.74 ,$59.30 ,$44.18 ,$38.84 , N/A ,$31.25 , N/A ,$37.42 ,$37.42 ,$37.42 ,$37.42 ,$53.37 ,$44.48 , N/A ,$52.18 , N/A ,$44.48 ,$44.48 ,$50.41 ,$50.41 , N/A ,$50.41 , N/A ,$46.85 ,$46.85 ,$46.85 ,$53.37 , N/A ,$53.37 , N/A ,$59.30 ,$38.84 , N/A ,$25.74 , N/A , N/A ,$53.37 , N/A ,$37.42 ,$35.58 ,$53.37 , N/A ,$53.37 ,$53.37 , N/A ,$38.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200231,N/A,HC AEROCHAMBER,272,1 ,$47.62 ,$30.95 ,$20.67 ,$47.62 ,$35.48 ,$31.19 , N/A ,$25.10 , N/A ,$30.05 ,$30.05 ,$30.05 ,$30.05 ,$42.86 ,$35.72 , N/A ,$41.91 , N/A ,$35.72 ,$35.72 ,$40.48 ,$40.48 , N/A ,$40.48 , N/A ,$37.62 ,$37.62 ,$37.62 ,$42.86 , N/A ,$42.86 , N/A ,$47.62 ,$31.19 , N/A ,$20.67 , N/A , N/A ,$42.86 , N/A ,$30.05 ,$28.57 ,$42.86 , N/A ,$42.86 ,$42.86 , N/A ,$30.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200261,N/A,HC ARMBOARD IV,272,1 ,$30.39 ,$19.75 ,$13.19 ,$30.39 ,$22.64 ,$19.91 , N/A ,$16.02 , N/A ,$19.18 ,$19.18 ,$19.18 ,$19.18 ,$27.35 ,$22.79 , N/A ,$26.74 , N/A ,$22.79 ,$22.79 ,$25.83 ,$25.83 , N/A ,$25.83 , N/A ,$24.01 ,$24.01 ,$24.01 ,$27.35 , N/A ,$27.35 , N/A ,$30.39 ,$19.91 , N/A ,$13.19 , N/A , N/A ,$27.35 , N/A ,$19.18 ,$18.23 ,$27.35 , N/A ,$27.35 ,$27.35 , N/A ,$19.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200283,N/A,HC ATRIUM CHEST DRAINAGE,272,1 ,$475.09 ,$308.81 ,$206.19 ,$475.09 ,$353.94 ,$311.18 , N/A ,$250.37 , N/A ,$299.78 ,$299.78 ,$299.78 ,$299.78 ,$427.58 ,$356.32 , N/A ,$418.08 , N/A ,$356.32 ,$356.32 ,$403.83 ,$403.83 , N/A ,$403.83 , N/A ,$375.32 ,$375.32 ,$375.32 ,$427.58 , N/A ,$427.58 , N/A ,$475.09 ,$311.18 , N/A ,$206.19 , N/A , N/A ,$427.58 , N/A ,$299.78 ,$285.05 ,$427.58 , N/A ,$427.58 ,$427.58 , N/A ,$308.81 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200297,N/A,HC BAG RESUSCITATION DISP,272,1 ,$16.00 ,$10.40 ,$6.94 ,$16.00 ,$11.92 ,$10.48 , N/A ,$8.43 , N/A ,$10.10 ,$10.10 ,$10.10 ,$10.10 ,$14.40 ,$12.00 , N/A ,$14.08 , N/A ,$12.00 ,$12.00 ,$13.60 ,$13.60 , N/A ,$13.60 , N/A ,$12.64 ,$12.64 ,$12.64 ,$14.40 , N/A ,$14.40 , N/A ,$16.00 ,$10.48 , N/A ,$6.94 , N/A , N/A ,$14.40 , N/A ,$10.10 ,$9.60 ,$14.40 , N/A ,$14.40 ,$14.40 , N/A ,$10.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200338,N/A,HC BIOPSY DEVICE NEEDLE CORE,272,1 ,"$2,209.18 ","$1,435.97 ",$958.78 ,"$2,209.18 ","$1,645.84 ","$1,447.01 ", N/A ,"$1,164.24 ", N/A ,"$1,393.99 ","$1,393.99 ","$1,393.99 ","$1,393.99 ","$1,988.26 ","$1,656.89 ", N/A ,"$1,944.08 ", N/A ,"$1,656.89 ","$1,656.89 ","$1,877.80 ","$1,877.80 ", N/A ,"$1,877.80 ", N/A ,"$1,745.25 ","$1,745.25 ","$1,745.25 ","$1,988.26 ", N/A ,"$1,988.26 ", N/A ,"$2,209.18 ","$1,447.01 ", N/A ,$958.78 , N/A , N/A ,"$1,988.26 ", N/A ,"$1,393.99 ","$1,325.51 ","$1,988.26 ", N/A ,"$1,988.26 ","$1,988.26 ", N/A ,"$1,435.97 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200351,N/A,HC BIOPSY GUIDE,272,1 ,$13.79 ,$8.96 ,$5.98 ,$13.79 ,$10.27 ,$9.03 , N/A ,$7.27 , N/A ,$8.70 ,$8.70 ,$8.70 ,$8.70 ,$12.41 ,$10.34 , N/A ,$12.14 , N/A ,$10.34 ,$10.34 ,$11.72 ,$11.72 , N/A ,$11.72 , N/A ,$10.89 ,$10.89 ,$10.89 ,$12.41 , N/A ,$12.41 , N/A ,$13.79 ,$9.03 , N/A ,$5.98 , N/A , N/A ,$12.41 , N/A ,$8.70 ,$8.27 ,$12.41 , N/A ,$12.41 ,$12.41 , N/A ,$8.96 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200357,N/A,HC BIS MONITOR STRIP,272,1 ,$163.28 ,$106.13 ,$70.86 ,$163.28 ,$121.64 ,$106.95 , N/A ,$86.05 , N/A ,$103.03 ,$103.03 ,$103.03 ,$103.03 ,$146.95 ,$122.46 , N/A ,$143.69 , N/A ,$122.46 ,$122.46 ,$138.79 ,$138.79 , N/A ,$138.79 , N/A ,$128.99 ,$128.99 ,$128.99 ,$146.95 , N/A ,$146.95 , N/A ,$163.28 ,$106.95 , N/A ,$70.86 , N/A , N/A ,$146.95 , N/A ,$103.03 ,$97.97 ,$146.95 , N/A ,$146.95 ,$146.95 , N/A ,$106.13 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200480,N/A,HC BLADE PATELLA REAMER,272,1 ,$509.82 ,$331.38 ,$221.26 ,$509.82 ,$379.82 ,$333.93 , N/A ,$268.68 , N/A ,$321.70 ,$321.70 ,$321.70 ,$321.70 ,$458.84 ,$382.37 , N/A ,$448.64 , N/A ,$382.37 ,$382.37 ,$433.35 ,$433.35 , N/A ,$433.35 , N/A ,$402.76 ,$402.76 ,$402.76 ,$458.84 , N/A ,$458.84 , N/A ,$509.82 ,$333.93 , N/A ,$221.26 , N/A , N/A ,$458.84 , N/A ,$321.70 ,$305.89 ,$458.84 , N/A ,$458.84 ,$458.84 , N/A ,$331.38 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200543,N/A,HC BLOOD FILTER,272,1 ,$67.65 ,$43.97 ,$29.36 ,$67.65 ,$50.40 ,$44.31 , N/A ,$35.65 , N/A ,$42.69 ,$42.69 ,$42.69 ,$42.69 ,$60.89 ,$50.74 , N/A ,$59.53 , N/A ,$50.74 ,$50.74 ,$57.50 ,$57.50 , N/A ,$57.50 , N/A ,$53.44 ,$53.44 ,$53.44 ,$60.89 , N/A ,$60.89 , N/A ,$67.65 ,$44.31 , N/A ,$29.36 , N/A , N/A ,$60.89 , N/A ,$42.69 ,$40.59 ,$60.89 , N/A ,$60.89 ,$60.89 , N/A ,$43.97 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200551,N/A,HC BONE CEMENT KIT,272,1 ,$162.42 ,$105.57 ,$70.49 ,$162.42 ,$121.00 ,$106.39 , N/A ,$85.60 , N/A ,$102.49 ,$102.49 ,$102.49 ,$102.49 ,$146.18 ,$121.82 , N/A ,$142.93 , N/A ,$121.82 ,$121.82 ,$138.06 ,$138.06 , N/A ,$138.06 , N/A ,$128.31 ,$128.31 ,$128.31 ,$146.18 , N/A ,$146.18 , N/A ,$162.42 ,$106.39 , N/A ,$70.49 , N/A , N/A ,$146.18 , N/A ,$102.49 ,$97.45 ,$146.18 , N/A ,$146.18 ,$146.18 , N/A ,$105.57 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200571,N/A,HC BREAST PUMP KIT,272,1 ,$162.35 ,$105.53 ,$70.46 ,$162.35 ,$120.95 ,$106.34 , N/A ,$85.56 , N/A ,$102.44 ,$102.44 ,$102.44 ,$102.44 ,$146.12 ,$121.76 , N/A ,$142.87 , N/A ,$121.76 ,$121.76 ,$138.00 ,$138.00 , N/A ,$138.00 , N/A ,$128.26 ,$128.26 ,$128.26 ,$146.12 , N/A ,$146.12 , N/A ,$162.35 ,$106.34 , N/A ,$70.46 , N/A , N/A ,$146.12 , N/A ,$102.44 ,$97.41 ,$146.12 , N/A ,$146.12 ,$146.12 , N/A ,$105.53 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200747,N/A,HC CATH ARGYLE THORACIC,272,1 ,$57.02 ,$37.06 ,$24.75 ,$57.02 ,$42.48 ,$37.35 , N/A ,$30.05 , N/A ,$35.98 ,$35.98 ,$35.98 ,$35.98 ,$51.32 ,$42.77 , N/A ,$50.18 , N/A ,$42.77 ,$42.77 ,$48.47 ,$48.47 , N/A ,$48.47 , N/A ,$45.05 ,$45.05 ,$45.05 ,$51.32 , N/A ,$51.32 , N/A ,$57.02 ,$37.35 , N/A ,$24.75 , N/A , N/A ,$51.32 , N/A ,$35.98 ,$34.21 ,$51.32 , N/A ,$51.32 ,$51.32 , N/A ,$37.06 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200819,N/A,HC CATH RED RUBBER,272,1 ,$157.46 ,$102.35 ,$68.34 ,$157.46 ,$117.31 ,$103.14 , N/A ,$82.98 , N/A ,$99.36 ,$99.36 ,$99.36 ,$99.36 ,$141.71 ,$118.10 , N/A ,$138.56 , N/A ,$118.10 ,$118.10 ,$133.84 ,$133.84 , N/A ,$133.84 , N/A ,$124.39 ,$124.39 ,$124.39 ,$141.71 , N/A ,$141.71 , N/A ,$157.46 ,$103.14 , N/A ,$68.34 , N/A , N/A ,$141.71 , N/A ,$99.36 ,$94.48 ,$141.71 , N/A ,$141.71 ,$141.71 , N/A ,$102.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200832,N/A,HC CATH TRAY WITH FOLEY,272,1 ,$100.87 ,$65.57 ,$43.78 ,$100.87 ,$75.15 ,$66.07 , N/A ,$53.16 , N/A ,$63.65 ,$63.65 ,$63.65 ,$63.65 ,$90.78 ,$75.65 , N/A ,$88.77 , N/A ,$75.65 ,$75.65 ,$85.74 ,$85.74 , N/A ,$85.74 , N/A ,$79.69 ,$79.69 ,$79.69 ,$90.78 , N/A ,$90.78 , N/A ,$100.87 ,$66.07 , N/A ,$43.78 , N/A , N/A ,$90.78 , N/A ,$63.65 ,$60.52 ,$90.78 , N/A ,$90.78 ,$90.78 , N/A ,$65.57 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200848,N/A,HC CATHETER - ARTERIAL SET,272,1 ,$79.91 ,$51.94 ,$34.68 ,$79.91 ,$59.53 ,$52.34 , N/A ,$42.11 , N/A ,$50.42 ,$50.42 ,$50.42 ,$50.42 ,$71.92 ,$59.93 , N/A ,$70.32 , N/A ,$59.93 ,$59.93 ,$67.92 ,$67.92 , N/A ,$67.92 , N/A ,$63.13 ,$63.13 ,$63.13 ,$71.92 , N/A ,$71.92 , N/A ,$79.91 ,$52.34 , N/A ,$34.68 , N/A , N/A ,$71.92 , N/A ,$50.42 ,$47.95 ,$71.92 , N/A ,$71.92 ,$71.92 , N/A ,$51.94 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200849,N/A,HC CATHETER - FOLEY,272,1 ,$29.00 ,$18.85 ,$12.59 ,$29.00 ,$21.61 ,$19.00 , N/A ,$15.28 , N/A ,$18.30 ,$18.30 ,$18.30 ,$18.30 ,$26.10 ,$21.75 , N/A ,$25.52 , N/A ,$21.75 ,$21.75 ,$24.65 ,$24.65 , N/A ,$24.65 , N/A ,$22.91 ,$22.91 ,$22.91 ,$26.10 , N/A ,$26.10 , N/A ,$29.00 ,$19.00 , N/A ,$12.59 , N/A , N/A ,$26.10 , N/A ,$18.30 ,$17.40 ,$26.10 , N/A ,$26.10 ,$26.10 , N/A ,$18.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200906,N/A,HC CHIBA NEEDLE,272,1 ,$12.57 ,$8.17 ,$5.46 ,$12.57 ,$9.36 ,$8.23 , N/A ,$6.62 , N/A ,$7.93 ,$7.93 ,$7.93 ,$7.93 ,$11.31 ,$9.43 , N/A ,$11.06 , N/A ,$9.43 ,$9.43 ,$10.68 ,$10.68 , N/A ,$10.68 , N/A ,$9.93 ,$9.93 ,$9.93 ,$11.31 , N/A ,$11.31 , N/A ,$12.57 ,$8.23 , N/A ,$5.46 , N/A , N/A ,$11.31 , N/A ,$7.93 ,$7.54 ,$11.31 , N/A ,$11.31 ,$11.31 , N/A ,$8.17 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200907,N/A,HC CHLORAPREP,272,1 ,$16.41 ,$10.67 ,$7.12 ,$16.41 ,$12.23 ,$10.75 , N/A ,$8.65 , N/A ,$10.35 ,$10.35 ,$10.35 ,$10.35 ,$14.77 ,$12.31 , N/A ,$14.44 , N/A ,$12.31 ,$12.31 ,$13.95 ,$13.95 , N/A ,$13.95 , N/A ,$12.96 ,$12.96 ,$12.96 ,$14.77 , N/A ,$14.77 , N/A ,$16.41 ,$10.75 , N/A ,$7.12 , N/A , N/A ,$14.77 , N/A ,$10.35 ,$9.85 ,$14.77 , N/A ,$14.77 ,$14.77 , N/A ,$10.67 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27200942,N/A,HC COAXIAL GUIDING NEEDLE,272,1 ,$191.67 ,$124.59 ,$83.18 ,$191.67 ,$142.79 ,$125.54 , N/A ,$101.01 , N/A ,$120.94 ,$120.94 ,$120.94 ,$120.94 ,$172.50 ,$143.75 , N/A ,$168.67 , N/A ,$143.75 ,$143.75 ,$162.92 ,$162.92 , N/A ,$162.92 , N/A ,$151.42 ,$151.42 ,$151.42 ,$172.50 , N/A ,$172.50 , N/A ,$191.67 ,$125.54 , N/A ,$83.18 , N/A , N/A ,$172.50 , N/A ,$120.94 ,$115.00 ,$172.50 , N/A ,$172.50 ,$172.50 , N/A ,$124.59 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201009,N/A,HC CRICOTHYROTOMY CATH SET,272,1 ,"$1,576.91 ","$1,024.99 ",$684.38 ,"$1,576.91 ","$1,174.80 ","$1,032.88 ", N/A ,$831.03 , N/A ,$995.03 ,$995.03 ,$995.03 ,$995.03 ,"$1,419.22 ","$1,182.68 ", N/A ,"$1,387.68 ", N/A ,"$1,182.68 ","$1,182.68 ","$1,340.37 ","$1,340.37 ", N/A ,"$1,340.37 ", N/A ,"$1,245.76 ","$1,245.76 ","$1,245.76 ","$1,419.22 ", N/A ,"$1,419.22 ", N/A ,"$1,576.91 ","$1,032.88 ", N/A ,$684.38 , N/A , N/A ,"$1,419.22 ", N/A ,$995.03 ,$946.15 ,"$1,419.22 ", N/A ,"$1,419.22 ","$1,419.22 ", N/A ,"$1,024.99 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201012,N/A,HC BONOPTY BX SET,272,1 ,$95.09 ,$61.81 ,$41.27 ,$95.09 ,$70.84 ,$62.28 , N/A ,$50.11 , N/A ,$60.00 ,$60.00 ,$60.00 ,$60.00 ,$85.58 ,$71.32 , N/A ,$83.68 , N/A ,$71.32 ,$71.32 ,$80.83 ,$80.83 , N/A ,$80.83 , N/A ,$75.12 ,$75.12 ,$75.12 ,$85.58 , N/A ,$85.58 , N/A ,$95.09 ,$62.28 , N/A ,$41.27 , N/A , N/A ,$85.58 , N/A ,$60.00 ,$57.05 ,$85.58 , N/A ,$85.58 ,$85.58 , N/A ,$61.81 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201013,N/A,HC BONOPTY ED DRILL,272,1 ,$33.08 ,$21.50 ,$14.36 ,$33.08 ,$24.64 ,$21.67 , N/A ,$17.43 , N/A ,$20.87 ,$20.87 ,$20.87 ,$20.87 ,$29.77 ,$24.81 , N/A ,$29.11 , N/A ,$24.81 ,$24.81 ,$28.12 ,$28.12 , N/A ,$28.12 , N/A ,$26.13 ,$26.13 ,$26.13 ,$29.77 , N/A ,$29.77 , N/A ,$33.08 ,$21.67 , N/A ,$14.36 , N/A , N/A ,$29.77 , N/A ,$20.87 ,$19.85 ,$29.77 , N/A ,$29.77 ,$29.77 , N/A ,$21.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201014,N/A,HC BONOPTY PENETRATION SET,272,1 ,$413.44 ,$268.74 ,$179.43 ,$413.44 ,$308.01 ,$270.80 , N/A ,$217.88 , N/A ,$260.88 ,$260.88 ,$260.88 ,$260.88 ,$372.10 ,$310.08 , N/A ,$363.83 , N/A ,$310.08 ,$310.08 ,$351.42 ,$351.42 , N/A ,$351.42 , N/A ,$326.62 ,$326.62 ,$326.62 ,$372.10 , N/A ,$372.10 , N/A ,$413.44 ,$270.80 , N/A ,$179.43 , N/A , N/A ,$372.10 , N/A ,$260.88 ,$248.06 ,$372.10 , N/A ,$372.10 ,$372.10 , N/A ,$268.74 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201042,N/A,HC DERMABOND,272,1 ,$32.66 ,$21.23 ,$14.17 ,$32.66 ,$24.33 ,$21.39 , N/A ,$17.21 , N/A ,$20.61 ,$20.61 ,$20.61 ,$20.61 ,$29.39 ,$24.50 , N/A ,$28.74 , N/A ,$24.50 ,$24.50 ,$27.76 ,$27.76 , N/A ,$27.76 , N/A ,$25.80 ,$25.80 ,$25.80 ,$29.39 , N/A ,$29.39 , N/A ,$32.66 ,$21.39 , N/A ,$14.17 , N/A , N/A ,$29.39 , N/A ,$20.61 ,$19.60 ,$29.39 , N/A ,$29.39 ,$29.39 , N/A ,$21.23 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201071,N/A,HC DILATOR BARD,272,1 ,$21.88 ,$14.22 ,$9.50 ,$21.88 ,$16.30 ,$14.33 , N/A ,$11.53 , N/A ,$13.81 ,$13.81 ,$13.81 ,$13.81 ,$19.69 ,$16.41 , N/A ,$19.25 , N/A ,$16.41 ,$16.41 ,$18.60 ,$18.60 , N/A ,$18.60 , N/A ,$17.29 ,$17.29 ,$17.29 ,$19.69 , N/A ,$19.69 , N/A ,$21.88 ,$14.33 , N/A ,$9.50 , N/A , N/A ,$19.69 , N/A ,$13.81 ,$13.13 ,$19.69 , N/A ,$19.69 ,$19.69 , N/A ,$14.22 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201077,N/A,HC DIS INCENTIVE SPIROMETER,272,1 ,$61.47 ,$39.96 ,$26.68 ,$61.47 ,$45.80 ,$40.26 , N/A ,$32.39 , N/A ,$38.79 ,$38.79 ,$38.79 ,$38.79 ,$55.32 ,$46.10 , N/A ,$54.09 , N/A ,$46.10 ,$46.10 ,$52.25 ,$52.25 , N/A ,$52.25 , N/A ,$48.56 ,$48.56 ,$48.56 ,$55.32 , N/A ,$55.32 , N/A ,$61.47 ,$40.26 , N/A ,$26.68 , N/A , N/A ,$55.32 , N/A ,$38.79 ,$36.88 ,$55.32 , N/A ,$55.32 ,$55.32 , N/A ,$39.96 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201083,N/A,HC DISP. OXIMETER SENSOR,272,1 ,$129.41 ,$84.12 ,$56.16 ,$129.41 ,$96.41 ,$84.76 , N/A ,$68.20 , N/A ,$81.66 ,$81.66 ,$81.66 ,$81.66 ,$116.47 ,$97.06 , N/A ,$113.88 , N/A ,$97.06 ,$97.06 ,$110.00 ,$110.00 , N/A ,$110.00 , N/A ,$102.23 ,$102.23 ,$102.23 ,$116.47 , N/A ,$116.47 , N/A ,$129.41 ,$84.76 , N/A ,$56.16 , N/A , N/A ,$116.47 , N/A ,$81.66 ,$77.65 ,$116.47 , N/A ,$116.47 ,$116.47 , N/A ,$84.12 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201138,N/A,HC WOUND VAC DRAPE,272,1 ,$15.59 ,$10.13 ,$6.77 ,$15.59 ,$11.61 ,$10.21 , N/A ,$8.22 , N/A ,$9.84 ,$9.84 ,$9.84 ,$9.84 ,$14.03 ,$11.69 , N/A ,$13.72 , N/A ,$11.69 ,$11.69 ,$13.25 ,$13.25 , N/A ,$13.25 , N/A ,$12.32 ,$12.32 ,$12.32 ,$14.03 , N/A ,$14.03 , N/A ,$15.59 ,$10.21 , N/A ,$6.77 , N/A , N/A ,$14.03 , N/A ,$9.84 ,$9.35 ,$14.03 , N/A ,$14.03 ,$14.03 , N/A ,$10.13 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201165,N/A,HC MORGAN LENS,272,1 ,$247.54 ,$160.90 ,$107.43 ,$247.54 ,$184.42 ,$162.14 , N/A ,$130.45 , N/A ,$156.20 ,$156.20 ,$156.20 ,$156.20 ,$222.79 ,$185.66 , N/A ,$217.84 , N/A ,$185.66 ,$185.66 ,$210.41 ,$210.41 , N/A ,$210.41 , N/A ,$195.56 ,$195.56 ,$195.56 ,$222.79 , N/A ,$222.79 , N/A ,$247.54 ,$162.14 , N/A ,$107.43 , N/A , N/A ,$222.79 , N/A ,$156.20 ,$148.52 ,$222.79 , N/A ,$222.79 ,$222.79 , N/A ,$160.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201252,N/A,HC EPIDURAL TRAY,272,1 ,$156.20 ,$101.53 ,$67.79 ,$156.20 ,$116.37 ,$102.31 , N/A ,$82.32 , N/A ,$98.56 ,$98.56 ,$98.56 ,$98.56 ,$140.58 ,$117.15 , N/A ,$137.46 , N/A ,$117.15 ,$117.15 ,$132.77 ,$132.77 , N/A ,$132.77 , N/A ,$123.40 ,$123.40 ,$123.40 ,$140.58 , N/A ,$140.58 , N/A ,$156.20 ,$102.31 , N/A ,$67.79 , N/A , N/A ,$140.58 , N/A ,$98.56 ,$93.72 ,$140.58 , N/A ,$140.58 ,$140.58 , N/A ,$101.53 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201279,N/A,HC FECAL MANAGEMENT KIT,272,1 ,$246.00 ,$159.90 ,$106.76 ,$246.00 ,$183.27 ,$161.13 , N/A ,$129.64 , N/A ,$155.23 ,$155.23 ,$155.23 ,$155.23 ,$221.40 ,$184.50 , N/A ,$216.48 , N/A ,$184.50 ,$184.50 ,$209.10 ,$209.10 , N/A ,$209.10 , N/A ,$194.34 ,$194.34 ,$194.34 ,$221.40 , N/A ,$221.40 , N/A ,$246.00 ,$161.13 , N/A ,$106.76 , N/A , N/A ,$221.40 , N/A ,$155.23 ,$147.60 ,$221.40 , N/A ,$221.40 ,$221.40 , N/A ,$159.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201332,N/A,HC GASTRIC LAVAGE KIT,272,1 ,"$1,882.87 ","$1,223.87 ",$817.17 ,"$1,882.87 ","$1,402.74 ","$1,233.28 ", N/A ,$992.27 , N/A ,"$1,188.09 ","$1,188.09 ","$1,188.09 ","$1,188.09 ","$1,694.58 ","$1,412.15 ", N/A ,"$1,656.93 ", N/A ,"$1,412.15 ","$1,412.15 ","$1,600.44 ","$1,600.44 ", N/A ,"$1,600.44 ", N/A ,"$1,487.47 ","$1,487.47 ","$1,487.47 ","$1,694.58 ", N/A ,"$1,694.58 ", N/A ,"$1,882.87 ","$1,233.28 ", N/A ,$817.17 , N/A , N/A ,"$1,694.58 ", N/A ,"$1,188.09 ","$1,129.72 ","$1,694.58 ", N/A ,"$1,694.58 ","$1,694.58 ", N/A ,"$1,223.87 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201339,N/A,HC GELFILM,272,1 ,$16.80 ,$10.92 ,$7.29 ,$16.80 ,$12.52 ,$11.00 , N/A ,$8.85 , N/A ,$10.60 ,$10.60 ,$10.60 ,$10.60 ,$15.12 ,$12.60 , N/A ,$14.78 , N/A ,$12.60 ,$12.60 ,$14.28 ,$14.28 , N/A ,$14.28 , N/A ,$13.27 ,$13.27 ,$13.27 ,$15.12 , N/A ,$15.12 , N/A ,$16.80 ,$11.00 , N/A ,$7.29 , N/A , N/A ,$15.12 , N/A ,$10.60 ,$10.08 ,$15.12 , N/A ,$15.12 ,$15.12 , N/A ,$10.92 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201391,N/A,HC HEEL PROTECTOR EA,272,1 ,$57.96 ,$37.67 ,$25.15 ,$57.96 ,$43.18 ,$37.96 , N/A ,$30.54 , N/A ,$36.57 ,$36.57 ,$36.57 ,$36.57 ,$52.16 ,$43.47 , N/A ,$51.00 , N/A ,$43.47 ,$43.47 ,$49.27 ,$49.27 , N/A ,$49.27 , N/A ,$45.79 ,$45.79 ,$45.79 ,$52.16 , N/A ,$52.16 , N/A ,$57.96 ,$37.96 , N/A ,$25.15 , N/A , N/A ,$52.16 , N/A ,$36.57 ,$34.78 ,$52.16 , N/A ,$52.16 ,$52.16 , N/A ,$37.67 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201404,N/A,HC HEMOVAC MINI EVACAT ONLY,272,1 ,$288.17 ,$187.31 ,$125.07 ,$288.17 ,$214.69 ,$188.75 , N/A ,$151.87 , N/A ,$181.84 ,$181.84 ,$181.84 ,$181.84 ,$259.35 ,$216.13 , N/A ,$253.59 , N/A ,$216.13 ,$216.13 ,$244.94 ,$244.94 , N/A ,$244.94 , N/A ,$227.65 ,$227.65 ,$227.65 ,$259.35 , N/A ,$259.35 , N/A ,$288.17 ,$188.75 , N/A ,$125.07 , N/A , N/A ,$259.35 , N/A ,$181.84 ,$172.90 ,$259.35 , N/A ,$259.35 ,$259.35 , N/A ,$187.31 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201419,N/A,HC HUBER NEEDLE,272,1 ,$10.00 ,$6.50 ,$4.34 ,$10.00 ,$7.45 ,$6.55 , N/A ,$5.27 , N/A ,$6.31 ,$6.31 ,$6.31 ,$6.31 ,$9.00 ,$7.50 , N/A ,$8.80 , N/A ,$7.50 ,$7.50 ,$8.50 ,$8.50 , N/A ,$8.50 , N/A ,$7.90 ,$7.90 ,$7.90 ,$9.00 , N/A ,$9.00 , N/A ,$10.00 ,$6.55 , N/A ,$4.34 , N/A , N/A ,$9.00 , N/A ,$6.31 ,$6.00 ,$9.00 , N/A ,$9.00 ,$9.00 , N/A ,$6.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201521,N/A,HC KIT INTRODUCER,272,1 ,$25.83 ,$16.79 ,$11.21 ,$25.83 ,$19.24 ,$16.92 , N/A ,$13.61 , N/A ,$16.30 ,$16.30 ,$16.30 ,$16.30 ,$23.25 ,$19.37 , N/A ,$22.73 , N/A ,$19.37 ,$19.37 ,$21.96 ,$21.96 , N/A ,$21.96 , N/A ,$20.41 ,$20.41 ,$20.41 ,$23.25 , N/A ,$23.25 , N/A ,$25.83 ,$16.92 , N/A ,$11.21 , N/A , N/A ,$23.25 , N/A ,$16.30 ,$15.50 ,$23.25 , N/A ,$23.25 ,$23.25 , N/A ,$16.79 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201637,N/A,HC MAMMOTOME PROBE,272,1 ,$534.56 ,$347.46 ,$232.00 ,$534.56 ,$398.25 ,$350.14 , N/A ,$281.71 , N/A ,$337.31 ,$337.31 ,$337.31 ,$337.31 ,$481.10 ,$400.92 , N/A ,$470.41 , N/A ,$400.92 ,$400.92 ,$454.38 ,$454.38 , N/A ,$454.38 , N/A ,$422.30 ,$422.30 ,$422.30 ,$481.10 , N/A ,$481.10 , N/A ,$534.56 ,$350.14 , N/A ,$232.00 , N/A , N/A ,$481.10 , N/A ,$337.31 ,$320.74 ,$481.10 , N/A ,$481.10 ,$481.10 , N/A ,$347.46 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201647,N/A,HC METER URINE,272,1 ,$61.03 ,$39.67 ,$26.49 ,$61.03 ,$45.47 ,$39.97 , N/A ,$32.16 , N/A ,$38.51 ,$38.51 ,$38.51 ,$38.51 ,$54.93 ,$45.77 , N/A ,$53.71 , N/A ,$45.77 ,$45.77 ,$51.88 ,$51.88 , N/A ,$51.88 , N/A ,$48.21 ,$48.21 ,$48.21 ,$54.93 , N/A ,$54.93 , N/A ,$61.03 ,$39.97 , N/A ,$26.49 , N/A , N/A ,$54.93 , N/A ,$38.51 ,$36.62 ,$54.93 , N/A ,$54.93 ,$54.93 , N/A ,$39.67 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201737,N/A,HC NIPPLE ENHANCER,272,1 ,$12.31 ,$8.00 ,$5.34 ,$12.31 ,$9.17 ,$8.06 , N/A ,$6.49 , N/A ,$7.77 ,$7.77 ,$7.77 ,$7.77 ,$11.08 ,$9.23 , N/A ,$10.83 , N/A ,$9.23 ,$9.23 ,$10.46 ,$10.46 , N/A ,$10.46 , N/A ,$9.72 ,$9.72 ,$9.72 ,$11.08 , N/A ,$11.08 , N/A ,$12.31 ,$8.06 , N/A ,$5.34 , N/A , N/A ,$11.08 , N/A ,$7.77 ,$7.39 ,$11.08 , N/A ,$11.08 ,$11.08 , N/A ,$8.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201867,N/A,HC PLEURX DRAINAGE KIT,272,1 ,$78.75 ,$51.19 ,$34.18 ,$78.75 ,$58.67 ,$51.58 , N/A ,$41.50 , N/A ,$49.69 ,$49.69 ,$49.69 ,$49.69 ,$70.88 ,$59.06 , N/A ,$69.30 , N/A ,$59.06 ,$59.06 ,$66.94 ,$66.94 , N/A ,$66.94 , N/A ,$62.21 ,$62.21 ,$62.21 ,$70.88 , N/A ,$70.88 , N/A ,$78.75 ,$51.58 , N/A ,$34.18 , N/A , N/A ,$70.88 , N/A ,$49.69 ,$47.25 ,$70.88 , N/A ,$70.88 ,$70.88 , N/A ,$51.19 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201868,N/A,HC PLEURX DRAINAGE LINE SET,272,1 ,$32.66 ,$21.23 ,$14.17 ,$32.66 ,$24.33 ,$21.39 , N/A ,$17.21 , N/A ,$20.61 ,$20.61 ,$20.61 ,$20.61 ,$29.39 ,$24.50 , N/A ,$28.74 , N/A ,$24.50 ,$24.50 ,$27.76 ,$27.76 , N/A ,$27.76 , N/A ,$25.80 ,$25.80 ,$25.80 ,$29.39 , N/A ,$29.39 , N/A ,$32.66 ,$21.39 , N/A ,$14.17 , N/A , N/A ,$29.39 , N/A ,$20.61 ,$19.60 ,$29.39 , N/A ,$29.39 ,$29.39 , N/A ,$21.23 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201869,N/A,HC PLEURX REPLACEMENT CAP,272,1 ,$11.03 ,$7.17 ,$4.79 ,$11.03 ,$8.22 ,$7.22 , N/A ,$5.81 , N/A ,$6.96 ,$6.96 ,$6.96 ,$6.96 ,$9.93 ,$8.27 , N/A ,$9.71 , N/A ,$8.27 ,$8.27 ,$9.38 ,$9.38 , N/A ,$9.38 , N/A ,$8.71 ,$8.71 ,$8.71 ,$9.93 , N/A ,$9.93 , N/A ,$11.03 ,$7.22 , N/A ,$4.79 , N/A , N/A ,$9.93 , N/A ,$6.96 ,$6.62 ,$9.93 , N/A ,$9.93 ,$9.93 , N/A ,$7.17 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201890,N/A,HC PREP CHLORAPREP 26ML,272,1 ,$53.06 ,$34.49 ,$23.03 ,$53.06 ,$39.53 ,$34.75 , N/A ,$27.96 , N/A ,$33.48 ,$33.48 ,$33.48 ,$33.48 ,$47.75 ,$39.80 , N/A ,$46.69 , N/A ,$39.80 ,$39.80 ,$45.10 ,$45.10 , N/A ,$45.10 , N/A ,$41.92 ,$41.92 ,$41.92 ,$47.75 , N/A ,$47.75 , N/A ,$53.06 ,$34.75 , N/A ,$23.03 , N/A , N/A ,$47.75 , N/A ,$33.48 ,$31.84 ,$47.75 , N/A ,$47.75 ,$47.75 , N/A ,$34.49 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201896,N/A,HC PREVENA INCISION SYSTEM,272,1 ,"$1,560.00 ","$1,014.00 ",$677.04 ,"$1,560.00 ","$1,162.20 ","$1,021.80 ", N/A ,$822.12 , N/A ,$984.36 ,$984.36 ,$984.36 ,$984.36 ,"$1,404.00 ","$1,170.00 ", N/A ,"$1,372.80 ", N/A ,"$1,170.00 ","$1,170.00 ","$1,326.00 ","$1,326.00 ", N/A ,"$1,326.00 ", N/A ,"$1,232.40 ","$1,232.40 ","$1,232.40 ","$1,404.00 ", N/A ,"$1,404.00 ", N/A ,"$1,560.00 ","$1,021.80 ", N/A ,$677.04 , N/A , N/A ,"$1,404.00 ", N/A ,$984.36 ,$936.00 ,"$1,404.00 ", N/A ,"$1,404.00 ","$1,404.00 ", N/A ,"$1,014.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27201938,N/A,HC PULSE OXIMETER PROBE DISP,272,1 ,$24.87 ,$16.17 ,$10.79 ,$24.87 ,$18.53 ,$16.29 , N/A ,$13.11 , N/A ,$15.69 ,$15.69 ,$15.69 ,$15.69 ,$22.38 ,$18.65 , N/A ,$21.89 , N/A ,$18.65 ,$18.65 ,$21.14 ,$21.14 , N/A ,$21.14 , N/A ,$19.65 ,$19.65 ,$19.65 ,$22.38 , N/A ,$22.38 , N/A ,$24.87 ,$16.29 , N/A ,$10.79 , N/A , N/A ,$22.38 , N/A ,$15.69 ,$14.92 ,$22.38 , N/A ,$22.38 ,$22.38 , N/A ,$16.17 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27202002,N/A,HC SCD SLEEVE KNEE,272,1 ,$42.00 ,$27.30 ,$18.23 ,$42.00 ,$31.29 ,$27.51 , N/A ,$22.13 , N/A ,$26.50 ,$26.50 ,$26.50 ,$26.50 ,$37.80 ,$31.50 , N/A ,$36.96 , N/A ,$31.50 ,$31.50 ,$35.70 ,$35.70 , N/A ,$35.70 , N/A ,$33.18 ,$33.18 ,$33.18 ,$37.80 , N/A ,$37.80 , N/A ,$42.00 ,$27.51 , N/A ,$18.23 , N/A , N/A ,$37.80 , N/A ,$26.50 ,$25.20 ,$37.80 , N/A ,$37.80 ,$37.80 , N/A ,$27.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27202013,N/A,HC SEALANT FLOSEAL MATRIX,272,1 ,$384.33 ,$249.81 ,$166.80 ,$384.33 ,$286.33 ,$251.74 , N/A ,$202.54 , N/A ,$242.51 ,$242.51 ,$242.51 ,$242.51 ,$345.90 ,$288.25 , N/A ,$338.21 , N/A ,$288.25 ,$288.25 ,$326.68 ,$326.68 , N/A ,$326.68 , N/A ,$303.62 ,$303.62 ,$303.62 ,$345.90 , N/A ,$345.90 , N/A ,$384.33 ,$251.74 , N/A ,$166.80 , N/A , N/A ,$345.90 , N/A ,$242.51 ,$230.60 ,$345.90 , N/A ,$345.90 ,$345.90 , N/A ,$249.81 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27202018,N/A,HC SENSOR ADULT ADHESIVE,272,1 ,$457.97 ,$297.68 ,$198.76 ,$457.97 ,$341.19 ,$299.97 , N/A ,$241.35 , N/A ,$288.98 ,$288.98 ,$288.98 ,$288.98 ,$412.17 ,$343.48 , N/A ,$403.01 , N/A ,$343.48 ,$343.48 ,$389.27 ,$389.27 , N/A ,$389.27 , N/A ,$361.80 ,$361.80 ,$361.80 ,$412.17 , N/A ,$412.17 , N/A ,$457.97 ,$299.97 , N/A ,$198.76 , N/A , N/A ,$412.17 , N/A ,$288.98 ,$274.78 ,$412.17 , N/A ,$412.17 ,$412.17 , N/A ,$297.68 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27202120,N/A,HC STAPLER SKIN,272,1 ,$18.00 ,$11.70 ,$7.81 ,$18.00 ,$13.41 ,$11.79 , N/A ,$9.49 , N/A ,$11.36 ,$11.36 ,$11.36 ,$11.36 ,$16.20 ,$13.50 , N/A ,$15.84 , N/A ,$13.50 ,$13.50 ,$15.30 ,$15.30 , N/A ,$15.30 , N/A ,$14.22 ,$14.22 ,$14.22 ,$16.20 , N/A ,$16.20 , N/A ,$18.00 ,$11.79 , N/A ,$7.81 , N/A , N/A ,$16.20 , N/A ,$11.36 ,$10.80 ,$16.20 , N/A ,$16.20 ,$16.20 , N/A ,$11.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27202600,N/A,HC SUTURE,272,1 ,$27.37 ,$17.79 ,$11.88 ,$27.37 ,$20.39 ,$17.93 , N/A ,$14.42 , N/A ,$17.27 ,$17.27 ,$17.27 ,$17.27 ,$24.63 ,$20.53 , N/A ,$24.09 , N/A ,$20.53 ,$20.53 ,$23.26 ,$23.26 , N/A ,$23.26 , N/A ,$21.62 ,$21.62 ,$21.62 ,$24.63 , N/A ,$24.63 , N/A ,$27.37 ,$17.93 , N/A ,$11.88 , N/A , N/A ,$24.63 , N/A ,$17.27 ,$16.42 ,$24.63 , N/A ,$24.63 ,$24.63 , N/A ,$17.79 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27202665,N/A,HC THORACENTESIS TRAY,272,1 ,$249.75 ,$162.34 ,$108.39 ,$249.75 ,$186.06 ,$163.59 , N/A ,$131.62 , N/A ,$157.59 ,$157.59 ,$157.59 ,$157.59 ,$224.78 ,$187.31 , N/A ,$219.78 , N/A ,$187.31 ,$187.31 ,$212.29 ,$212.29 , N/A ,$212.29 , N/A ,$197.30 ,$197.30 ,$197.30 ,$224.78 , N/A ,$224.78 , N/A ,$249.75 ,$163.59 , N/A ,$108.39 , N/A , N/A ,$224.78 , N/A ,$157.59 ,$149.85 ,$224.78 , N/A ,$224.78 ,$224.78 , N/A ,$162.34 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27202729,N/A,HC TRANSDUCER COVER,272,1 ,$16.21 ,$10.54 ,$7.04 ,$16.21 ,$12.08 ,$10.62 , N/A ,$8.54 , N/A ,$10.23 ,$10.23 ,$10.23 ,$10.23 ,$14.59 ,$12.16 , N/A ,$14.26 , N/A ,$12.16 ,$12.16 ,$13.78 ,$13.78 , N/A ,$13.78 , N/A ,$12.81 ,$12.81 ,$12.81 ,$14.59 , N/A ,$14.59 , N/A ,$16.21 ,$10.62 , N/A ,$7.04 , N/A , N/A ,$14.59 , N/A ,$10.23 ,$9.73 ,$14.59 , N/A ,$14.59 ,$14.59 , N/A ,$10.54 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27202743,N/A,HC TRAY CATH,272,1 ,$96.43 ,$62.68 ,$41.85 ,$96.43 ,$71.84 ,$63.16 , N/A ,$50.82 , N/A ,$60.85 ,$60.85 ,$60.85 ,$60.85 ,$86.79 ,$72.32 , N/A ,$84.86 , N/A ,$72.32 ,$72.32 ,$81.97 ,$81.97 , N/A ,$81.97 , N/A ,$76.18 ,$76.18 ,$76.18 ,$86.79 , N/A ,$86.79 , N/A ,$96.43 ,$63.16 , N/A ,$41.85 , N/A , N/A ,$86.79 , N/A ,$60.85 ,$57.86 ,$86.79 , N/A ,$86.79 ,$86.79 , N/A ,$62.68 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27202786,N/A,HC TRAY PERI-CERV BLOCK,272,1 ,$66.14 ,$42.99 ,$28.70 ,$66.14 ,$49.27 ,$43.32 , N/A ,$34.86 , N/A ,$41.73 ,$41.73 ,$41.73 ,$41.73 ,$59.53 ,$49.61 , N/A ,$58.20 , N/A ,$49.61 ,$49.61 ,$56.22 ,$56.22 , N/A ,$56.22 , N/A ,$52.25 ,$52.25 ,$52.25 ,$59.53 , N/A ,$59.53 , N/A ,$66.14 ,$43.32 , N/A ,$28.70 , N/A , N/A ,$59.53 , N/A ,$41.73 ,$39.68 ,$59.53 , N/A ,$59.53 ,$59.53 , N/A ,$42.99 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27202807,N/A,HC TRAY SPINAL,272,1 ,$141.67 ,$92.09 ,$61.48 ,$141.67 ,$105.54 ,$92.79 , N/A ,$74.66 , N/A ,$89.39 ,$89.39 ,$89.39 ,$89.39 ,$127.50 ,$106.25 , N/A ,$124.67 , N/A ,$106.25 ,$106.25 ,$120.42 ,$120.42 , N/A ,$120.42 , N/A ,$111.92 ,$111.92 ,$111.92 ,$127.50 , N/A ,$127.50 , N/A ,$141.67 ,$92.79 , N/A ,$61.48 , N/A , N/A ,$127.50 , N/A ,$89.39 ,$85.00 ,$127.50 , N/A ,$127.50 ,$127.50 , N/A ,$92.09 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27202901,N/A,HC TUBES TRACH,278,1 ,$72.81 ,$47.33 ,$31.60 ,$72.81 ,$54.24 ,$47.69 , N/A ,$38.37 , N/A ,$45.94 ,$45.94 ,$45.94 ,$45.94 ,$65.53 ,$54.61 , N/A ,$64.07 , N/A ,$54.61 ,$54.61 ,$61.89 ,$61.89 , N/A ,$61.89 , N/A ,$57.52 ,$57.52 ,$57.52 ,$65.53 , N/A ,$65.53 , N/A ,$72.81 ,$47.69 , N/A ,$31.60 , N/A , N/A ,$65.53 , N/A ,$45.94 ,$43.69 ,$65.53 , N/A ,$65.53 ,$65.53 , N/A ,$47.33 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27202915,N/A,HC TUBING CYSTO,272,1 ,$604.69 ,$393.05 ,$262.44 ,$604.69 ,$450.49 ,$396.07 , N/A ,$318.67 , N/A ,$381.56 ,$381.56 ,$381.56 ,$381.56 ,$544.22 ,$453.52 , N/A ,$532.13 , N/A ,$453.52 ,$453.52 ,$513.99 ,$513.99 , N/A ,$513.99 , N/A ,$477.71 ,$477.71 ,$477.71 ,$544.22 , N/A ,$544.22 , N/A ,$604.69 ,$396.07 , N/A ,$262.44 , N/A , N/A ,$544.22 , N/A ,$381.56 ,$362.81 ,$544.22 , N/A ,$544.22 ,$544.22 , N/A ,$393.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203239,N/A,HC PUTTY,272,1 ,$13.52 ,$8.79 ,$5.87 ,$13.52 ,$10.07 ,$8.86 , N/A ,$7.13 , N/A ,$8.53 ,$8.53 ,$8.53 ,$8.53 ,$12.17 ,$10.14 , N/A ,$11.90 , N/A ,$10.14 ,$10.14 ,$11.49 ,$11.49 , N/A ,$11.49 , N/A ,$10.68 ,$10.68 ,$10.68 ,$12.17 , N/A ,$12.17 , N/A ,$13.52 ,$8.86 , N/A ,$5.87 , N/A , N/A ,$12.17 , N/A ,$8.53 ,$8.11 ,$12.17 , N/A ,$12.17 ,$12.17 , N/A ,$8.79 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203246,N/A,HC ERGONOMIC HAND EXERCISER,272,1 ,$34.09 ,$22.16 ,$14.80 ,$34.09 ,$25.40 ,$22.33 , N/A ,$17.97 , N/A ,$21.51 ,$21.51 ,$21.51 ,$21.51 ,$30.68 ,$25.57 , N/A ,$30.00 , N/A ,$25.57 ,$25.57 ,$28.98 ,$28.98 , N/A ,$28.98 , N/A ,$26.93 ,$26.93 ,$26.93 ,$30.68 , N/A ,$30.68 , N/A ,$34.09 ,$22.33 , N/A ,$14.80 , N/A , N/A ,$30.68 , N/A ,$21.51 ,$20.45 ,$30.68 , N/A ,$30.68 ,$30.68 , N/A ,$22.16 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203255,N/A,HC CPM PADS,272,1 ,$158.11 ,$102.77 ,$68.62 ,$158.11 ,$117.79 ,$103.56 , N/A ,$83.32 , N/A ,$99.77 ,$99.77 ,$99.77 ,$99.77 ,$142.30 ,$118.58 , N/A ,$139.14 , N/A ,$118.58 ,$118.58 ,$134.39 ,$134.39 , N/A ,$134.39 , N/A ,$124.91 ,$124.91 ,$124.91 ,$142.30 , N/A ,$142.30 , N/A ,$158.11 ,$103.56 , N/A ,$68.62 , N/A , N/A ,$142.30 , N/A ,$99.77 ,$94.87 ,$142.30 , N/A ,$142.30 ,$142.30 , N/A ,$102.77 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203271,N/A,HC WOUND VAC VERALINK CASSETTE,272,1 ,$140.25 ,$91.16 ,$60.87 ,$140.25 ,$104.49 ,$91.86 , N/A ,$73.91 , N/A ,$88.50 ,$88.50 ,$88.50 ,$88.50 ,$126.23 ,$105.19 , N/A ,$123.42 , N/A ,$105.19 ,$105.19 ,$119.21 ,$119.21 , N/A ,$119.21 , N/A ,$110.80 ,$110.80 ,$110.80 ,$126.23 , N/A ,$126.23 , N/A ,$140.25 ,$91.86 , N/A ,$60.87 , N/A , N/A ,$126.23 , N/A ,$88.50 ,$84.15 ,$126.23 , N/A ,$126.23 ,$126.23 , N/A ,$91.16 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203503,N/A,HC CANNULA NASAL HEATED HI FLOW,272,1 ,$63.00 ,$40.95 ,$27.34 ,$63.00 ,$46.94 ,$41.27 , N/A ,$33.20 , N/A ,$39.75 ,$39.75 ,$39.75 ,$39.75 ,$56.70 ,$47.25 , N/A ,$55.44 , N/A ,$47.25 ,$47.25 ,$53.55 ,$53.55 , N/A ,$53.55 , N/A ,$49.77 ,$49.77 ,$49.77 ,$56.70 , N/A ,$56.70 , N/A ,$63.00 ,$41.27 , N/A ,$27.34 , N/A , N/A ,$56.70 , N/A ,$39.75 ,$37.80 ,$56.70 , N/A ,$56.70 ,$56.70 , N/A ,$40.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203509,N/A,HC CATHETER FOLEY 3W,272,1 ,$46.81 ,$30.43 ,$20.32 ,$46.81 ,$34.87 ,$30.66 , N/A ,$24.67 , N/A ,$29.54 ,$29.54 ,$29.54 ,$29.54 ,$42.13 ,$35.11 , N/A ,$41.19 , N/A ,$35.11 ,$35.11 ,$39.79 ,$39.79 , N/A ,$39.79 , N/A ,$36.98 ,$36.98 ,$36.98 ,$42.13 , N/A ,$42.13 , N/A ,$46.81 ,$30.66 , N/A ,$20.32 , N/A , N/A ,$42.13 , N/A ,$29.54 ,$28.09 ,$42.13 , N/A ,$42.13 ,$42.13 , N/A ,$30.43 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203512,A6196,HC DRESSING ALGINATE <16,623,1 ,$16.23 ,$10.55 ,$7.04 ,$16.23 ,$12.09 ,$10.63 , N/A ,$8.55 , N/A ,$10.24 ,$10.24 ,$10.24 ,$10.24 ,$14.61 ,$12.17 , N/A ,$14.28 , N/A ,$12.17 ,$12.17 ,$13.80 ,$13.80 , N/A ,$13.80 , N/A ,$12.82 ,$12.82 ,$12.82 ,$14.61 , N/A ,$14.61 , N/A ,$16.23 ,$10.63 , N/A ,$7.04 , N/A , N/A ,$14.61 , N/A ,$10.24 ,$9.74 ,$14.61 , N/A ,$14.61 ,$14.61 , N/A ,$10.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203524,A6258,HC DRESSING TRANSPARENT >16 AND <48 SQ CM TIER 1,623,1 ,$5.99 ,$3.89 ,$2.60 ,$5.99 ,$4.46 ,$3.92 , N/A ,$3.16 , N/A ,$3.78 ,$3.78 ,$3.78 ,$3.78 ,$5.39 ,$4.49 , N/A ,$5.27 , N/A ,$4.49 ,$4.49 ,$5.09 ,$5.09 , N/A ,$5.09 , N/A ,$4.73 ,$4.73 ,$4.73 ,$5.39 , N/A ,$5.39 , N/A ,$5.99 ,$3.92 , N/A ,$2.60 , N/A , N/A ,$5.39 , N/A ,$3.78 ,$3.59 ,$5.39 , N/A ,$5.39 ,$5.39 , N/A ,$3.89 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203525,A6258,HC DRESSING TRANSPARENT >16 AND <48 SQ CM TIER 2,623,1 ,$20.00 ,$13.00 ,$8.68 ,$20.00 ,$14.90 ,$13.10 , N/A ,$10.54 , N/A ,$12.62 ,$12.62 ,$12.62 ,$12.62 ,$18.00 ,$15.00 , N/A ,$17.60 , N/A ,$15.00 ,$15.00 ,$17.00 ,$17.00 , N/A ,$17.00 , N/A ,$15.80 ,$15.80 ,$15.80 ,$18.00 , N/A ,$18.00 , N/A ,$20.00 ,$13.10 , N/A ,$8.68 , N/A , N/A ,$18.00 , N/A ,$12.62 ,$12.00 ,$18.00 , N/A ,$18.00 ,$18.00 , N/A ,$13.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203531,C1751,HC CATHETER CV TRIPLE-LUMEN,272,1 ,"$1,352.31 ",$879.00 ,$586.90 ,"$1,352.31 ","$1,007.47 ",$885.76 , N/A ,$712.67 , N/A ,$853.31 ,$853.31 ,$853.31 ,$853.31 ,"$1,217.08 ","$1,014.23 ", N/A ,"$1,190.03 ", N/A ,"$1,014.23 ","$1,014.23 ","$1,149.46 ","$1,149.46 ", N/A ,"$1,149.46 ", N/A ,"$1,068.32 ","$1,068.32 ","$1,068.32 ","$1,217.08 ", N/A ,"$1,217.08 ", N/A ,"$1,352.31 ",$885.76 , N/A ,$586.90 , N/A , N/A ,"$1,217.08 ", N/A ,$853.31 ,$811.39 ,"$1,217.08 ", N/A ,"$1,217.08 ","$1,217.08 ", N/A ,$879.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203533,C1751,HC CATHETER CV SINGLE-LUMEN,272,1 ,$345.03 ,$224.27 ,$149.74 ,$345.03 ,$257.05 ,$225.99 , N/A ,$181.83 , N/A ,$217.71 ,$217.71 ,$217.71 ,$217.71 ,$310.53 ,$258.77 , N/A ,$303.63 , N/A ,$258.77 ,$258.77 ,$293.28 ,$293.28 , N/A ,$293.28 , N/A ,$272.57 ,$272.57 ,$272.57 ,$310.53 , N/A ,$310.53 , N/A ,$345.03 ,$225.99 , N/A ,$149.74 , N/A , N/A ,$310.53 , N/A ,$217.71 ,$207.02 ,$310.53 , N/A ,$310.53 ,$310.53 , N/A ,$224.27 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203535,N/A,HC TRAY LUMBAR PUNCTURE,272,1 ,$160.63 ,$104.41 ,$69.71 ,$160.63 ,$119.67 ,$105.21 , N/A ,$84.65 , N/A ,$101.36 ,$101.36 ,$101.36 ,$101.36 ,$144.57 ,$120.47 , N/A ,$141.35 , N/A ,$120.47 ,$120.47 ,$136.54 ,$136.54 , N/A ,$136.54 , N/A ,$126.90 ,$126.90 ,$126.90 ,$144.57 , N/A ,$144.57 , N/A ,$160.63 ,$105.21 , N/A ,$69.71 , N/A , N/A ,$144.57 , N/A ,$101.36 ,$96.38 ,$144.57 , N/A ,$144.57 ,$144.57 , N/A ,$104.41 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203544,N/A,HC CATHETER FEMORAL ARTERY,272,1 ,$119.13 ,$77.43 ,$51.70 ,$119.13 ,$88.75 ,$78.03 , N/A ,$62.78 , N/A ,$75.17 ,$75.17 ,$75.17 ,$75.17 ,$107.22 ,$89.35 , N/A ,$104.83 , N/A ,$89.35 ,$89.35 ,$101.26 ,$101.26 , N/A ,$101.26 , N/A ,$94.11 ,$94.11 ,$94.11 ,$107.22 , N/A ,$107.22 , N/A ,$119.13 ,$78.03 , N/A ,$51.70 , N/A , N/A ,$107.22 , N/A ,$75.17 ,$71.48 ,$107.22 , N/A ,$107.22 ,$107.22 , N/A ,$77.43 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203554,N/A,HC KIT ICP PRESSURE MONITOR,272,1 ,$68.76 ,$44.69 ,$29.84 ,$68.76 ,$51.23 ,$45.04 , N/A ,$36.24 , N/A ,$43.39 ,$43.39 ,$43.39 ,$43.39 ,$61.88 ,$51.57 , N/A ,$60.51 , N/A ,$51.57 ,$51.57 ,$58.45 ,$58.45 , N/A ,$58.45 , N/A ,$54.32 ,$54.32 ,$54.32 ,$61.88 , N/A ,$61.88 , N/A ,$68.76 ,$45.04 , N/A ,$29.84 , N/A , N/A ,$61.88 , N/A ,$43.39 ,$41.26 ,$61.88 , N/A ,$61.88 ,$61.88 , N/A ,$44.69 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203557,N/A,HC CATHETER INTRAUTERINE,272,1 ,$158.69 ,$103.15 ,$68.87 ,$158.69 ,$118.22 ,$103.94 , N/A ,$83.63 , N/A ,$100.13 ,$100.13 ,$100.13 ,$100.13 ,$142.82 ,$119.02 , N/A ,$139.65 , N/A ,$119.02 ,$119.02 ,$134.89 ,$134.89 , N/A ,$134.89 , N/A ,$125.37 ,$125.37 ,$125.37 ,$142.82 , N/A ,$142.82 , N/A ,$158.69 ,$103.94 , N/A ,$68.87 , N/A , N/A ,$142.82 , N/A ,$100.13 ,$95.21 ,$142.82 , N/A ,$142.82 ,$142.82 , N/A ,$103.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203562,N/A,HC CATHETER SUCTION,272,1 ,$6.23 ,$4.05 ,$2.70 ,$6.23 ,$4.64 ,$4.08 , N/A ,$3.28 , N/A ,$3.93 ,$3.93 ,$3.93 ,$3.93 ,$5.61 ,$4.67 , N/A ,$5.48 , N/A ,$4.67 ,$4.67 ,$5.30 ,$5.30 , N/A ,$5.30 , N/A ,$4.92 ,$4.92 ,$4.92 ,$5.61 , N/A ,$5.61 , N/A ,$6.23 ,$4.08 , N/A ,$2.70 , N/A , N/A ,$5.61 , N/A ,$3.93 ,$3.74 ,$5.61 , N/A ,$5.61 ,$5.61 , N/A ,$4.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203563,N/A,HC CATHETER TROCAR,272,1 ,$143.61 ,$93.35 ,$62.33 ,$143.61 ,$106.99 ,$94.06 , N/A ,$75.68 , N/A ,$90.62 ,$90.62 ,$90.62 ,$90.62 ,$129.25 ,$107.71 , N/A ,$126.38 , N/A ,$107.71 ,$107.71 ,$122.07 ,$122.07 , N/A ,$122.07 , N/A ,$113.45 ,$113.45 ,$113.45 ,$129.25 , N/A ,$129.25 , N/A ,$143.61 ,$94.06 , N/A ,$62.33 , N/A , N/A ,$129.25 , N/A ,$90.62 ,$86.17 ,$129.25 , N/A ,$129.25 ,$129.25 , N/A ,$93.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203564,N/A,HC CATHETER UMBILICAL ARTERY,272,1 ,$88.21 ,$57.34 ,$38.28 ,$88.21 ,$65.72 ,$57.78 , N/A ,$46.49 , N/A ,$55.66 ,$55.66 ,$55.66 ,$55.66 ,$79.39 ,$66.16 , N/A ,$77.62 , N/A ,$66.16 ,$66.16 ,$74.98 ,$74.98 , N/A ,$74.98 , N/A ,$69.69 ,$69.69 ,$69.69 ,$79.39 , N/A ,$79.39 , N/A ,$88.21 ,$57.78 , N/A ,$38.28 , N/A , N/A ,$79.39 , N/A ,$55.66 ,$52.93 ,$79.39 , N/A ,$79.39 ,$79.39 , N/A ,$57.34 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203573,A6237,HC DRESSING COMBIDERM <16 SQ CM,623,1 ,$94.75 ,$61.59 ,$41.12 ,$94.75 ,$70.59 ,$62.06 , N/A ,$49.93 , N/A ,$59.79 ,$59.79 ,$59.79 ,$59.79 ,$85.28 ,$71.06 , N/A ,$83.38 , N/A ,$71.06 ,$71.06 ,$80.54 ,$80.54 , N/A ,$80.54 , N/A ,$74.85 ,$74.85 ,$74.85 ,$85.28 , N/A ,$85.28 , N/A ,$94.75 ,$62.06 , N/A ,$41.12 , N/A , N/A ,$85.28 , N/A ,$59.79 ,$56.85 ,$85.28 , N/A ,$85.28 ,$85.28 , N/A ,$61.59 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203576,N/A,HC DRESSING V.A.C.,272,1 ,$477.13 ,$310.13 ,$207.07 ,$477.13 ,$355.46 ,$312.52 , N/A ,$251.45 , N/A ,$301.07 ,$301.07 ,$301.07 ,$301.07 ,$429.42 ,$357.85 , N/A ,$419.87 , N/A ,$357.85 ,$357.85 ,$405.56 ,$405.56 , N/A ,$405.56 , N/A ,$376.93 ,$376.93 ,$376.93 ,$429.42 , N/A ,$429.42 , N/A ,$477.13 ,$312.52 , N/A ,$207.07 , N/A , N/A ,$429.42 , N/A ,$301.07 ,$286.28 ,$429.42 , N/A ,$429.42 ,$429.42 , N/A ,$310.13 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203597,N/A,HC TUBING ANY,272,1 ,$179.50 ,$116.68 ,$77.90 ,$179.50 ,$133.73 ,$117.57 , N/A ,$94.60 , N/A ,$113.26 ,$113.26 ,$113.26 ,$113.26 ,$161.55 ,$134.63 , N/A ,$157.96 , N/A ,$134.63 ,$134.63 ,$152.58 ,$152.58 , N/A ,$152.58 , N/A ,$141.81 ,$141.81 ,$141.81 ,$161.55 , N/A ,$161.55 , N/A ,$179.50 ,$117.57 , N/A ,$77.90 , N/A , N/A ,$161.55 , N/A ,$113.26 ,$107.70 ,$161.55 , N/A ,$161.55 ,$161.55 , N/A ,$116.68 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203636,N/A,HC TRAY MYELOGRAM,272,1 ,$96.85 ,$62.95 ,$42.03 ,$96.85 ,$72.15 ,$63.44 , N/A ,$51.04 , N/A ,$61.11 ,$61.11 ,$61.11 ,$61.11 ,$87.17 ,$72.64 , N/A ,$85.23 , N/A ,$72.64 ,$72.64 ,$82.32 ,$82.32 , N/A ,$82.32 , N/A ,$76.51 ,$76.51 ,$76.51 ,$87.17 , N/A ,$87.17 , N/A ,$96.85 ,$63.44 , N/A ,$42.03 , N/A , N/A ,$87.17 , N/A ,$61.11 ,$58.11 ,$87.17 , N/A ,$87.17 ,$87.17 , N/A ,$62.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203641,N/A,HC NEEDLE BIOPSY,272,1 ,$162.42 ,$105.57 ,$70.49 ,$162.42 ,$121.00 ,$106.39 , N/A ,$85.60 , N/A ,$102.49 ,$102.49 ,$102.49 ,$102.49 ,$146.18 ,$121.82 , N/A ,$142.93 , N/A ,$121.82 ,$121.82 ,$138.06 ,$138.06 , N/A ,$138.06 , N/A ,$128.31 ,$128.31 ,$128.31 ,$146.18 , N/A ,$146.18 , N/A ,$162.42 ,$106.39 , N/A ,$70.49 , N/A , N/A ,$146.18 , N/A ,$102.49 ,$97.45 ,$146.18 , N/A ,$146.18 ,$146.18 , N/A ,$105.57 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203654,N/A,HC CATHETER SWAN GANZ,272,1 ,$309.06 ,$200.89 ,$134.13 ,$309.06 ,$230.25 ,$202.43 , N/A ,$162.87 , N/A ,$195.02 ,$195.02 ,$195.02 ,$195.02 ,$278.15 ,$231.80 , N/A ,$271.97 , N/A ,$231.80 ,$231.80 ,$262.70 ,$262.70 , N/A ,$262.70 , N/A ,$244.16 ,$244.16 ,$244.16 ,$278.15 , N/A ,$278.15 , N/A ,$309.06 ,$202.43 , N/A ,$134.13 , N/A , N/A ,$278.15 , N/A ,$195.02 ,$185.44 ,$278.15 , N/A ,$278.15 ,$278.15 , N/A ,$200.89 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203657,C1769,HC GUIDEWIRE,272,1 ,$243.29 ,$158.14 ,$105.59 ,$243.29 ,$181.25 ,$159.36 , N/A ,$128.21 , N/A ,$153.52 ,$153.52 ,$153.52 ,$153.52 ,$218.96 ,$182.47 , N/A ,$214.10 , N/A ,$182.47 ,$182.47 ,$206.80 ,$206.80 , N/A ,$206.80 , N/A ,$192.20 ,$192.20 ,$192.20 ,$218.96 , N/A ,$218.96 , N/A ,$243.29 ,$159.36 , N/A ,$105.59 , N/A , N/A ,$218.96 , N/A ,$153.52 ,$145.97 ,$218.96 , N/A ,$218.96 ,$218.96 , N/A ,$158.14 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203658,C1769,HC GUIDEWIRE GLIDEWIRE,272,1 ,$672.14 ,$436.89 ,$291.71 ,$672.14 ,$500.74 ,$440.25 , N/A ,$354.22 , N/A ,$424.12 ,$424.12 ,$424.12 ,$424.12 ,$604.93 ,$504.11 , N/A ,$591.48 , N/A ,$504.11 ,$504.11 ,$571.32 ,$571.32 , N/A ,$571.32 , N/A ,$530.99 ,$530.99 ,$530.99 ,$604.93 , N/A ,$604.93 , N/A ,$672.14 ,$440.25 , N/A ,$291.71 , N/A , N/A ,$604.93 , N/A ,$424.12 ,$403.28 ,$604.93 , N/A ,$604.93 ,$604.93 , N/A ,$436.89 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203689,N/A,HC COVER PROBE,272,1 ,$22.04 ,$14.33 ,$9.57 ,$22.04 ,$16.42 ,$14.44 , N/A ,$11.62 , N/A ,$13.91 ,$13.91 ,$13.91 ,$13.91 ,$19.84 ,$16.53 , N/A ,$19.40 , N/A ,$16.53 ,$16.53 ,$18.73 ,$18.73 , N/A ,$18.73 , N/A ,$17.41 ,$17.41 ,$17.41 ,$19.84 , N/A ,$19.84 , N/A ,$22.04 ,$14.44 , N/A ,$9.57 , N/A , N/A ,$19.84 , N/A ,$13.91 ,$13.22 ,$19.84 , N/A ,$19.84 ,$19.84 , N/A ,$14.33 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203691,N/A,HC TUBE GASTROSTOMY,272,1 ,$33.08 ,$21.50 ,$14.36 ,$33.08 ,$24.64 ,$21.67 , N/A ,$17.43 , N/A ,$20.87 ,$20.87 ,$20.87 ,$20.87 ,$29.77 ,$24.81 , N/A ,$29.11 , N/A ,$24.81 ,$24.81 ,$28.12 ,$28.12 , N/A ,$28.12 , N/A ,$26.13 ,$26.13 ,$26.13 ,$29.77 , N/A ,$29.77 , N/A ,$33.08 ,$21.67 , N/A ,$14.36 , N/A , N/A ,$29.77 , N/A ,$20.87 ,$19.85 ,$29.77 , N/A ,$29.77 ,$29.77 , N/A ,$21.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203703,C1751,HC CATHETER PICC,272,1 ,$556.00 ,$361.40 ,$241.30 ,$556.00 ,$414.22 ,$364.18 , N/A ,$293.01 , N/A ,$350.84 ,$350.84 ,$350.84 ,$350.84 ,$500.40 ,$417.00 , N/A ,$489.28 , N/A ,$417.00 ,$417.00 ,$472.60 ,$472.60 , N/A ,$472.60 , N/A ,$439.24 ,$439.24 ,$439.24 ,$500.40 , N/A ,$500.40 , N/A ,$556.00 ,$364.18 , N/A ,$241.30 , N/A , N/A ,$500.40 , N/A ,$350.84 ,$333.60 ,$500.40 , N/A ,$500.40 ,$500.40 , N/A ,$361.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203719,C1729,HC CATHETER CENTESIS ONE STEP,272,1 ,$51.71 ,$33.61 ,$22.44 ,$51.71 ,$38.52 ,$33.87 , N/A ,$27.25 , N/A ,$32.63 ,$32.63 ,$32.63 ,$32.63 ,$46.54 ,$38.78 , N/A ,$45.50 , N/A ,$38.78 ,$38.78 ,$43.95 ,$43.95 , N/A ,$43.95 , N/A ,$40.85 ,$40.85 ,$40.85 ,$46.54 , N/A ,$46.54 , N/A ,$51.71 ,$33.87 , N/A ,$22.44 , N/A , N/A ,$46.54 , N/A ,$32.63 ,$31.03 ,$46.54 , N/A ,$46.54 ,$46.54 , N/A ,$33.61 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203720,N/A,HC MARKER BREAST CORE MARK,272,1 ,$167.28 ,$108.73 ,$72.60 ,$167.28 ,$124.62 ,$109.57 , N/A ,$88.16 , N/A ,$105.55 ,$105.55 ,$105.55 ,$105.55 ,$150.55 ,$125.46 , N/A ,$147.21 , N/A ,$125.46 ,$125.46 ,$142.19 ,$142.19 , N/A ,$142.19 , N/A ,$132.15 ,$132.15 ,$132.15 ,$150.55 , N/A ,$150.55 , N/A ,$167.28 ,$109.57 , N/A ,$72.60 , N/A , N/A ,$150.55 , N/A ,$105.55 ,$100.37 ,$150.55 , N/A ,$150.55 ,$150.55 , N/A ,$108.73 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203766,N/A,HC CATHETER SELECT,272,1 ,$267.79 ,$174.06 ,$116.22 ,$267.79 ,$199.50 ,$175.40 , N/A ,$141.13 , N/A ,$168.98 ,$168.98 ,$168.98 ,$168.98 ,$241.01 ,$200.84 , N/A ,$235.66 , N/A ,$200.84 ,$200.84 ,$227.62 ,$227.62 , N/A ,$227.62 , N/A ,$211.55 ,$211.55 ,$211.55 ,$241.01 , N/A ,$241.01 , N/A ,$267.79 ,$175.40 , N/A ,$116.22 , N/A , N/A ,$241.01 , N/A ,$168.98 ,$160.67 ,$241.01 , N/A ,$241.01 ,$241.01 , N/A ,$174.06 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203846,N/A,HC SYSTEM VACUUM ASSIST MUSHROOM CAP,272,1 ,$90.93 ,$59.10 ,$39.46 ,$90.93 ,$67.74 ,$59.56 , N/A ,$47.92 , N/A ,$57.38 ,$57.38 ,$57.38 ,$57.38 ,$81.84 ,$68.20 , N/A ,$80.02 , N/A ,$68.20 ,$68.20 ,$77.29 ,$77.29 , N/A ,$77.29 , N/A ,$71.83 ,$71.83 ,$71.83 ,$81.84 , N/A ,$81.84 , N/A ,$90.93 ,$59.56 , N/A ,$39.46 , N/A , N/A ,$81.84 , N/A ,$57.38 ,$54.56 ,$81.84 , N/A ,$81.84 ,$81.84 , N/A ,$59.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203847,N/A,HC NEEDLE INTRAOSSEOUS,272,1 ,$369.08 ,$239.90 ,$160.18 ,$369.08 ,$274.96 ,$241.75 , N/A ,$194.51 , N/A ,$232.89 ,$232.89 ,$232.89 ,$232.89 ,$332.17 ,$276.81 , N/A ,$324.79 , N/A ,$276.81 ,$276.81 ,$313.72 ,$313.72 , N/A ,$313.72 , N/A ,$291.57 ,$291.57 ,$291.57 ,$332.17 , N/A ,$332.17 , N/A ,$369.08 ,$241.75 , N/A ,$160.18 , N/A , N/A ,$332.17 , N/A ,$232.89 ,$221.45 ,$332.17 , N/A ,$332.17 ,$332.17 , N/A ,$239.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203848,N/A,HC PACK GYNE,272,1 ,$117.34 ,$76.27 ,$50.93 ,$117.34 ,$87.42 ,$76.86 , N/A ,$61.84 , N/A ,$74.04 ,$74.04 ,$74.04 ,$74.04 ,$105.61 ,$88.01 , N/A ,$103.26 , N/A ,$88.01 ,$88.01 ,$99.74 ,$99.74 , N/A ,$99.74 , N/A ,$92.70 ,$92.70 ,$92.70 ,$105.61 , N/A ,$105.61 , N/A ,$117.34 ,$76.86 , N/A ,$50.93 , N/A , N/A ,$105.61 , N/A ,$74.04 ,$70.40 ,$105.61 , N/A ,$105.61 ,$105.61 , N/A ,$76.27 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203860,N/A,HC KIT DRESSING WOUND VAC GRANUFOAM SILVER,272,1 ,$293.25 ,$190.61 ,$127.27 ,$293.25 ,$218.47 ,$192.08 , N/A ,$154.54 , N/A ,$185.04 ,$185.04 ,$185.04 ,$185.04 ,$263.93 ,$219.94 , N/A ,$258.06 , N/A ,$219.94 ,$219.94 ,$249.26 ,$249.26 , N/A ,$249.26 , N/A ,$231.67 ,$231.67 ,$231.67 ,$263.93 , N/A ,$263.93 , N/A ,$293.25 ,$192.08 , N/A ,$127.27 , N/A , N/A ,$263.93 , N/A ,$185.04 ,$175.95 ,$263.93 , N/A ,$263.93 ,$263.93 , N/A ,$190.61 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203871,N/A,HC NASAL RHINO ROCKET,272,1 ,$53.32 ,$34.66 ,$23.14 ,$53.32 ,$39.72 ,$34.92 , N/A ,$28.10 , N/A ,$33.64 ,$33.64 ,$33.64 ,$33.64 ,$47.99 ,$39.99 , N/A ,$46.92 , N/A ,$39.99 ,$39.99 ,$45.32 ,$45.32 , N/A ,$45.32 , N/A ,$42.12 ,$42.12 ,$42.12 ,$47.99 , N/A ,$47.99 , N/A ,$53.32 ,$34.92 , N/A ,$23.14 , N/A , N/A ,$47.99 , N/A ,$33.64 ,$31.99 ,$47.99 , N/A ,$47.99 ,$47.99 , N/A ,$34.66 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203873,N/A,HC BAG RESUSCITATION PEDI,272,1 ,$119.19 ,$77.47 ,$51.73 ,$119.19 ,$88.80 ,$78.07 , N/A ,$62.81 , N/A ,$75.21 ,$75.21 ,$75.21 ,$75.21 ,$107.27 ,$89.39 , N/A ,$104.89 , N/A ,$89.39 ,$89.39 ,$101.31 ,$101.31 , N/A ,$101.31 , N/A ,$94.16 ,$94.16 ,$94.16 ,$107.27 , N/A ,$107.27 , N/A ,$119.19 ,$78.07 , N/A ,$51.73 , N/A , N/A ,$107.27 , N/A ,$75.21 ,$71.51 ,$107.27 , N/A ,$107.27 ,$107.27 , N/A ,$77.47 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203874,N/A,HC KIT DRESSING WOUND VAC GRANUFOAM LARGE,272,1 ,$660.00 ,$429.00 ,$286.44 ,$660.00 ,$491.70 ,$432.30 , N/A ,$347.82 , N/A ,$416.46 ,$416.46 ,$416.46 ,$416.46 ,$594.00 ,$495.00 , N/A ,$580.80 , N/A ,$495.00 ,$495.00 ,$561.00 ,$561.00 , N/A ,$561.00 , N/A ,$521.40 ,$521.40 ,$521.40 ,$594.00 , N/A ,$594.00 , N/A ,$660.00 ,$432.30 , N/A ,$286.44 , N/A , N/A ,$594.00 , N/A ,$416.46 ,$396.00 ,$594.00 , N/A ,$594.00 ,$594.00 , N/A ,$429.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203875,N/A,HC SYSTEM DRESSING WOUND VAC THERAPY,272,1 ,"$1,521.00 ",$988.65 ,$660.11 ,"$1,521.00 ","$1,133.15 ",$996.26 , N/A ,$801.57 , N/A ,$959.75 ,$959.75 ,$959.75 ,$959.75 ,"$1,368.90 ","$1,140.75 ", N/A ,"$1,338.48 ", N/A ,"$1,140.75 ","$1,140.75 ","$1,292.85 ","$1,292.85 ", N/A ,"$1,292.85 ", N/A ,"$1,201.59 ","$1,201.59 ","$1,201.59 ","$1,368.90 ", N/A ,"$1,368.90 ", N/A ,"$1,521.00 ",$996.26 , N/A ,$660.11 , N/A , N/A ,"$1,368.90 ", N/A ,$959.75 ,$912.60 ,"$1,368.90 ", N/A ,"$1,368.90 ","$1,368.90 ", N/A ,$988.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203885,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T10,272,1 ,$525.00 ,$341.25 ,$227.85 ,$525.00 ,$391.13 ,$343.88 , N/A ,$276.68 , N/A ,$331.28 ,$331.28 ,$331.28 ,$331.28 ,$472.50 ,$393.75 , N/A ,$462.00 , N/A ,$393.75 ,$393.75 ,$446.25 ,$446.25 , N/A ,$446.25 , N/A ,$414.75 ,$414.75 ,$414.75 ,$472.50 , N/A ,$472.50 , N/A ,$525.00 ,$343.88 , N/A ,$227.85 , N/A , N/A ,$472.50 , N/A ,$331.28 ,$315.00 ,$472.50 , N/A ,$472.50 ,$472.50 , N/A ,$341.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203886,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T11,272,1 ,$600.00 ,$390.00 ,$260.40 ,$600.00 ,$447.00 ,$393.00 , N/A ,$316.20 , N/A ,$378.60 ,$378.60 ,$378.60 ,$378.60 ,$540.00 ,$450.00 , N/A ,$528.00 , N/A ,$450.00 ,$450.00 ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$474.00 ,$474.00 ,$474.00 ,$540.00 , N/A ,$540.00 , N/A ,$600.00 ,$393.00 , N/A ,$260.40 , N/A , N/A ,$540.00 , N/A ,$378.60 ,$360.00 ,$540.00 , N/A ,$540.00 ,$540.00 , N/A ,$390.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203887,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T12,272,1 ,$750.00 ,$487.50 ,$325.50 ,$750.00 ,$558.75 ,$491.25 , N/A ,$395.25 , N/A ,$473.25 ,$473.25 ,$473.25 ,$473.25 ,$675.00 ,$562.50 , N/A ,$660.00 , N/A ,$562.50 ,$562.50 ,$637.50 ,$637.50 , N/A ,$637.50 , N/A ,$592.50 ,$592.50 ,$592.50 ,$675.00 , N/A ,$675.00 , N/A ,$750.00 ,$491.25 , N/A ,$325.50 , N/A , N/A ,$675.00 , N/A ,$473.25 ,$450.00 ,$675.00 , N/A ,$675.00 ,$675.00 , N/A ,$487.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203888,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T13,272,1 ,$900.00 ,$585.00 ,$390.60 ,$900.00 ,$670.50 ,$589.50 , N/A ,$474.30 , N/A ,$567.90 ,$567.90 ,$567.90 ,$567.90 ,$810.00 ,$675.00 , N/A ,$792.00 , N/A ,$675.00 ,$675.00 ,$765.00 ,$765.00 , N/A ,$765.00 , N/A ,$711.00 ,$711.00 ,$711.00 ,$810.00 , N/A ,$810.00 , N/A ,$900.00 ,$589.50 , N/A ,$390.60 , N/A , N/A ,$810.00 , N/A ,$567.90 ,$540.00 ,$810.00 , N/A ,$810.00 ,$810.00 , N/A ,$585.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203889,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T14,272,1 ,"$1,050.00 ",$682.50 ,$455.70 ,"$1,050.00 ",$782.25 ,$687.75 , N/A ,$553.35 , N/A ,$662.55 ,$662.55 ,$662.55 ,$662.55 ,$945.00 ,$787.50 , N/A ,$924.00 , N/A ,$787.50 ,$787.50 ,$892.50 ,$892.50 , N/A ,$892.50 , N/A ,$829.50 ,$829.50 ,$829.50 ,$945.00 , N/A ,$945.00 , N/A ,"$1,050.00 ",$687.75 , N/A ,$455.70 , N/A , N/A ,$945.00 , N/A ,$662.55 ,$630.00 ,$945.00 , N/A ,$945.00 ,$945.00 , N/A ,$682.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203890,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T15,272,1 ,"$1,200.00 ",$780.00 ,$520.80 ,"$1,200.00 ",$894.00 ,$786.00 , N/A ,$632.40 , N/A ,$757.20 ,$757.20 ,$757.20 ,$757.20 ,"$1,080.00 ",$900.00 , N/A ,"$1,056.00 ", N/A ,$900.00 ,$900.00 ,"$1,020.00 ","$1,020.00 ", N/A ,"$1,020.00 ", N/A ,$948.00 ,$948.00 ,$948.00 ,"$1,080.00 ", N/A ,"$1,080.00 ", N/A ,"$1,200.00 ",$786.00 , N/A ,$520.80 , N/A , N/A ,"$1,080.00 ", N/A ,$757.20 ,$720.00 ,"$1,080.00 ", N/A ,"$1,080.00 ","$1,080.00 ", N/A ,$780.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203891,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T16,272,1 ,"$1,350.00 ",$877.50 ,$585.90 ,"$1,350.00 ","$1,005.75 ",$884.25 , N/A ,$711.45 , N/A ,$851.85 ,$851.85 ,$851.85 ,$851.85 ,"$1,215.00 ","$1,012.50 ", N/A ,"$1,188.00 ", N/A ,"$1,012.50 ","$1,012.50 ","$1,147.50 ","$1,147.50 ", N/A ,"$1,147.50 ", N/A ,"$1,066.50 ","$1,066.50 ","$1,066.50 ","$1,215.00 ", N/A ,"$1,215.00 ", N/A ,"$1,350.00 ",$884.25 , N/A ,$585.90 , N/A , N/A ,"$1,215.00 ", N/A ,$851.85 ,$810.00 ,"$1,215.00 ", N/A ,"$1,215.00 ","$1,215.00 ", N/A ,$877.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203892,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T17,272,1 ,"$1,500.00 ",$975.00 ,$651.00 ,"$1,500.00 ","$1,117.50 ",$982.50 , N/A ,$790.50 , N/A ,$946.50 ,$946.50 ,$946.50 ,$946.50 ,"$1,350.00 ","$1,125.00 ", N/A ,"$1,320.00 ", N/A ,"$1,125.00 ","$1,125.00 ","$1,275.00 ","$1,275.00 ", N/A ,"$1,275.00 ", N/A ,"$1,185.00 ","$1,185.00 ","$1,185.00 ","$1,350.00 ", N/A ,"$1,350.00 ", N/A ,"$1,500.00 ",$982.50 , N/A ,$651.00 , N/A , N/A ,"$1,350.00 ", N/A ,$946.50 ,$900.00 ,"$1,350.00 ", N/A ,"$1,350.00 ","$1,350.00 ", N/A ,$975.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203893,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T18,272,1 ,"$2,100.00 ","$1,365.00 ",$911.40 ,"$2,100.00 ","$1,564.50 ","$1,375.50 ", N/A ,"$1,106.70 ", N/A ,"$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,890.00 ","$1,575.00 ", N/A ,"$1,848.00 ", N/A ,"$1,575.00 ","$1,575.00 ","$1,785.00 ","$1,785.00 ", N/A ,"$1,785.00 ", N/A ,"$1,659.00 ","$1,659.00 ","$1,659.00 ","$1,890.00 ", N/A ,"$1,890.00 ", N/A ,"$2,100.00 ","$1,375.50 ", N/A ,$911.40 , N/A , N/A ,"$1,890.00 ", N/A ,"$1,325.10 ","$1,260.00 ","$1,890.00 ", N/A ,"$1,890.00 ","$1,890.00 ", N/A ,"$1,365.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203894,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T19,272,1 ,"$2,700.00 ","$1,755.00 ","$1,171.80 ","$2,700.00 ","$2,011.50 ","$1,768.50 ", N/A ,"$1,422.90 ", N/A ,"$1,703.70 ","$1,703.70 ","$1,703.70 ","$1,703.70 ","$2,430.00 ","$2,025.00 ", N/A ,"$2,376.00 ", N/A ,"$2,025.00 ","$2,025.00 ","$2,295.00 ","$2,295.00 ", N/A ,"$2,295.00 ", N/A ,"$2,133.00 ","$2,133.00 ","$2,133.00 ","$2,430.00 ", N/A ,"$2,430.00 ", N/A ,"$2,700.00 ","$1,768.50 ", N/A ,"$1,171.80 ", N/A , N/A ,"$2,430.00 ", N/A ,"$1,703.70 ","$1,620.00 ","$2,430.00 ", N/A ,"$2,430.00 ","$2,430.00 ", N/A ,"$1,755.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203895,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T20,272,1 ,"$3,300.00 ","$2,145.00 ","$1,432.20 ","$3,300.00 ","$2,458.50 ","$2,161.50 ", N/A ,"$1,739.10 ", N/A ,"$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,970.00 ","$2,475.00 ", N/A ,"$2,904.00 ", N/A ,"$2,475.00 ","$2,475.00 ","$2,805.00 ","$2,805.00 ", N/A ,"$2,805.00 ", N/A ,"$2,607.00 ","$2,607.00 ","$2,607.00 ","$2,970.00 ", N/A ,"$2,970.00 ", N/A ,"$3,300.00 ","$2,161.50 ", N/A ,"$1,432.20 ", N/A , N/A ,"$2,970.00 ", N/A ,"$2,082.30 ","$1,980.00 ","$2,970.00 ", N/A ,"$2,970.00 ","$2,970.00 ", N/A ,"$2,145.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203896,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T21,272,1 ,"$3,900.00 ","$2,535.00 ","$1,692.60 ","$3,900.00 ","$2,905.50 ","$2,554.50 ", N/A ,"$2,055.30 ", N/A ,"$2,460.90 ","$2,460.90 ","$2,460.90 ","$2,460.90 ","$3,510.00 ","$2,925.00 ", N/A ,"$3,432.00 ", N/A ,"$2,925.00 ","$2,925.00 ","$3,315.00 ","$3,315.00 ", N/A ,"$3,315.00 ", N/A ,"$3,081.00 ","$3,081.00 ","$3,081.00 ","$3,510.00 ", N/A ,"$3,510.00 ", N/A ,"$3,900.00 ","$2,554.50 ", N/A ,"$1,692.60 ", N/A , N/A ,"$3,510.00 ", N/A ,"$2,460.90 ","$2,340.00 ","$3,510.00 ", N/A ,"$3,510.00 ","$3,510.00 ", N/A ,"$2,535.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203897,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T22,272,1 ,"$4,500.00 ","$2,925.00 ","$1,953.00 ","$4,500.00 ","$3,352.50 ","$2,947.50 ", N/A ,"$2,371.50 ", N/A ,"$2,839.50 ","$2,839.50 ","$2,839.50 ","$2,839.50 ","$4,050.00 ","$3,375.00 ", N/A ,"$3,960.00 ", N/A ,"$3,375.00 ","$3,375.00 ","$3,825.00 ","$3,825.00 ", N/A ,"$3,825.00 ", N/A ,"$3,555.00 ","$3,555.00 ","$3,555.00 ","$4,050.00 ", N/A ,"$4,050.00 ", N/A ,"$4,500.00 ","$2,947.50 ", N/A ,"$1,953.00 ", N/A , N/A ,"$4,050.00 ", N/A ,"$2,839.50 ","$2,700.00 ","$4,050.00 ", N/A ,"$4,050.00 ","$4,050.00 ", N/A ,"$2,925.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203898,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T23,272,1 ,"$5,100.00 ","$3,315.00 ","$2,213.40 ","$5,100.00 ","$3,799.50 ","$3,340.50 ", N/A ,"$2,687.70 ", N/A ,"$3,218.10 ","$3,218.10 ","$3,218.10 ","$3,218.10 ","$4,590.00 ","$3,825.00 ", N/A ,"$4,488.00 ", N/A ,"$3,825.00 ","$3,825.00 ","$4,335.00 ","$4,335.00 ", N/A ,"$4,335.00 ", N/A ,"$4,029.00 ","$4,029.00 ","$4,029.00 ","$4,590.00 ", N/A ,"$4,590.00 ", N/A ,"$5,100.00 ","$3,340.50 ", N/A ,"$2,213.40 ", N/A , N/A ,"$4,590.00 ", N/A ,"$3,218.10 ","$3,060.00 ","$4,590.00 ", N/A ,"$4,590.00 ","$4,590.00 ", N/A ,"$3,315.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203899,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T24,272,1 ,"$5,700.00 ","$3,705.00 ","$2,473.80 ","$5,700.00 ","$4,246.50 ","$3,733.50 ", N/A ,"$3,003.90 ", N/A ,"$3,596.70 ","$3,596.70 ","$3,596.70 ","$3,596.70 ","$5,130.00 ","$4,275.00 ", N/A ,"$5,016.00 ", N/A ,"$4,275.00 ","$4,275.00 ","$4,845.00 ","$4,845.00 ", N/A ,"$4,845.00 ", N/A ,"$4,503.00 ","$4,503.00 ","$4,503.00 ","$5,130.00 ", N/A ,"$5,130.00 ", N/A ,"$5,700.00 ","$3,733.50 ", N/A ,"$2,473.80 ", N/A , N/A ,"$5,130.00 ", N/A ,"$3,596.70 ","$3,420.00 ","$5,130.00 ", N/A ,"$5,130.00 ","$5,130.00 ", N/A ,"$3,705.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203900,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T25,272,1 ,"$6,300.00 ","$4,095.00 ","$2,734.20 ","$6,300.00 ","$4,693.50 ","$4,126.50 ", N/A ,"$3,320.10 ", N/A ,"$3,975.30 ","$3,975.30 ","$3,975.30 ","$3,975.30 ","$5,670.00 ","$4,725.00 ", N/A ,"$5,544.00 ", N/A ,"$4,725.00 ","$4,725.00 ","$5,355.00 ","$5,355.00 ", N/A ,"$5,355.00 ", N/A ,"$4,977.00 ","$4,977.00 ","$4,977.00 ","$5,670.00 ", N/A ,"$5,670.00 ", N/A ,"$6,300.00 ","$4,126.50 ", N/A ,"$2,734.20 ", N/A , N/A ,"$5,670.00 ", N/A ,"$3,975.30 ","$3,780.00 ","$5,670.00 ", N/A ,"$5,670.00 ","$5,670.00 ", N/A ,"$4,095.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203901,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T26,272,1 ,"$6,900.00 ","$4,485.00 ","$2,994.60 ","$6,900.00 ","$5,140.50 ","$4,519.50 ", N/A ,"$3,636.30 ", N/A ,"$4,353.90 ","$4,353.90 ","$4,353.90 ","$4,353.90 ","$6,210.00 ","$5,175.00 ", N/A ,"$6,072.00 ", N/A ,"$5,175.00 ","$5,175.00 ","$5,865.00 ","$5,865.00 ", N/A ,"$5,865.00 ", N/A ,"$5,451.00 ","$5,451.00 ","$5,451.00 ","$6,210.00 ", N/A ,"$6,210.00 ", N/A ,"$6,900.00 ","$4,519.50 ", N/A ,"$2,994.60 ", N/A , N/A ,"$6,210.00 ", N/A ,"$4,353.90 ","$4,140.00 ","$6,210.00 ", N/A ,"$6,210.00 ","$6,210.00 ", N/A ,"$4,485.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203902,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T27,272,1 ,"$7,500.00 ","$4,875.00 ","$3,255.00 ","$7,500.00 ","$5,587.50 ","$4,912.50 ", N/A ,"$3,952.50 ", N/A ,"$4,732.50 ","$4,732.50 ","$4,732.50 ","$4,732.50 ","$6,750.00 ","$5,625.00 ", N/A ,"$6,600.00 ", N/A ,"$5,625.00 ","$5,625.00 ","$6,375.00 ","$6,375.00 ", N/A ,"$6,375.00 ", N/A ,"$5,925.00 ","$5,925.00 ","$5,925.00 ","$6,750.00 ", N/A ,"$6,750.00 ", N/A ,"$7,500.00 ","$4,912.50 ", N/A ,"$3,255.00 ", N/A , N/A ,"$6,750.00 ", N/A ,"$4,732.50 ","$4,500.00 ","$6,750.00 ", N/A ,"$6,750.00 ","$6,750.00 ", N/A ,"$4,875.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203903,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T28,272,1 ,"$8,100.00 ","$5,265.00 ","$3,515.40 ","$8,100.00 ","$6,034.50 ","$5,305.50 ", N/A ,"$4,268.70 ", N/A ,"$5,111.10 ","$5,111.10 ","$5,111.10 ","$5,111.10 ","$7,290.00 ","$6,075.00 ", N/A ,"$7,128.00 ", N/A ,"$6,075.00 ","$6,075.00 ","$6,885.00 ","$6,885.00 ", N/A ,"$6,885.00 ", N/A ,"$6,399.00 ","$6,399.00 ","$6,399.00 ","$7,290.00 ", N/A ,"$7,290.00 ", N/A ,"$8,100.00 ","$5,305.50 ", N/A ,"$3,515.40 ", N/A , N/A ,"$7,290.00 ", N/A ,"$5,111.10 ","$4,860.00 ","$7,290.00 ", N/A ,"$7,290.00 ","$7,290.00 ", N/A ,"$5,265.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203904,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T29,272,1 ,"$8,700.00 ","$5,655.00 ","$3,775.80 ","$8,700.00 ","$6,481.50 ","$5,698.50 ", N/A ,"$4,584.90 ", N/A ,"$5,489.70 ","$5,489.70 ","$5,489.70 ","$5,489.70 ","$7,830.00 ","$6,525.00 ", N/A ,"$7,656.00 ", N/A ,"$6,525.00 ","$6,525.00 ","$7,395.00 ","$7,395.00 ", N/A ,"$7,395.00 ", N/A ,"$6,873.00 ","$6,873.00 ","$6,873.00 ","$7,830.00 ", N/A ,"$7,830.00 ", N/A ,"$8,700.00 ","$5,698.50 ", N/A ,"$3,775.80 ", N/A , N/A ,"$7,830.00 ", N/A ,"$5,489.70 ","$5,220.00 ","$7,830.00 ", N/A ,"$7,830.00 ","$7,830.00 ", N/A ,"$5,655.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203905,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T30,272,1 ,"$9,300.00 ","$6,045.00 ","$4,036.20 ","$9,300.00 ","$6,928.50 ","$6,091.50 ", N/A ,"$4,901.10 ", N/A ,"$5,868.30 ","$5,868.30 ","$5,868.30 ","$5,868.30 ","$8,370.00 ","$6,975.00 ", N/A ,"$8,184.00 ", N/A ,"$6,975.00 ","$6,975.00 ","$7,905.00 ","$7,905.00 ", N/A ,"$7,905.00 ", N/A ,"$7,347.00 ","$7,347.00 ","$7,347.00 ","$8,370.00 ", N/A ,"$8,370.00 ", N/A ,"$9,300.00 ","$6,091.50 ", N/A ,"$4,036.20 ", N/A , N/A ,"$8,370.00 ", N/A ,"$5,868.30 ","$5,580.00 ","$8,370.00 ", N/A ,"$8,370.00 ","$8,370.00 ", N/A ,"$6,045.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203906,C1714,HC CATHETER ATHERECTOMY TRANSLUMINAL DIRECTIONAL T31,272,1 ,"$9,900.00 ","$6,435.00 ","$4,296.60 ","$9,900.00 ","$7,375.50 ","$6,484.50 ", N/A ,"$5,217.30 ", N/A ,"$6,246.90 ","$6,246.90 ","$6,246.90 ","$6,246.90 ","$8,910.00 ","$7,425.00 ", N/A ,"$8,712.00 ", N/A ,"$7,425.00 ","$7,425.00 ","$8,415.00 ","$8,415.00 ", N/A ,"$8,415.00 ", N/A ,"$7,821.00 ","$7,821.00 ","$7,821.00 ","$8,910.00 ", N/A ,"$8,910.00 ", N/A ,"$9,900.00 ","$6,484.50 ", N/A ,"$4,296.60 ", N/A , N/A ,"$8,910.00 ", N/A ,"$6,246.90 ","$5,940.00 ","$8,910.00 ", N/A ,"$8,910.00 ","$8,910.00 ", N/A ,"$6,435.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203922,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T12,272,1 ,$750.00 ,$487.50 ,$325.50 ,$750.00 ,$558.75 ,$491.25 , N/A ,$395.25 , N/A ,$473.25 ,$473.25 ,$473.25 ,$473.25 ,$675.00 ,$562.50 , N/A ,$660.00 , N/A ,$562.50 ,$562.50 ,$637.50 ,$637.50 , N/A ,$637.50 , N/A ,$592.50 ,$592.50 ,$592.50 ,$675.00 , N/A ,$675.00 , N/A ,$750.00 ,$491.25 , N/A ,$325.50 , N/A , N/A ,$675.00 , N/A ,$473.25 ,$450.00 ,$675.00 , N/A ,$675.00 ,$675.00 , N/A ,$487.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203923,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T13,272,1 ,$900.00 ,$585.00 ,$390.60 ,$900.00 ,$670.50 ,$589.50 , N/A ,$474.30 , N/A ,$567.90 ,$567.90 ,$567.90 ,$567.90 ,$810.00 ,$675.00 , N/A ,$792.00 , N/A ,$675.00 ,$675.00 ,$765.00 ,$765.00 , N/A ,$765.00 , N/A ,$711.00 ,$711.00 ,$711.00 ,$810.00 , N/A ,$810.00 , N/A ,$900.00 ,$589.50 , N/A ,$390.60 , N/A , N/A ,$810.00 , N/A ,$567.90 ,$540.00 ,$810.00 , N/A ,$810.00 ,$810.00 , N/A ,$585.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203924,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T14,272,1 ,"$1,050.00 ",$682.50 ,$455.70 ,"$1,050.00 ",$782.25 ,$687.75 , N/A ,$553.35 , N/A ,$662.55 ,$662.55 ,$662.55 ,$662.55 ,$945.00 ,$787.50 , N/A ,$924.00 , N/A ,$787.50 ,$787.50 ,$892.50 ,$892.50 , N/A ,$892.50 , N/A ,$829.50 ,$829.50 ,$829.50 ,$945.00 , N/A ,$945.00 , N/A ,"$1,050.00 ",$687.75 , N/A ,$455.70 , N/A , N/A ,$945.00 , N/A ,$662.55 ,$630.00 ,$945.00 , N/A ,$945.00 ,$945.00 , N/A ,$682.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203925,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T15,272,1 ,"$1,200.00 ",$780.00 ,$520.80 ,"$1,200.00 ",$894.00 ,$786.00 , N/A ,$632.40 , N/A ,$757.20 ,$757.20 ,$757.20 ,$757.20 ,"$1,080.00 ",$900.00 , N/A ,"$1,056.00 ", N/A ,$900.00 ,$900.00 ,"$1,020.00 ","$1,020.00 ", N/A ,"$1,020.00 ", N/A ,$948.00 ,$948.00 ,$948.00 ,"$1,080.00 ", N/A ,"$1,080.00 ", N/A ,"$1,200.00 ",$786.00 , N/A ,$520.80 , N/A , N/A ,"$1,080.00 ", N/A ,$757.20 ,$720.00 ,"$1,080.00 ", N/A ,"$1,080.00 ","$1,080.00 ", N/A ,$780.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203926,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T16,272,1 ,"$1,350.00 ",$877.50 ,$585.90 ,"$1,350.00 ","$1,005.75 ",$884.25 , N/A ,$711.45 , N/A ,$851.85 ,$851.85 ,$851.85 ,$851.85 ,"$1,215.00 ","$1,012.50 ", N/A ,"$1,188.00 ", N/A ,"$1,012.50 ","$1,012.50 ","$1,147.50 ","$1,147.50 ", N/A ,"$1,147.50 ", N/A ,"$1,066.50 ","$1,066.50 ","$1,066.50 ","$1,215.00 ", N/A ,"$1,215.00 ", N/A ,"$1,350.00 ",$884.25 , N/A ,$585.90 , N/A , N/A ,"$1,215.00 ", N/A ,$851.85 ,$810.00 ,"$1,215.00 ", N/A ,"$1,215.00 ","$1,215.00 ", N/A ,$877.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203927,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T17,272,1 ,"$1,500.00 ",$975.00 ,$651.00 ,"$1,500.00 ","$1,117.50 ",$982.50 , N/A ,$790.50 , N/A ,$946.50 ,$946.50 ,$946.50 ,$946.50 ,"$1,350.00 ","$1,125.00 ", N/A ,"$1,320.00 ", N/A ,"$1,125.00 ","$1,125.00 ","$1,275.00 ","$1,275.00 ", N/A ,"$1,275.00 ", N/A ,"$1,185.00 ","$1,185.00 ","$1,185.00 ","$1,350.00 ", N/A ,"$1,350.00 ", N/A ,"$1,500.00 ",$982.50 , N/A ,$651.00 , N/A , N/A ,"$1,350.00 ", N/A ,$946.50 ,$900.00 ,"$1,350.00 ", N/A ,"$1,350.00 ","$1,350.00 ", N/A ,$975.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203928,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T18,272,1 ,"$2,100.00 ","$1,365.00 ",$911.40 ,"$2,100.00 ","$1,564.50 ","$1,375.50 ", N/A ,"$1,106.70 ", N/A ,"$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,890.00 ","$1,575.00 ", N/A ,"$1,848.00 ", N/A ,"$1,575.00 ","$1,575.00 ","$1,785.00 ","$1,785.00 ", N/A ,"$1,785.00 ", N/A ,"$1,659.00 ","$1,659.00 ","$1,659.00 ","$1,890.00 ", N/A ,"$1,890.00 ", N/A ,"$2,100.00 ","$1,375.50 ", N/A ,$911.40 , N/A , N/A ,"$1,890.00 ", N/A ,"$1,325.10 ","$1,260.00 ","$1,890.00 ", N/A ,"$1,890.00 ","$1,890.00 ", N/A ,"$1,365.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203929,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T19,272,1 ,"$2,700.00 ","$1,755.00 ","$1,171.80 ","$2,700.00 ","$2,011.50 ","$1,768.50 ", N/A ,"$1,422.90 ", N/A ,"$1,703.70 ","$1,703.70 ","$1,703.70 ","$1,703.70 ","$2,430.00 ","$2,025.00 ", N/A ,"$2,376.00 ", N/A ,"$2,025.00 ","$2,025.00 ","$2,295.00 ","$2,295.00 ", N/A ,"$2,295.00 ", N/A ,"$2,133.00 ","$2,133.00 ","$2,133.00 ","$2,430.00 ", N/A ,"$2,430.00 ", N/A ,"$2,700.00 ","$1,768.50 ", N/A ,"$1,171.80 ", N/A , N/A ,"$2,430.00 ", N/A ,"$1,703.70 ","$1,620.00 ","$2,430.00 ", N/A ,"$2,430.00 ","$2,430.00 ", N/A ,"$1,755.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203930,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T20,272,1 ,"$3,300.00 ","$2,145.00 ","$1,432.20 ","$3,300.00 ","$2,458.50 ","$2,161.50 ", N/A ,"$1,739.10 ", N/A ,"$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,970.00 ","$2,475.00 ", N/A ,"$2,904.00 ", N/A ,"$2,475.00 ","$2,475.00 ","$2,805.00 ","$2,805.00 ", N/A ,"$2,805.00 ", N/A ,"$2,607.00 ","$2,607.00 ","$2,607.00 ","$2,970.00 ", N/A ,"$2,970.00 ", N/A ,"$3,300.00 ","$2,161.50 ", N/A ,"$1,432.20 ", N/A , N/A ,"$2,970.00 ", N/A ,"$2,082.30 ","$1,980.00 ","$2,970.00 ", N/A ,"$2,970.00 ","$2,970.00 ", N/A ,"$2,145.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203931,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T21,272,1 ,"$3,900.00 ","$2,535.00 ","$1,692.60 ","$3,900.00 ","$2,905.50 ","$2,554.50 ", N/A ,"$2,055.30 ", N/A ,"$2,460.90 ","$2,460.90 ","$2,460.90 ","$2,460.90 ","$3,510.00 ","$2,925.00 ", N/A ,"$3,432.00 ", N/A ,"$2,925.00 ","$2,925.00 ","$3,315.00 ","$3,315.00 ", N/A ,"$3,315.00 ", N/A ,"$3,081.00 ","$3,081.00 ","$3,081.00 ","$3,510.00 ", N/A ,"$3,510.00 ", N/A ,"$3,900.00 ","$2,554.50 ", N/A ,"$1,692.60 ", N/A , N/A ,"$3,510.00 ", N/A ,"$2,460.90 ","$2,340.00 ","$3,510.00 ", N/A ,"$3,510.00 ","$3,510.00 ", N/A ,"$2,535.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203932,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T22,272,1 ,"$4,500.00 ","$2,925.00 ","$1,953.00 ","$4,500.00 ","$3,352.50 ","$2,947.50 ", N/A ,"$2,371.50 ", N/A ,"$2,839.50 ","$2,839.50 ","$2,839.50 ","$2,839.50 ","$4,050.00 ","$3,375.00 ", N/A ,"$3,960.00 ", N/A ,"$3,375.00 ","$3,375.00 ","$3,825.00 ","$3,825.00 ", N/A ,"$3,825.00 ", N/A ,"$3,555.00 ","$3,555.00 ","$3,555.00 ","$4,050.00 ", N/A ,"$4,050.00 ", N/A ,"$4,500.00 ","$2,947.50 ", N/A ,"$1,953.00 ", N/A , N/A ,"$4,050.00 ", N/A ,"$2,839.50 ","$2,700.00 ","$4,050.00 ", N/A ,"$4,050.00 ","$4,050.00 ", N/A ,"$2,925.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203933,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T23,272,1 ,"$5,100.00 ","$3,315.00 ","$2,213.40 ","$5,100.00 ","$3,799.50 ","$3,340.50 ", N/A ,"$2,687.70 ", N/A ,"$3,218.10 ","$3,218.10 ","$3,218.10 ","$3,218.10 ","$4,590.00 ","$3,825.00 ", N/A ,"$4,488.00 ", N/A ,"$3,825.00 ","$3,825.00 ","$4,335.00 ","$4,335.00 ", N/A ,"$4,335.00 ", N/A ,"$4,029.00 ","$4,029.00 ","$4,029.00 ","$4,590.00 ", N/A ,"$4,590.00 ", N/A ,"$5,100.00 ","$3,340.50 ", N/A ,"$2,213.40 ", N/A , N/A ,"$4,590.00 ", N/A ,"$3,218.10 ","$3,060.00 ","$4,590.00 ", N/A ,"$4,590.00 ","$4,590.00 ", N/A ,"$3,315.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203934,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T24,272,1 ,"$5,700.00 ","$3,705.00 ","$2,473.80 ","$5,700.00 ","$4,246.50 ","$3,733.50 ", N/A ,"$3,003.90 ", N/A ,"$3,596.70 ","$3,596.70 ","$3,596.70 ","$3,596.70 ","$5,130.00 ","$4,275.00 ", N/A ,"$5,016.00 ", N/A ,"$4,275.00 ","$4,275.00 ","$4,845.00 ","$4,845.00 ", N/A ,"$4,845.00 ", N/A ,"$4,503.00 ","$4,503.00 ","$4,503.00 ","$5,130.00 ", N/A ,"$5,130.00 ", N/A ,"$5,700.00 ","$3,733.50 ", N/A ,"$2,473.80 ", N/A , N/A ,"$5,130.00 ", N/A ,"$3,596.70 ","$3,420.00 ","$5,130.00 ", N/A ,"$5,130.00 ","$5,130.00 ", N/A ,"$3,705.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203935,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T25,272,1 ,"$6,300.00 ","$4,095.00 ","$2,734.20 ","$6,300.00 ","$4,693.50 ","$4,126.50 ", N/A ,"$3,320.10 ", N/A ,"$3,975.30 ","$3,975.30 ","$3,975.30 ","$3,975.30 ","$5,670.00 ","$4,725.00 ", N/A ,"$5,544.00 ", N/A ,"$4,725.00 ","$4,725.00 ","$5,355.00 ","$5,355.00 ", N/A ,"$5,355.00 ", N/A ,"$4,977.00 ","$4,977.00 ","$4,977.00 ","$5,670.00 ", N/A ,"$5,670.00 ", N/A ,"$6,300.00 ","$4,126.50 ", N/A ,"$2,734.20 ", N/A , N/A ,"$5,670.00 ", N/A ,"$3,975.30 ","$3,780.00 ","$5,670.00 ", N/A ,"$5,670.00 ","$5,670.00 ", N/A ,"$4,095.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203936,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T26,272,1 ,"$6,900.00 ","$4,485.00 ","$2,994.60 ","$6,900.00 ","$5,140.50 ","$4,519.50 ", N/A ,"$3,636.30 ", N/A ,"$4,353.90 ","$4,353.90 ","$4,353.90 ","$4,353.90 ","$6,210.00 ","$5,175.00 ", N/A ,"$6,072.00 ", N/A ,"$5,175.00 ","$5,175.00 ","$5,865.00 ","$5,865.00 ", N/A ,"$5,865.00 ", N/A ,"$5,451.00 ","$5,451.00 ","$5,451.00 ","$6,210.00 ", N/A ,"$6,210.00 ", N/A ,"$6,900.00 ","$4,519.50 ", N/A ,"$2,994.60 ", N/A , N/A ,"$6,210.00 ", N/A ,"$4,353.90 ","$4,140.00 ","$6,210.00 ", N/A ,"$6,210.00 ","$6,210.00 ", N/A ,"$4,485.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203937,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T27,272,1 ,"$7,500.00 ","$4,875.00 ","$3,255.00 ","$7,500.00 ","$5,587.50 ","$4,912.50 ", N/A ,"$3,952.50 ", N/A ,"$4,732.50 ","$4,732.50 ","$4,732.50 ","$4,732.50 ","$6,750.00 ","$5,625.00 ", N/A ,"$6,600.00 ", N/A ,"$5,625.00 ","$5,625.00 ","$6,375.00 ","$6,375.00 ", N/A ,"$6,375.00 ", N/A ,"$5,925.00 ","$5,925.00 ","$5,925.00 ","$6,750.00 ", N/A ,"$6,750.00 ", N/A ,"$7,500.00 ","$4,912.50 ", N/A ,"$3,255.00 ", N/A , N/A ,"$6,750.00 ", N/A ,"$4,732.50 ","$4,500.00 ","$6,750.00 ", N/A ,"$6,750.00 ","$6,750.00 ", N/A ,"$4,875.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203938,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T28,272,1 ,"$8,100.00 ","$5,265.00 ","$3,515.40 ","$8,100.00 ","$6,034.50 ","$5,305.50 ", N/A ,"$4,268.70 ", N/A ,"$5,111.10 ","$5,111.10 ","$5,111.10 ","$5,111.10 ","$7,290.00 ","$6,075.00 ", N/A ,"$7,128.00 ", N/A ,"$6,075.00 ","$6,075.00 ","$6,885.00 ","$6,885.00 ", N/A ,"$6,885.00 ", N/A ,"$6,399.00 ","$6,399.00 ","$6,399.00 ","$7,290.00 ", N/A ,"$7,290.00 ", N/A ,"$8,100.00 ","$5,305.50 ", N/A ,"$3,515.40 ", N/A , N/A ,"$7,290.00 ", N/A ,"$5,111.10 ","$4,860.00 ","$7,290.00 ", N/A ,"$7,290.00 ","$7,290.00 ", N/A ,"$5,265.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203939,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T29,272,1 ,"$8,700.00 ","$5,655.00 ","$3,775.80 ","$8,700.00 ","$6,481.50 ","$5,698.50 ", N/A ,"$4,584.90 ", N/A ,"$5,489.70 ","$5,489.70 ","$5,489.70 ","$5,489.70 ","$7,830.00 ","$6,525.00 ", N/A ,"$7,656.00 ", N/A ,"$6,525.00 ","$6,525.00 ","$7,395.00 ","$7,395.00 ", N/A ,"$7,395.00 ", N/A ,"$6,873.00 ","$6,873.00 ","$6,873.00 ","$7,830.00 ", N/A ,"$7,830.00 ", N/A ,"$8,700.00 ","$5,698.50 ", N/A ,"$3,775.80 ", N/A , N/A ,"$7,830.00 ", N/A ,"$5,489.70 ","$5,220.00 ","$7,830.00 ", N/A ,"$7,830.00 ","$7,830.00 ", N/A ,"$5,655.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203940,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T30,272,1 ,"$9,300.00 ","$6,045.00 ","$4,036.20 ","$9,300.00 ","$6,928.50 ","$6,091.50 ", N/A ,"$4,901.10 ", N/A ,"$5,868.30 ","$5,868.30 ","$5,868.30 ","$5,868.30 ","$8,370.00 ","$6,975.00 ", N/A ,"$8,184.00 ", N/A ,"$6,975.00 ","$6,975.00 ","$7,905.00 ","$7,905.00 ", N/A ,"$7,905.00 ", N/A ,"$7,347.00 ","$7,347.00 ","$7,347.00 ","$8,370.00 ", N/A ,"$8,370.00 ", N/A ,"$9,300.00 ","$6,091.50 ", N/A ,"$4,036.20 ", N/A , N/A ,"$8,370.00 ", N/A ,"$5,868.30 ","$5,580.00 ","$8,370.00 ", N/A ,"$8,370.00 ","$8,370.00 ", N/A ,"$6,045.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203941,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T31,272,1 ,"$9,900.00 ","$6,435.00 ","$4,296.60 ","$9,900.00 ","$7,375.50 ","$6,484.50 ", N/A ,"$5,217.30 ", N/A ,"$6,246.90 ","$6,246.90 ","$6,246.90 ","$6,246.90 ","$8,910.00 ","$7,425.00 ", N/A ,"$8,712.00 ", N/A ,"$7,425.00 ","$7,425.00 ","$8,415.00 ","$8,415.00 ", N/A ,"$8,415.00 ", N/A ,"$7,821.00 ","$7,821.00 ","$7,821.00 ","$8,910.00 ", N/A ,"$8,910.00 ", N/A ,"$9,900.00 ","$6,484.50 ", N/A ,"$4,296.60 ", N/A , N/A ,"$8,910.00 ", N/A ,"$6,246.90 ","$5,940.00 ","$8,910.00 ", N/A ,"$8,910.00 ","$8,910.00 ", N/A ,"$6,435.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203942,C1724,HC CATHETER TRANSLUMINAL ATHERECTOMY ROTATIONAL T32,272,1 ,"$10,500.00 ","$6,825.00 ","$4,557.00 ","$10,500.00 ","$7,822.50 ","$6,877.50 ", N/A ,"$5,533.50 ", N/A ,"$6,625.50 ","$6,625.50 ","$6,625.50 ","$6,625.50 ","$9,450.00 ","$7,875.00 ", N/A ,"$9,240.00 ", N/A ,"$7,875.00 ","$7,875.00 ","$8,925.00 ","$8,925.00 ", N/A ,"$8,925.00 ", N/A ,"$8,295.00 ","$8,295.00 ","$8,295.00 ","$9,450.00 ", N/A ,"$9,450.00 ", N/A ,"$10,500.00 ","$6,877.50 ", N/A ,"$4,557.00 ", N/A , N/A ,"$9,450.00 ", N/A ,"$6,625.50 ","$6,300.00 ","$9,450.00 ", N/A ,"$9,450.00 ","$9,450.00 ", N/A ,"$6,825.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203943,C1725,HC CATHETER TRANSLUMINAL ANGIOPLASTY NON-LASER T1,272,1 ,$10.00 ,$6.50 ,$4.34 ,$10.00 ,$7.45 ,$6.55 , N/A ,$5.27 , N/A ,$6.31 ,$6.31 ,$6.31 ,$6.31 ,$9.00 ,$7.50 , N/A ,$8.80 , N/A ,$7.50 ,$7.50 ,$8.50 ,$8.50 , N/A ,$8.50 , N/A ,$7.90 ,$7.90 ,$7.90 ,$9.00 , N/A ,$9.00 , N/A ,$10.00 ,$6.55 , N/A ,$4.34 , N/A , N/A ,$9.00 , N/A ,$6.31 ,$6.00 ,$9.00 , N/A ,$9.00 ,$9.00 , N/A ,$6.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203944,C1725,HC CATHETER TRANSLUMINAL ANGIOPLASTY NON-LASER T2,272,1 ,$20.00 ,$13.00 ,$8.68 ,$20.00 ,$14.90 ,$13.10 , N/A ,$10.54 , N/A ,$12.62 ,$12.62 ,$12.62 ,$12.62 ,$18.00 ,$15.00 , N/A ,$17.60 , N/A ,$15.00 ,$15.00 ,$17.00 ,$17.00 , N/A ,$17.00 , N/A ,$15.80 ,$15.80 ,$15.80 ,$18.00 , N/A ,$18.00 , N/A ,$20.00 ,$13.10 , N/A ,$8.68 , N/A , N/A ,$18.00 , N/A ,$12.62 ,$12.00 ,$18.00 , N/A ,$18.00 ,$18.00 , N/A ,$13.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203945,C1725,HC CATHETER TRANSLUMINAL ANGIOPLASTY NON-LASER T3,272,1 ,$30.00 ,$19.50 ,$13.02 ,$30.00 ,$22.35 ,$19.65 , N/A ,$15.81 , N/A ,$18.93 ,$18.93 ,$18.93 ,$18.93 ,$27.00 ,$22.50 , N/A ,$26.40 , N/A ,$22.50 ,$22.50 ,$25.50 ,$25.50 , N/A ,$25.50 , N/A ,$23.70 ,$23.70 ,$23.70 ,$27.00 , N/A ,$27.00 , N/A ,$30.00 ,$19.65 , N/A ,$13.02 , N/A , N/A ,$27.00 , N/A ,$18.93 ,$18.00 ,$27.00 , N/A ,$27.00 ,$27.00 , N/A ,$19.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203946,C1725,HC CATHETER TRANSLUMINAL ANGIOPLASTY NON-LASER T4,272,1 ,$75.00 ,$48.75 ,$32.55 ,$75.00 ,$55.88 ,$49.13 , N/A ,$39.53 , N/A ,$47.33 ,$47.33 ,$47.33 ,$47.33 ,$67.50 ,$56.25 , N/A ,$66.00 , N/A ,$56.25 ,$56.25 ,$63.75 ,$63.75 , N/A ,$63.75 , N/A ,$59.25 ,$59.25 ,$59.25 ,$67.50 , N/A ,$67.50 , N/A ,$75.00 ,$49.13 , N/A ,$32.55 , N/A , N/A ,$67.50 , N/A ,$47.33 ,$45.00 ,$67.50 , N/A ,$67.50 ,$67.50 , N/A ,$48.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203947,C1725,HC CATHETER TRANSLUMINAL ANGIOPLASTY NON-LASER T5,272,1 ,$150.00 ,$97.50 ,$65.10 ,$150.00 ,$111.75 ,$98.25 , N/A ,$79.05 , N/A ,$94.65 ,$94.65 ,$94.65 ,$94.65 ,$135.00 ,$112.50 , N/A ,$132.00 , N/A ,$112.50 ,$112.50 ,$127.50 ,$127.50 , N/A ,$127.50 , N/A ,$118.50 ,$118.50 ,$118.50 ,$135.00 , N/A ,$135.00 , N/A ,$150.00 ,$98.25 , N/A ,$65.10 , N/A , N/A ,$135.00 , N/A ,$94.65 ,$90.00 ,$135.00 , N/A ,$135.00 ,$135.00 , N/A ,$97.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203948,C1725,HC CATHETER TRANSLUMINAL ANGIOPLASTY NON-LASER T6,272,1 ,$225.00 ,$146.25 ,$97.65 ,$225.00 ,$167.63 ,$147.38 , N/A ,$118.58 , N/A ,$141.98 ,$141.98 ,$141.98 ,$141.98 ,$202.50 ,$168.75 , N/A ,$198.00 , N/A ,$168.75 ,$168.75 ,$191.25 ,$191.25 , N/A ,$191.25 , N/A ,$177.75 ,$177.75 ,$177.75 ,$202.50 , N/A ,$202.50 , N/A ,$225.00 ,$147.38 , N/A ,$97.65 , N/A , N/A ,$202.50 , N/A ,$141.98 ,$135.00 ,$202.50 , N/A ,$202.50 ,$202.50 , N/A ,$146.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203949,C1725,HC CATHETER TRANSLUMINAL ANGIOPLASTY NON-LASER T7,272,1 ,$300.00 ,$195.00 ,$130.20 ,$300.00 ,$223.50 ,$196.50 , N/A ,$158.10 , N/A ,$189.30 ,$189.30 ,$189.30 ,$189.30 ,$270.00 ,$225.00 , N/A ,$264.00 , N/A ,$225.00 ,$225.00 ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$237.00 ,$237.00 ,$237.00 ,$270.00 , N/A ,$270.00 , N/A ,$300.00 ,$196.50 , N/A ,$130.20 , N/A , N/A ,$270.00 , N/A ,$189.30 ,$180.00 ,$270.00 , N/A ,$270.00 ,$270.00 , N/A ,$195.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203950,C1725,HC CATHETER TRANSLUMINAL ANGIOPLASTY NON-LASER T8,272,1 ,$375.00 ,$243.75 ,$162.75 ,$375.00 ,$279.38 ,$245.63 , N/A ,$197.63 , N/A ,$236.63 ,$236.63 ,$236.63 ,$236.63 ,$337.50 ,$281.25 , N/A ,$330.00 , N/A ,$281.25 ,$281.25 ,$318.75 ,$318.75 , N/A ,$318.75 , N/A ,$296.25 ,$296.25 ,$296.25 ,$337.50 , N/A ,$337.50 , N/A ,$375.00 ,$245.63 , N/A ,$162.75 , N/A , N/A ,$337.50 , N/A ,$236.63 ,$225.00 ,$337.50 , N/A ,$337.50 ,$337.50 , N/A ,$243.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203951,C1725,HC CATHETER TRANSLUMINAL ANGIOPLASTY NON-LASER T9,272,1 ,$450.00 ,$292.50 ,$195.30 ,$450.00 ,$335.25 ,$294.75 , N/A ,$237.15 , N/A ,$283.95 ,$283.95 ,$283.95 ,$283.95 ,$405.00 ,$337.50 , N/A ,$396.00 , N/A ,$337.50 ,$337.50 ,$382.50 ,$382.50 , N/A ,$382.50 , N/A ,$355.50 ,$355.50 ,$355.50 ,$405.00 , N/A ,$405.00 , N/A ,$450.00 ,$294.75 , N/A ,$195.30 , N/A , N/A ,$405.00 , N/A ,$283.95 ,$270.00 ,$405.00 , N/A ,$405.00 ,$405.00 , N/A ,$292.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203952,C1725,HC CATHETER TRANSLUMINAL ANGIOPLASTY NON-LASER T10,272,1 ,$525.00 ,$341.25 ,$227.85 ,$525.00 ,$391.13 ,$343.88 , N/A ,$276.68 , N/A ,$331.28 ,$331.28 ,$331.28 ,$331.28 ,$472.50 ,$393.75 , N/A ,$462.00 , N/A ,$393.75 ,$393.75 ,$446.25 ,$446.25 , N/A ,$446.25 , N/A ,$414.75 ,$414.75 ,$414.75 ,$472.50 , N/A ,$472.50 , N/A ,$525.00 ,$343.88 , N/A ,$227.85 , N/A , N/A ,$472.50 , N/A ,$331.28 ,$315.00 ,$472.50 , N/A ,$472.50 ,$472.50 , N/A ,$341.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203953,C1725,HC CATHETER TRANSLUMINAL ANGIOPLASTY NON-LASER T11,272,1 ,$600.00 ,$390.00 ,$260.40 ,$600.00 ,$447.00 ,$393.00 , N/A ,$316.20 , N/A ,$378.60 ,$378.60 ,$378.60 ,$378.60 ,$540.00 ,$450.00 , N/A ,$528.00 , N/A ,$450.00 ,$450.00 ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$474.00 ,$474.00 ,$474.00 ,$540.00 , N/A ,$540.00 , N/A ,$600.00 ,$393.00 , N/A ,$260.40 , N/A , N/A ,$540.00 , N/A ,$378.60 ,$360.00 ,$540.00 , N/A ,$540.00 ,$540.00 , N/A ,$390.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203954,C1725,HC CATHETER TRANSLUMINAL ANGIOPLASTY NON-LASER T12,272,1 ,$750.00 ,$487.50 ,$325.50 ,$750.00 ,$558.75 ,$491.25 , N/A ,$395.25 , N/A ,$473.25 ,$473.25 ,$473.25 ,$473.25 ,$675.00 ,$562.50 , N/A ,$660.00 , N/A ,$562.50 ,$562.50 ,$637.50 ,$637.50 , N/A ,$637.50 , N/A ,$592.50 ,$592.50 ,$592.50 ,$675.00 , N/A ,$675.00 , N/A ,$750.00 ,$491.25 , N/A ,$325.50 , N/A , N/A ,$675.00 , N/A ,$473.25 ,$450.00 ,$675.00 , N/A ,$675.00 ,$675.00 , N/A ,$487.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203955,C1725,HC CATHETER TRANSLUMINAL ANGIOPLASTY NON-LASER T13,272,1 ,$900.00 ,$585.00 ,$390.60 ,$900.00 ,$670.50 ,$589.50 , N/A ,$474.30 , N/A ,$567.90 ,$567.90 ,$567.90 ,$567.90 ,$810.00 ,$675.00 , N/A ,$792.00 , N/A ,$675.00 ,$675.00 ,$765.00 ,$765.00 , N/A ,$765.00 , N/A ,$711.00 ,$711.00 ,$711.00 ,$810.00 , N/A ,$810.00 , N/A ,$900.00 ,$589.50 , N/A ,$390.60 , N/A , N/A ,$810.00 , N/A ,$567.90 ,$540.00 ,$810.00 , N/A ,$810.00 ,$810.00 , N/A ,$585.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203956,C1725,HC CATHETER TRANSLUMINAL ANGIOPLASTY NON-LASER T14,272,1 ,"$1,050.00 ",$682.50 ,$455.70 ,"$1,050.00 ",$782.25 ,$687.75 , N/A ,$553.35 , N/A ,$662.55 ,$662.55 ,$662.55 ,$662.55 ,$945.00 ,$787.50 , N/A ,$924.00 , N/A ,$787.50 ,$787.50 ,$892.50 ,$892.50 , N/A ,$892.50 , N/A ,$829.50 ,$829.50 ,$829.50 ,$945.00 , N/A ,$945.00 , N/A ,"$1,050.00 ",$687.75 , N/A ,$455.70 , N/A , N/A ,$945.00 , N/A ,$662.55 ,$630.00 ,$945.00 , N/A ,$945.00 ,$945.00 , N/A ,$682.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203957,C1725,HC CATHETER TRANSLUMINAL ANGIOPLASTY NON-LASER T15,272,1 ,"$1,200.00 ",$780.00 ,$520.80 ,"$1,200.00 ",$894.00 ,$786.00 , N/A ,$632.40 , N/A ,$757.20 ,$757.20 ,$757.20 ,$757.20 ,"$1,080.00 ",$900.00 , N/A ,"$1,056.00 ", N/A ,$900.00 ,$900.00 ,"$1,020.00 ","$1,020.00 ", N/A ,"$1,020.00 ", N/A ,$948.00 ,$948.00 ,$948.00 ,"$1,080.00 ", N/A ,"$1,080.00 ", N/A ,"$1,200.00 ",$786.00 , N/A ,$520.80 , N/A , N/A ,"$1,080.00 ", N/A ,$757.20 ,$720.00 ,"$1,080.00 ", N/A ,"$1,080.00 ","$1,080.00 ", N/A ,$780.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203961,C1725,HC CATHETER TRANSLUMINAL ANGIOPLASTY NON-LASER T19,272,1 ,"$2,700.00 ","$1,755.00 ","$1,171.80 ","$2,700.00 ","$2,011.50 ","$1,768.50 ", N/A ,"$1,422.90 ", N/A ,"$1,703.70 ","$1,703.70 ","$1,703.70 ","$1,703.70 ","$2,430.00 ","$2,025.00 ", N/A ,"$2,376.00 ", N/A ,"$2,025.00 ","$2,025.00 ","$2,295.00 ","$2,295.00 ", N/A ,"$2,295.00 ", N/A ,"$2,133.00 ","$2,133.00 ","$2,133.00 ","$2,430.00 ", N/A ,"$2,430.00 ", N/A ,"$2,700.00 ","$1,768.50 ", N/A ,"$1,171.80 ", N/A , N/A ,"$2,430.00 ", N/A ,"$1,703.70 ","$1,620.00 ","$2,430.00 ", N/A ,"$2,430.00 ","$2,430.00 ", N/A ,"$1,755.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27203962,C1725,HC CATHETER TRANSLUMINAL ANGIOPLASTY NON-LASER T20,272,1 ,"$3,300.00 ","$2,145.00 ","$1,432.20 ","$3,300.00 ","$2,458.50 ","$2,161.50 ", N/A ,"$1,739.10 ", N/A ,"$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,970.00 ","$2,475.00 ", N/A ,"$2,904.00 ", N/A ,"$2,475.00 ","$2,475.00 ","$2,805.00 ","$2,805.00 ", N/A ,"$2,805.00 ", N/A ,"$2,607.00 ","$2,607.00 ","$2,607.00 ","$2,970.00 ", N/A ,"$2,970.00 ", N/A ,"$3,300.00 ","$2,161.50 ", N/A ,"$1,432.20 ", N/A , N/A ,"$2,970.00 ", N/A ,"$2,082.30 ","$1,980.00 ","$2,970.00 ", N/A ,"$2,970.00 ","$2,970.00 ", N/A ,"$2,145.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204058,C1733,HC CATHETER EP DIAG/ABLATION OTHR COOL TIP T12,272,1 ,"$7,500.00 ","$4,875.00 ","$3,255.00 ","$7,500.00 ","$5,587.50 ","$4,912.50 ", N/A ,"$3,952.50 ", N/A ,"$4,732.50 ","$4,732.50 ","$4,732.50 ","$4,732.50 ","$6,750.00 ","$5,625.00 ", N/A ,"$6,600.00 ", N/A ,"$5,625.00 ","$5,625.00 ","$6,375.00 ","$6,375.00 ", N/A ,"$6,375.00 ", N/A ,"$5,925.00 ","$5,925.00 ","$5,925.00 ","$6,750.00 ", N/A ,"$6,750.00 ", N/A ,"$7,500.00 ","$4,912.50 ", N/A ,"$3,255.00 ", N/A , N/A ,"$6,750.00 ", N/A ,"$4,732.50 ","$4,500.00 ","$6,750.00 ", N/A ,"$6,750.00 ","$6,750.00 ", N/A ,"$4,875.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204066,C1733,HC CATHETER EP DIAG/ABLATION OTHR COOL TIP T20,272,1 ,"$3,150.00 ","$2,047.50 ","$1,367.10 ","$3,150.00 ","$2,346.75 ","$2,063.25 ", N/A ,"$1,660.05 ", N/A ,"$1,987.65 ","$1,987.65 ","$1,987.65 ","$1,987.65 ","$2,835.00 ","$2,362.50 ", N/A ,"$2,772.00 ", N/A ,"$2,362.50 ","$2,362.50 ","$2,677.50 ","$2,677.50 ", N/A ,"$2,677.50 ", N/A ,"$2,488.50 ","$2,488.50 ","$2,488.50 ","$2,835.00 ", N/A ,"$2,835.00 ", N/A ,"$3,150.00 ","$2,063.25 ", N/A ,"$1,367.10 ", N/A , N/A ,"$2,835.00 ", N/A ,"$1,987.65 ","$1,890.00 ","$2,835.00 ", N/A ,"$2,835.00 ","$2,835.00 ", N/A ,"$2,047.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204073,C1751,HC CATHETER INFUSION PICC/CV/MIDLINE T1,272,1 ,$150.00 ,$97.50 ,$65.10 ,$150.00 ,$111.75 ,$98.25 , N/A ,$79.05 , N/A ,$94.65 ,$94.65 ,$94.65 ,$94.65 ,$135.00 ,$112.50 , N/A ,$132.00 , N/A ,$112.50 ,$112.50 ,$127.50 ,$127.50 , N/A ,$127.50 , N/A ,$118.50 ,$118.50 ,$118.50 ,$135.00 , N/A ,$135.00 , N/A ,$150.00 ,$98.25 , N/A ,$65.10 , N/A , N/A ,$135.00 , N/A ,$94.65 ,$90.00 ,$135.00 , N/A ,$135.00 ,$135.00 , N/A ,$97.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204078,C1751,HC CATHETER INFUSION PICC/CV/MIDLINE T6,272,1 ,$705.00 ,$458.25 ,$305.97 ,$705.00 ,$525.23 ,$461.78 , N/A ,$371.54 , N/A ,$444.86 ,$444.86 ,$444.86 ,$444.86 ,$634.50 ,$528.75 , N/A ,$620.40 , N/A ,$528.75 ,$528.75 ,$599.25 ,$599.25 , N/A ,$599.25 , N/A ,$556.95 ,$556.95 ,$556.95 ,$634.50 , N/A ,$634.50 , N/A ,$705.00 ,$461.78 , N/A ,$305.97 , N/A , N/A ,$634.50 , N/A ,$444.86 ,$423.00 ,$634.50 , N/A ,$634.50 ,$634.50 , N/A ,$458.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204090,C1753,HC CATHETER US IMAGING/IVUS T5,272,1 ,"$2,100.00 ","$1,365.00 ",$911.40 ,"$2,100.00 ","$1,564.50 ","$1,375.50 ", N/A ,"$1,106.70 ", N/A ,"$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,890.00 ","$1,575.00 ", N/A ,"$1,848.00 ", N/A ,"$1,575.00 ","$1,575.00 ","$1,785.00 ","$1,785.00 ", N/A ,"$1,785.00 ", N/A ,"$1,659.00 ","$1,659.00 ","$1,659.00 ","$1,890.00 ", N/A ,"$1,890.00 ", N/A ,"$2,100.00 ","$1,375.50 ", N/A ,$911.40 , N/A , N/A ,"$1,890.00 ", N/A ,"$1,325.10 ","$1,260.00 ","$1,890.00 ", N/A ,"$1,890.00 ","$1,890.00 ", N/A ,"$1,365.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204091,C1753,HC CATHETER US IMAGING/IVUS T6,272,1 ,"$2,700.00 ","$1,755.00 ","$1,171.80 ","$2,700.00 ","$2,011.50 ","$1,768.50 ", N/A ,"$1,422.90 ", N/A ,"$1,703.70 ","$1,703.70 ","$1,703.70 ","$1,703.70 ","$2,430.00 ","$2,025.00 ", N/A ,"$2,376.00 ", N/A ,"$2,025.00 ","$2,025.00 ","$2,295.00 ","$2,295.00 ", N/A ,"$2,295.00 ", N/A ,"$2,133.00 ","$2,133.00 ","$2,133.00 ","$2,430.00 ", N/A ,"$2,430.00 ", N/A ,"$2,700.00 ","$1,768.50 ", N/A ,"$1,171.80 ", N/A , N/A ,"$2,430.00 ", N/A ,"$1,703.70 ","$1,620.00 ","$2,430.00 ", N/A ,"$2,430.00 ","$2,430.00 ", N/A ,"$1,755.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204092,C1753,HC CATHETER US IMAGING/IVUS T7,272,1 ,"$3,300.00 ","$2,145.00 ","$1,432.20 ","$3,300.00 ","$2,458.50 ","$2,161.50 ", N/A ,"$1,739.10 ", N/A ,"$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,970.00 ","$2,475.00 ", N/A ,"$2,904.00 ", N/A ,"$2,475.00 ","$2,475.00 ","$2,805.00 ","$2,805.00 ", N/A ,"$2,805.00 ", N/A ,"$2,607.00 ","$2,607.00 ","$2,607.00 ","$2,970.00 ", N/A ,"$2,970.00 ", N/A ,"$3,300.00 ","$2,161.50 ", N/A ,"$1,432.20 ", N/A , N/A ,"$2,970.00 ", N/A ,"$2,082.30 ","$1,980.00 ","$2,970.00 ", N/A ,"$2,970.00 ","$2,970.00 ", N/A ,"$2,145.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204093,C1753,HC CATHETER US IMAGING/IVUS T8,272,1 ,"$3,900.00 ","$2,535.00 ","$1,692.60 ","$3,900.00 ","$2,905.50 ","$2,554.50 ", N/A ,"$2,055.30 ", N/A ,"$2,460.90 ","$2,460.90 ","$2,460.90 ","$2,460.90 ","$3,510.00 ","$2,925.00 ", N/A ,"$3,432.00 ", N/A ,"$2,925.00 ","$2,925.00 ","$3,315.00 ","$3,315.00 ", N/A ,"$3,315.00 ", N/A ,"$3,081.00 ","$3,081.00 ","$3,081.00 ","$3,510.00 ", N/A ,"$3,510.00 ", N/A ,"$3,900.00 ","$2,554.50 ", N/A ,"$1,692.60 ", N/A , N/A ,"$3,510.00 ", N/A ,"$2,460.90 ","$2,340.00 ","$3,510.00 ", N/A ,"$3,510.00 ","$3,510.00 ", N/A ,"$2,535.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204094,C1753,HC CATHETER US IMAGING/IVUS T9,272,1 ,"$4,500.00 ","$2,925.00 ","$1,953.00 ","$4,500.00 ","$3,352.50 ","$2,947.50 ", N/A ,"$2,371.50 ", N/A ,"$2,839.50 ","$2,839.50 ","$2,839.50 ","$2,839.50 ","$4,050.00 ","$3,375.00 ", N/A ,"$3,960.00 ", N/A ,"$3,375.00 ","$3,375.00 ","$3,825.00 ","$3,825.00 ", N/A ,"$3,825.00 ", N/A ,"$3,555.00 ","$3,555.00 ","$3,555.00 ","$4,050.00 ", N/A ,"$4,050.00 ", N/A ,"$4,500.00 ","$2,947.50 ", N/A ,"$1,953.00 ", N/A , N/A ,"$4,050.00 ", N/A ,"$2,839.50 ","$2,700.00 ","$4,050.00 ", N/A ,"$4,050.00 ","$4,050.00 ", N/A ,"$2,925.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204095,C1753,HC CATHETER US IMAGING/IVUS T10,272,1 ,"$5,100.00 ","$3,315.00 ","$2,213.40 ","$5,100.00 ","$3,799.50 ","$3,340.50 ", N/A ,"$2,687.70 ", N/A ,"$3,218.10 ","$3,218.10 ","$3,218.10 ","$3,218.10 ","$4,590.00 ","$3,825.00 ", N/A ,"$4,488.00 ", N/A ,"$3,825.00 ","$3,825.00 ","$4,335.00 ","$4,335.00 ", N/A ,"$4,335.00 ", N/A ,"$4,029.00 ","$4,029.00 ","$4,029.00 ","$4,590.00 ", N/A ,"$4,590.00 ", N/A ,"$5,100.00 ","$3,340.50 ", N/A ,"$2,213.40 ", N/A , N/A ,"$4,590.00 ", N/A ,"$3,218.10 ","$3,060.00 ","$4,590.00 ", N/A ,"$4,590.00 ","$4,590.00 ", N/A ,"$3,315.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204096,C1753,HC CATHETER US IMAGING/IVUS T11,272,1 ,"$5,700.00 ","$3,705.00 ","$2,473.80 ","$5,700.00 ","$4,246.50 ","$3,733.50 ", N/A ,"$3,003.90 ", N/A ,"$3,596.70 ","$3,596.70 ","$3,596.70 ","$3,596.70 ","$5,130.00 ","$4,275.00 ", N/A ,"$5,016.00 ", N/A ,"$4,275.00 ","$4,275.00 ","$4,845.00 ","$4,845.00 ", N/A ,"$4,845.00 ", N/A ,"$4,503.00 ","$4,503.00 ","$4,503.00 ","$5,130.00 ", N/A ,"$5,130.00 ", N/A ,"$5,700.00 ","$3,733.50 ", N/A ,"$2,473.80 ", N/A , N/A ,"$5,130.00 ", N/A ,"$3,596.70 ","$3,420.00 ","$5,130.00 ", N/A ,"$5,130.00 ","$5,130.00 ", N/A ,"$3,705.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204097,C1753,HC CATHETER US IMAGING/IVUS T12,272,1 ,"$6,300.00 ","$4,095.00 ","$2,734.20 ","$6,300.00 ","$4,693.50 ","$4,126.50 ", N/A ,"$3,320.10 ", N/A ,"$3,975.30 ","$3,975.30 ","$3,975.30 ","$3,975.30 ","$5,670.00 ","$4,725.00 ", N/A ,"$5,544.00 ", N/A ,"$4,725.00 ","$4,725.00 ","$5,355.00 ","$5,355.00 ", N/A ,"$5,355.00 ", N/A ,"$4,977.00 ","$4,977.00 ","$4,977.00 ","$5,670.00 ", N/A ,"$5,670.00 ", N/A ,"$6,300.00 ","$4,126.50 ", N/A ,"$2,734.20 ", N/A , N/A ,"$5,670.00 ", N/A ,"$3,975.30 ","$3,780.00 ","$5,670.00 ", N/A ,"$5,670.00 ","$5,670.00 ", N/A ,"$4,095.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204112,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T12,272,1 ,$750.00 ,$487.50 ,$325.50 ,$750.00 ,$558.75 ,$491.25 , N/A ,$395.25 , N/A ,$473.25 ,$473.25 ,$473.25 ,$473.25 ,$675.00 ,$562.50 , N/A ,$660.00 , N/A ,$562.50 ,$562.50 ,$637.50 ,$637.50 , N/A ,$637.50 , N/A ,$592.50 ,$592.50 ,$592.50 ,$675.00 , N/A ,$675.00 , N/A ,$750.00 ,$491.25 , N/A ,$325.50 , N/A , N/A ,$675.00 , N/A ,$473.25 ,$450.00 ,$675.00 , N/A ,$675.00 ,$675.00 , N/A ,$487.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204113,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T13,272,1 ,$900.00 ,$585.00 ,$390.60 ,$900.00 ,$670.50 ,$589.50 , N/A ,$474.30 , N/A ,$567.90 ,$567.90 ,$567.90 ,$567.90 ,$810.00 ,$675.00 , N/A ,$792.00 , N/A ,$675.00 ,$675.00 ,$765.00 ,$765.00 , N/A ,$765.00 , N/A ,$711.00 ,$711.00 ,$711.00 ,$810.00 , N/A ,$810.00 , N/A ,$900.00 ,$589.50 , N/A ,$390.60 , N/A , N/A ,$810.00 , N/A ,$567.90 ,$540.00 ,$810.00 , N/A ,$810.00 ,$810.00 , N/A ,$585.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204115,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T15,272,1 ,"$1,200.00 ",$780.00 ,$520.80 ,"$1,200.00 ",$894.00 ,$786.00 , N/A ,$632.40 , N/A ,$757.20 ,$757.20 ,$757.20 ,$757.20 ,"$1,080.00 ",$900.00 , N/A ,"$1,056.00 ", N/A ,$900.00 ,$900.00 ,"$1,020.00 ","$1,020.00 ", N/A ,"$1,020.00 ", N/A ,$948.00 ,$948.00 ,$948.00 ,"$1,080.00 ", N/A ,"$1,080.00 ", N/A ,"$1,200.00 ",$786.00 , N/A ,$520.80 , N/A , N/A ,"$1,080.00 ", N/A ,$757.20 ,$720.00 ,"$1,080.00 ", N/A ,"$1,080.00 ","$1,080.00 ", N/A ,$780.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204116,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T16,272,1 ,"$1,350.00 ",$877.50 ,$585.90 ,"$1,350.00 ","$1,005.75 ",$884.25 , N/A ,$711.45 , N/A ,$851.85 ,$851.85 ,$851.85 ,$851.85 ,"$1,215.00 ","$1,012.50 ", N/A ,"$1,188.00 ", N/A ,"$1,012.50 ","$1,012.50 ","$1,147.50 ","$1,147.50 ", N/A ,"$1,147.50 ", N/A ,"$1,066.50 ","$1,066.50 ","$1,066.50 ","$1,215.00 ", N/A ,"$1,215.00 ", N/A ,"$1,350.00 ",$884.25 , N/A ,$585.90 , N/A , N/A ,"$1,215.00 ", N/A ,$851.85 ,$810.00 ,"$1,215.00 ", N/A ,"$1,215.00 ","$1,215.00 ", N/A ,$877.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204117,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T17,272,1 ,"$1,500.00 ",$975.00 ,$651.00 ,"$1,500.00 ","$1,117.50 ",$982.50 , N/A ,$790.50 , N/A ,$946.50 ,$946.50 ,$946.50 ,$946.50 ,"$1,350.00 ","$1,125.00 ", N/A ,"$1,320.00 ", N/A ,"$1,125.00 ","$1,125.00 ","$1,275.00 ","$1,275.00 ", N/A ,"$1,275.00 ", N/A ,"$1,185.00 ","$1,185.00 ","$1,185.00 ","$1,350.00 ", N/A ,"$1,350.00 ", N/A ,"$1,500.00 ",$982.50 , N/A ,$651.00 , N/A , N/A ,"$1,350.00 ", N/A ,$946.50 ,$900.00 ,"$1,350.00 ", N/A ,"$1,350.00 ","$1,350.00 ", N/A ,$975.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204118,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T18,272,1 ,"$2,100.00 ","$1,365.00 ",$911.40 ,"$2,100.00 ","$1,564.50 ","$1,375.50 ", N/A ,"$1,106.70 ", N/A ,"$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,890.00 ","$1,575.00 ", N/A ,"$1,848.00 ", N/A ,"$1,575.00 ","$1,575.00 ","$1,785.00 ","$1,785.00 ", N/A ,"$1,785.00 ", N/A ,"$1,659.00 ","$1,659.00 ","$1,659.00 ","$1,890.00 ", N/A ,"$1,890.00 ", N/A ,"$2,100.00 ","$1,375.50 ", N/A ,$911.40 , N/A , N/A ,"$1,890.00 ", N/A ,"$1,325.10 ","$1,260.00 ","$1,890.00 ", N/A ,"$1,890.00 ","$1,890.00 ", N/A ,"$1,365.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204119,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T19,272,1 ,"$2,700.00 ","$1,755.00 ","$1,171.80 ","$2,700.00 ","$2,011.50 ","$1,768.50 ", N/A ,"$1,422.90 ", N/A ,"$1,703.70 ","$1,703.70 ","$1,703.70 ","$1,703.70 ","$2,430.00 ","$2,025.00 ", N/A ,"$2,376.00 ", N/A ,"$2,025.00 ","$2,025.00 ","$2,295.00 ","$2,295.00 ", N/A ,"$2,295.00 ", N/A ,"$2,133.00 ","$2,133.00 ","$2,133.00 ","$2,430.00 ", N/A ,"$2,430.00 ", N/A ,"$2,700.00 ","$1,768.50 ", N/A ,"$1,171.80 ", N/A , N/A ,"$2,430.00 ", N/A ,"$1,703.70 ","$1,620.00 ","$2,430.00 ", N/A ,"$2,430.00 ","$2,430.00 ", N/A ,"$1,755.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204120,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T20,272,1 ,"$3,300.00 ","$2,145.00 ","$1,432.20 ","$3,300.00 ","$2,458.50 ","$2,161.50 ", N/A ,"$1,739.10 ", N/A ,"$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,970.00 ","$2,475.00 ", N/A ,"$2,904.00 ", N/A ,"$2,475.00 ","$2,475.00 ","$2,805.00 ","$2,805.00 ", N/A ,"$2,805.00 ", N/A ,"$2,607.00 ","$2,607.00 ","$2,607.00 ","$2,970.00 ", N/A ,"$2,970.00 ", N/A ,"$3,300.00 ","$2,161.50 ", N/A ,"$1,432.20 ", N/A , N/A ,"$2,970.00 ", N/A ,"$2,082.30 ","$1,980.00 ","$2,970.00 ", N/A ,"$2,970.00 ","$2,970.00 ", N/A ,"$2,145.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204121,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T21,272,1 ,"$3,900.00 ","$2,535.00 ","$1,692.60 ","$3,900.00 ","$2,905.50 ","$2,554.50 ", N/A ,"$2,055.30 ", N/A ,"$2,460.90 ","$2,460.90 ","$2,460.90 ","$2,460.90 ","$3,510.00 ","$2,925.00 ", N/A ,"$3,432.00 ", N/A ,"$2,925.00 ","$2,925.00 ","$3,315.00 ","$3,315.00 ", N/A ,"$3,315.00 ", N/A ,"$3,081.00 ","$3,081.00 ","$3,081.00 ","$3,510.00 ", N/A ,"$3,510.00 ", N/A ,"$3,900.00 ","$2,554.50 ", N/A ,"$1,692.60 ", N/A , N/A ,"$3,510.00 ", N/A ,"$2,460.90 ","$2,340.00 ","$3,510.00 ", N/A ,"$3,510.00 ","$3,510.00 ", N/A ,"$2,535.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204122,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T22,272,1 ,"$4,500.00 ","$2,925.00 ","$1,953.00 ","$4,500.00 ","$3,352.50 ","$2,947.50 ", N/A ,"$2,371.50 ", N/A ,"$2,839.50 ","$2,839.50 ","$2,839.50 ","$2,839.50 ","$4,050.00 ","$3,375.00 ", N/A ,"$3,960.00 ", N/A ,"$3,375.00 ","$3,375.00 ","$3,825.00 ","$3,825.00 ", N/A ,"$3,825.00 ", N/A ,"$3,555.00 ","$3,555.00 ","$3,555.00 ","$4,050.00 ", N/A ,"$4,050.00 ", N/A ,"$4,500.00 ","$2,947.50 ", N/A ,"$1,953.00 ", N/A , N/A ,"$4,050.00 ", N/A ,"$2,839.50 ","$2,700.00 ","$4,050.00 ", N/A ,"$4,050.00 ","$4,050.00 ", N/A ,"$2,925.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204123,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T23,272,1 ,"$5,100.00 ","$3,315.00 ","$2,213.40 ","$5,100.00 ","$3,799.50 ","$3,340.50 ", N/A ,"$2,687.70 ", N/A ,"$3,218.10 ","$3,218.10 ","$3,218.10 ","$3,218.10 ","$4,590.00 ","$3,825.00 ", N/A ,"$4,488.00 ", N/A ,"$3,825.00 ","$3,825.00 ","$4,335.00 ","$4,335.00 ", N/A ,"$4,335.00 ", N/A ,"$4,029.00 ","$4,029.00 ","$4,029.00 ","$4,590.00 ", N/A ,"$4,590.00 ", N/A ,"$5,100.00 ","$3,340.50 ", N/A ,"$2,213.40 ", N/A , N/A ,"$4,590.00 ", N/A ,"$3,218.10 ","$3,060.00 ","$4,590.00 ", N/A ,"$4,590.00 ","$4,590.00 ", N/A ,"$3,315.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204124,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T24,272,1 ,"$5,700.00 ","$3,705.00 ","$2,473.80 ","$5,700.00 ","$4,246.50 ","$3,733.50 ", N/A ,"$3,003.90 ", N/A ,"$3,596.70 ","$3,596.70 ","$3,596.70 ","$3,596.70 ","$5,130.00 ","$4,275.00 ", N/A ,"$5,016.00 ", N/A ,"$4,275.00 ","$4,275.00 ","$4,845.00 ","$4,845.00 ", N/A ,"$4,845.00 ", N/A ,"$4,503.00 ","$4,503.00 ","$4,503.00 ","$5,130.00 ", N/A ,"$5,130.00 ", N/A ,"$5,700.00 ","$3,733.50 ", N/A ,"$2,473.80 ", N/A , N/A ,"$5,130.00 ", N/A ,"$3,596.70 ","$3,420.00 ","$5,130.00 ", N/A ,"$5,130.00 ","$5,130.00 ", N/A ,"$3,705.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204125,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T25,272,1 ,"$6,300.00 ","$4,095.00 ","$2,734.20 ","$6,300.00 ","$4,693.50 ","$4,126.50 ", N/A ,"$3,320.10 ", N/A ,"$3,975.30 ","$3,975.30 ","$3,975.30 ","$3,975.30 ","$5,670.00 ","$4,725.00 ", N/A ,"$5,544.00 ", N/A ,"$4,725.00 ","$4,725.00 ","$5,355.00 ","$5,355.00 ", N/A ,"$5,355.00 ", N/A ,"$4,977.00 ","$4,977.00 ","$4,977.00 ","$5,670.00 ", N/A ,"$5,670.00 ", N/A ,"$6,300.00 ","$4,126.50 ", N/A ,"$2,734.20 ", N/A , N/A ,"$5,670.00 ", N/A ,"$3,975.30 ","$3,780.00 ","$5,670.00 ", N/A ,"$5,670.00 ","$5,670.00 ", N/A ,"$4,095.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204126,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T26,272,1 ,"$6,900.00 ","$4,485.00 ","$2,994.60 ","$6,900.00 ","$5,140.50 ","$4,519.50 ", N/A ,"$3,636.30 ", N/A ,"$4,353.90 ","$4,353.90 ","$4,353.90 ","$4,353.90 ","$6,210.00 ","$5,175.00 ", N/A ,"$6,072.00 ", N/A ,"$5,175.00 ","$5,175.00 ","$5,865.00 ","$5,865.00 ", N/A ,"$5,865.00 ", N/A ,"$5,451.00 ","$5,451.00 ","$5,451.00 ","$6,210.00 ", N/A ,"$6,210.00 ", N/A ,"$6,900.00 ","$4,519.50 ", N/A ,"$2,994.60 ", N/A , N/A ,"$6,210.00 ", N/A ,"$4,353.90 ","$4,140.00 ","$6,210.00 ", N/A ,"$6,210.00 ","$6,210.00 ", N/A ,"$4,485.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204127,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T27,272,1 ,"$7,500.00 ","$4,875.00 ","$3,255.00 ","$7,500.00 ","$5,587.50 ","$4,912.50 ", N/A ,"$3,952.50 ", N/A ,"$4,732.50 ","$4,732.50 ","$4,732.50 ","$4,732.50 ","$6,750.00 ","$5,625.00 ", N/A ,"$6,600.00 ", N/A ,"$5,625.00 ","$5,625.00 ","$6,375.00 ","$6,375.00 ", N/A ,"$6,375.00 ", N/A ,"$5,925.00 ","$5,925.00 ","$5,925.00 ","$6,750.00 ", N/A ,"$6,750.00 ", N/A ,"$7,500.00 ","$4,912.50 ", N/A ,"$3,255.00 ", N/A , N/A ,"$6,750.00 ", N/A ,"$4,732.50 ","$4,500.00 ","$6,750.00 ", N/A ,"$6,750.00 ","$6,750.00 ", N/A ,"$4,875.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204131,C1757,HC CATHETER THROMBECTOMY/EMBOLECTOMY T31,272,1 ,"$9,900.00 ","$6,435.00 ","$4,296.60 ","$9,900.00 ","$7,375.50 ","$6,484.50 ", N/A ,"$5,217.30 ", N/A ,"$6,246.90 ","$6,246.90 ","$6,246.90 ","$6,246.90 ","$8,910.00 ","$7,425.00 ", N/A ,"$8,712.00 ", N/A ,"$7,425.00 ","$7,425.00 ","$8,415.00 ","$8,415.00 ", N/A ,"$8,415.00 ", N/A ,"$7,821.00 ","$7,821.00 ","$7,821.00 ","$8,910.00 ", N/A ,"$8,910.00 ", N/A ,"$9,900.00 ","$6,484.50 ", N/A ,"$4,296.60 ", N/A , N/A ,"$8,910.00 ", N/A ,"$6,246.90 ","$5,940.00 ","$8,910.00 ", N/A ,"$8,910.00 ","$8,910.00 ", N/A ,"$6,435.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204166,C1760,HC DEVICE VASCULAR CLOSURE T3,272,1 ,$30.00 ,$19.50 ,$13.02 ,$30.00 ,$22.35 ,$19.65 , N/A ,$15.81 , N/A ,$18.93 ,$18.93 ,$18.93 ,$18.93 ,$27.00 ,$22.50 , N/A ,$26.40 , N/A ,$22.50 ,$22.50 ,$25.50 ,$25.50 , N/A ,$25.50 , N/A ,$23.70 ,$23.70 ,$23.70 ,$27.00 , N/A ,$27.00 , N/A ,$30.00 ,$19.65 , N/A ,$13.02 , N/A , N/A ,$27.00 , N/A ,$18.93 ,$18.00 ,$27.00 , N/A ,$27.00 ,$27.00 , N/A ,$19.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204167,C1760,HC DEVICE VASCULAR CLOSURE T4,272,1 ,$75.00 ,$48.75 ,$32.55 ,$75.00 ,$55.88 ,$49.13 , N/A ,$39.53 , N/A ,$47.33 ,$47.33 ,$47.33 ,$47.33 ,$67.50 ,$56.25 , N/A ,$66.00 , N/A ,$56.25 ,$56.25 ,$63.75 ,$63.75 , N/A ,$63.75 , N/A ,$59.25 ,$59.25 ,$59.25 ,$67.50 , N/A ,$67.50 , N/A ,$75.00 ,$49.13 , N/A ,$32.55 , N/A , N/A ,$67.50 , N/A ,$47.33 ,$45.00 ,$67.50 , N/A ,$67.50 ,$67.50 , N/A ,$48.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204168,C1760,HC DEVICE VASCULAR CLOSURE T5,272,1 ,$150.00 ,$97.50 ,$65.10 ,$150.00 ,$111.75 ,$98.25 , N/A ,$79.05 , N/A ,$94.65 ,$94.65 ,$94.65 ,$94.65 ,$135.00 ,$112.50 , N/A ,$132.00 , N/A ,$112.50 ,$112.50 ,$127.50 ,$127.50 , N/A ,$127.50 , N/A ,$118.50 ,$118.50 ,$118.50 ,$135.00 , N/A ,$135.00 , N/A ,$150.00 ,$98.25 , N/A ,$65.10 , N/A , N/A ,$135.00 , N/A ,$94.65 ,$90.00 ,$135.00 , N/A ,$135.00 ,$135.00 , N/A ,$97.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204169,C1760,HC DEVICE VASCULAR CLOSURE T6,272,1 ,$225.00 ,$146.25 ,$97.65 ,$225.00 ,$167.63 ,$147.38 , N/A ,$118.58 , N/A ,$141.98 ,$141.98 ,$141.98 ,$141.98 ,$202.50 ,$168.75 , N/A ,$198.00 , N/A ,$168.75 ,$168.75 ,$191.25 ,$191.25 , N/A ,$191.25 , N/A ,$177.75 ,$177.75 ,$177.75 ,$202.50 , N/A ,$202.50 , N/A ,$225.00 ,$147.38 , N/A ,$97.65 , N/A , N/A ,$202.50 , N/A ,$141.98 ,$135.00 ,$202.50 , N/A ,$202.50 ,$202.50 , N/A ,$146.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204170,C1760,HC DEVICE VASCULAR CLOSURE T7,272,1 ,$300.00 ,$195.00 ,$130.20 ,$300.00 ,$223.50 ,$196.50 , N/A ,$158.10 , N/A ,$189.30 ,$189.30 ,$189.30 ,$189.30 ,$270.00 ,$225.00 , N/A ,$264.00 , N/A ,$225.00 ,$225.00 ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$237.00 ,$237.00 ,$237.00 ,$270.00 , N/A ,$270.00 , N/A ,$300.00 ,$196.50 , N/A ,$130.20 , N/A , N/A ,$270.00 , N/A ,$189.30 ,$180.00 ,$270.00 , N/A ,$270.00 ,$270.00 , N/A ,$195.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204171,C1760,HC DEVICE VASCULAR CLOSURE T8,272,1 ,$375.00 ,$243.75 ,$162.75 ,$375.00 ,$279.38 ,$245.63 , N/A ,$197.63 , N/A ,$236.63 ,$236.63 ,$236.63 ,$236.63 ,$337.50 ,$281.25 , N/A ,$330.00 , N/A ,$281.25 ,$281.25 ,$318.75 ,$318.75 , N/A ,$318.75 , N/A ,$296.25 ,$296.25 ,$296.25 ,$337.50 , N/A ,$337.50 , N/A ,$375.00 ,$245.63 , N/A ,$162.75 , N/A , N/A ,$337.50 , N/A ,$236.63 ,$225.00 ,$337.50 , N/A ,$337.50 ,$337.50 , N/A ,$243.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204172,C1760,HC DEVICE VASCULAR CLOSURE T9,272,1 ,$450.00 ,$292.50 ,$195.30 ,$450.00 ,$335.25 ,$294.75 , N/A ,$237.15 , N/A ,$283.95 ,$283.95 ,$283.95 ,$283.95 ,$405.00 ,$337.50 , N/A ,$396.00 , N/A ,$337.50 ,$337.50 ,$382.50 ,$382.50 , N/A ,$382.50 , N/A ,$355.50 ,$355.50 ,$355.50 ,$405.00 , N/A ,$405.00 , N/A ,$450.00 ,$294.75 , N/A ,$195.30 , N/A , N/A ,$405.00 , N/A ,$283.95 ,$270.00 ,$405.00 , N/A ,$405.00 ,$405.00 , N/A ,$292.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204173,C1760,HC DEVICE VASCULAR CLOSURE T10,272,1 ,$525.00 ,$341.25 ,$227.85 ,$525.00 ,$391.13 ,$343.88 , N/A ,$276.68 , N/A ,$331.28 ,$331.28 ,$331.28 ,$331.28 ,$472.50 ,$393.75 , N/A ,$462.00 , N/A ,$393.75 ,$393.75 ,$446.25 ,$446.25 , N/A ,$446.25 , N/A ,$414.75 ,$414.75 ,$414.75 ,$472.50 , N/A ,$472.50 , N/A ,$525.00 ,$343.88 , N/A ,$227.85 , N/A , N/A ,$472.50 , N/A ,$331.28 ,$315.00 ,$472.50 , N/A ,$472.50 ,$472.50 , N/A ,$341.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204174,C1760,HC DEVICE VASCULAR CLOSURE T11,272,1 ,$600.00 ,$390.00 ,$260.40 ,$600.00 ,$447.00 ,$393.00 , N/A ,$316.20 , N/A ,$378.60 ,$378.60 ,$378.60 ,$378.60 ,$540.00 ,$450.00 , N/A ,$528.00 , N/A ,$450.00 ,$450.00 ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$474.00 ,$474.00 ,$474.00 ,$540.00 , N/A ,$540.00 , N/A ,$600.00 ,$393.00 , N/A ,$260.40 , N/A , N/A ,$540.00 , N/A ,$378.60 ,$360.00 ,$540.00 , N/A ,$540.00 ,$540.00 , N/A ,$390.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204175,C1760,HC DEVICE VASCULAR CLOSURE T12,272,1 ,$750.00 ,$487.50 ,$325.50 ,$750.00 ,$558.75 ,$491.25 , N/A ,$395.25 , N/A ,$473.25 ,$473.25 ,$473.25 ,$473.25 ,$675.00 ,$562.50 , N/A ,$660.00 , N/A ,$562.50 ,$562.50 ,$637.50 ,$637.50 , N/A ,$637.50 , N/A ,$592.50 ,$592.50 ,$592.50 ,$675.00 , N/A ,$675.00 , N/A ,$750.00 ,$491.25 , N/A ,$325.50 , N/A , N/A ,$675.00 , N/A ,$473.25 ,$450.00 ,$675.00 , N/A ,$675.00 ,$675.00 , N/A ,$487.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204177,C1760,HC DEVICE VASCULAR CLOSURE T14,272,1 ,"$1,050.00 ",$682.50 ,$455.70 ,"$1,050.00 ",$782.25 ,$687.75 , N/A ,$553.35 , N/A ,$662.55 ,$662.55 ,$662.55 ,$662.55 ,$945.00 ,$787.50 , N/A ,$924.00 , N/A ,$787.50 ,$787.50 ,$892.50 ,$892.50 , N/A ,$892.50 , N/A ,$829.50 ,$829.50 ,$829.50 ,$945.00 , N/A ,$945.00 , N/A ,"$1,050.00 ",$687.75 , N/A ,$455.70 , N/A , N/A ,$945.00 , N/A ,$662.55 ,$630.00 ,$945.00 , N/A ,$945.00 ,$945.00 , N/A ,$682.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204201,C1769,HC GUIDEWIRE GLIDEWIRE T4,272,1 ,$75.00 ,$48.75 ,$32.55 ,$75.00 ,$55.88 ,$49.13 , N/A ,$39.53 , N/A ,$47.33 ,$47.33 ,$47.33 ,$47.33 ,$67.50 ,$56.25 , N/A ,$66.00 , N/A ,$56.25 ,$56.25 ,$63.75 ,$63.75 , N/A ,$63.75 , N/A ,$59.25 ,$59.25 ,$59.25 ,$67.50 , N/A ,$67.50 , N/A ,$75.00 ,$49.13 , N/A ,$32.55 , N/A , N/A ,$67.50 , N/A ,$47.33 ,$45.00 ,$67.50 , N/A ,$67.50 ,$67.50 , N/A ,$48.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204218,C1769,HC GUIDEWIRE T1,272,1 ,$10.00 ,$6.50 ,$4.34 ,$10.00 ,$7.45 ,$6.55 , N/A ,$5.27 , N/A ,$6.31 ,$6.31 ,$6.31 ,$6.31 ,$9.00 ,$7.50 , N/A ,$8.80 , N/A ,$7.50 ,$7.50 ,$8.50 ,$8.50 , N/A ,$8.50 , N/A ,$7.90 ,$7.90 ,$7.90 ,$9.00 , N/A ,$9.00 , N/A ,$10.00 ,$6.55 , N/A ,$4.34 , N/A , N/A ,$9.00 , N/A ,$6.31 ,$6.00 ,$9.00 , N/A ,$9.00 ,$9.00 , N/A ,$6.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204219,C1769,HC GUIDEWIRE T2,272,1 ,$20.00 ,$13.00 ,$8.68 ,$20.00 ,$14.90 ,$13.10 , N/A ,$10.54 , N/A ,$12.62 ,$12.62 ,$12.62 ,$12.62 ,$18.00 ,$15.00 , N/A ,$17.60 , N/A ,$15.00 ,$15.00 ,$17.00 ,$17.00 , N/A ,$17.00 , N/A ,$15.80 ,$15.80 ,$15.80 ,$18.00 , N/A ,$18.00 , N/A ,$20.00 ,$13.10 , N/A ,$8.68 , N/A , N/A ,$18.00 , N/A ,$12.62 ,$12.00 ,$18.00 , N/A ,$18.00 ,$18.00 , N/A ,$13.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204220,C1769,HC GUIDEWIRE T3,272,1 ,$30.00 ,$19.50 ,$13.02 ,$30.00 ,$22.35 ,$19.65 , N/A ,$15.81 , N/A ,$18.93 ,$18.93 ,$18.93 ,$18.93 ,$27.00 ,$22.50 , N/A ,$26.40 , N/A ,$22.50 ,$22.50 ,$25.50 ,$25.50 , N/A ,$25.50 , N/A ,$23.70 ,$23.70 ,$23.70 ,$27.00 , N/A ,$27.00 , N/A ,$30.00 ,$19.65 , N/A ,$13.02 , N/A , N/A ,$27.00 , N/A ,$18.93 ,$18.00 ,$27.00 , N/A ,$27.00 ,$27.00 , N/A ,$19.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204221,C1769,HC GUIDEWIRE T4,272,1 ,$75.00 ,$48.75 ,$32.55 ,$75.00 ,$55.88 ,$49.13 , N/A ,$39.53 , N/A ,$47.33 ,$47.33 ,$47.33 ,$47.33 ,$67.50 ,$56.25 , N/A ,$66.00 , N/A ,$56.25 ,$56.25 ,$63.75 ,$63.75 , N/A ,$63.75 , N/A ,$59.25 ,$59.25 ,$59.25 ,$67.50 , N/A ,$67.50 , N/A ,$75.00 ,$49.13 , N/A ,$32.55 , N/A , N/A ,$67.50 , N/A ,$47.33 ,$45.00 ,$67.50 , N/A ,$67.50 ,$67.50 , N/A ,$48.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204222,C1769,HC GUIDEWIRE T5,272,1 ,$150.00 ,$97.50 ,$65.10 ,$150.00 ,$111.75 ,$98.25 , N/A ,$79.05 , N/A ,$94.65 ,$94.65 ,$94.65 ,$94.65 ,$135.00 ,$112.50 , N/A ,$132.00 , N/A ,$112.50 ,$112.50 ,$127.50 ,$127.50 , N/A ,$127.50 , N/A ,$118.50 ,$118.50 ,$118.50 ,$135.00 , N/A ,$135.00 , N/A ,$150.00 ,$98.25 , N/A ,$65.10 , N/A , N/A ,$135.00 , N/A ,$94.65 ,$90.00 ,$135.00 , N/A ,$135.00 ,$135.00 , N/A ,$97.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204223,C1769,HC GUIDEWIRE T6,272,1 ,$225.00 ,$146.25 ,$97.65 ,$225.00 ,$167.63 ,$147.38 , N/A ,$118.58 , N/A ,$141.98 ,$141.98 ,$141.98 ,$141.98 ,$202.50 ,$168.75 , N/A ,$198.00 , N/A ,$168.75 ,$168.75 ,$191.25 ,$191.25 , N/A ,$191.25 , N/A ,$177.75 ,$177.75 ,$177.75 ,$202.50 , N/A ,$202.50 , N/A ,$225.00 ,$147.38 , N/A ,$97.65 , N/A , N/A ,$202.50 , N/A ,$141.98 ,$135.00 ,$202.50 , N/A ,$202.50 ,$202.50 , N/A ,$146.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204224,C1769,HC GUIDEWIRE T7,272,1 ,$300.00 ,$195.00 ,$130.20 ,$300.00 ,$223.50 ,$196.50 , N/A ,$158.10 , N/A ,$189.30 ,$189.30 ,$189.30 ,$189.30 ,$270.00 ,$225.00 , N/A ,$264.00 , N/A ,$225.00 ,$225.00 ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$237.00 ,$237.00 ,$237.00 ,$270.00 , N/A ,$270.00 , N/A ,$300.00 ,$196.50 , N/A ,$130.20 , N/A , N/A ,$270.00 , N/A ,$189.30 ,$180.00 ,$270.00 , N/A ,$270.00 ,$270.00 , N/A ,$195.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204225,C1769,HC GUIDEWIRE T8,272,1 ,$375.00 ,$243.75 ,$162.75 ,$375.00 ,$279.38 ,$245.63 , N/A ,$197.63 , N/A ,$236.63 ,$236.63 ,$236.63 ,$236.63 ,$337.50 ,$281.25 , N/A ,$330.00 , N/A ,$281.25 ,$281.25 ,$318.75 ,$318.75 , N/A ,$318.75 , N/A ,$296.25 ,$296.25 ,$296.25 ,$337.50 , N/A ,$337.50 , N/A ,$375.00 ,$245.63 , N/A ,$162.75 , N/A , N/A ,$337.50 , N/A ,$236.63 ,$225.00 ,$337.50 , N/A ,$337.50 ,$337.50 , N/A ,$243.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204226,C1769,HC GUIDEWIRE T9,272,1 ,$450.00 ,$292.50 ,$195.30 ,$450.00 ,$335.25 ,$294.75 , N/A ,$237.15 , N/A ,$283.95 ,$283.95 ,$283.95 ,$283.95 ,$405.00 ,$337.50 , N/A ,$396.00 , N/A ,$337.50 ,$337.50 ,$382.50 ,$382.50 , N/A ,$382.50 , N/A ,$355.50 ,$355.50 ,$355.50 ,$405.00 , N/A ,$405.00 , N/A ,$450.00 ,$294.75 , N/A ,$195.30 , N/A , N/A ,$405.00 , N/A ,$283.95 ,$270.00 ,$405.00 , N/A ,$405.00 ,$405.00 , N/A ,$292.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204227,C1769,HC GUIDEWIRE T10,272,1 ,$525.00 ,$341.25 ,$227.85 ,$525.00 ,$391.13 ,$343.88 , N/A ,$276.68 , N/A ,$331.28 ,$331.28 ,$331.28 ,$331.28 ,$472.50 ,$393.75 , N/A ,$462.00 , N/A ,$393.75 ,$393.75 ,$446.25 ,$446.25 , N/A ,$446.25 , N/A ,$414.75 ,$414.75 ,$414.75 ,$472.50 , N/A ,$472.50 , N/A ,$525.00 ,$343.88 , N/A ,$227.85 , N/A , N/A ,$472.50 , N/A ,$331.28 ,$315.00 ,$472.50 , N/A ,$472.50 ,$472.50 , N/A ,$341.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204228,C1769,HC GUIDEWIRE T11,272,1 ,$600.00 ,$390.00 ,$260.40 ,$600.00 ,$447.00 ,$393.00 , N/A ,$316.20 , N/A ,$378.60 ,$378.60 ,$378.60 ,$378.60 ,$540.00 ,$450.00 , N/A ,$528.00 , N/A ,$450.00 ,$450.00 ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$474.00 ,$474.00 ,$474.00 ,$540.00 , N/A ,$540.00 , N/A ,$600.00 ,$393.00 , N/A ,$260.40 , N/A , N/A ,$540.00 , N/A ,$378.60 ,$360.00 ,$540.00 , N/A ,$540.00 ,$540.00 , N/A ,$390.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204229,C1769,HC GUIDEWIRE T12,272,1 ,$750.00 ,$487.50 ,$325.50 ,$750.00 ,$558.75 ,$491.25 , N/A ,$395.25 , N/A ,$473.25 ,$473.25 ,$473.25 ,$473.25 ,$675.00 ,$562.50 , N/A ,$660.00 , N/A ,$562.50 ,$562.50 ,$637.50 ,$637.50 , N/A ,$637.50 , N/A ,$592.50 ,$592.50 ,$592.50 ,$675.00 , N/A ,$675.00 , N/A ,$750.00 ,$491.25 , N/A ,$325.50 , N/A , N/A ,$675.00 , N/A ,$473.25 ,$450.00 ,$675.00 , N/A ,$675.00 ,$675.00 , N/A ,$487.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204230,C1769,HC GUIDEWIRE T13,272,1 ,$900.00 ,$585.00 ,$390.60 ,$900.00 ,$670.50 ,$589.50 , N/A ,$474.30 , N/A ,$567.90 ,$567.90 ,$567.90 ,$567.90 ,$810.00 ,$675.00 , N/A ,$792.00 , N/A ,$675.00 ,$675.00 ,$765.00 ,$765.00 , N/A ,$765.00 , N/A ,$711.00 ,$711.00 ,$711.00 ,$810.00 , N/A ,$810.00 , N/A ,$900.00 ,$589.50 , N/A ,$390.60 , N/A , N/A ,$810.00 , N/A ,$567.90 ,$540.00 ,$810.00 , N/A ,$810.00 ,$810.00 , N/A ,$585.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204231,C1769,HC GUIDEWIRE T14,272,1 ,"$1,050.00 ",$682.50 ,$455.70 ,"$1,050.00 ",$782.25 ,$687.75 , N/A ,$553.35 , N/A ,$662.55 ,$662.55 ,$662.55 ,$662.55 ,$945.00 ,$787.50 , N/A ,$924.00 , N/A ,$787.50 ,$787.50 ,$892.50 ,$892.50 , N/A ,$892.50 , N/A ,$829.50 ,$829.50 ,$829.50 ,$945.00 , N/A ,$945.00 , N/A ,"$1,050.00 ",$687.75 , N/A ,$455.70 , N/A , N/A ,$945.00 , N/A ,$662.55 ,$630.00 ,$945.00 , N/A ,$945.00 ,$945.00 , N/A ,$682.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204232,C1769,HC GUIDEWIRE T15,272,1 ,"$1,200.00 ",$780.00 ,$520.80 ,"$1,200.00 ",$894.00 ,$786.00 , N/A ,$632.40 , N/A ,$757.20 ,$757.20 ,$757.20 ,$757.20 ,"$1,080.00 ",$900.00 , N/A ,"$1,056.00 ", N/A ,$900.00 ,$900.00 ,"$1,020.00 ","$1,020.00 ", N/A ,"$1,020.00 ", N/A ,$948.00 ,$948.00 ,$948.00 ,"$1,080.00 ", N/A ,"$1,080.00 ", N/A ,"$1,200.00 ",$786.00 , N/A ,$520.80 , N/A , N/A ,"$1,080.00 ", N/A ,$757.20 ,$720.00 ,"$1,080.00 ", N/A ,"$1,080.00 ","$1,080.00 ", N/A ,$780.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204251,C1773,HC DEVICE RETRIEVAL INSERTABLE T6,272,1 ,$225.00 ,$146.25 ,$97.65 ,$225.00 ,$167.63 ,$147.38 , N/A ,$118.58 , N/A ,$141.98 ,$141.98 ,$141.98 ,$141.98 ,$202.50 ,$168.75 , N/A ,$198.00 , N/A ,$168.75 ,$168.75 ,$191.25 ,$191.25 , N/A ,$191.25 , N/A ,$177.75 ,$177.75 ,$177.75 ,$202.50 , N/A ,$202.50 , N/A ,$225.00 ,$147.38 , N/A ,$97.65 , N/A , N/A ,$202.50 , N/A ,$141.98 ,$135.00 ,$202.50 , N/A ,$202.50 ,$202.50 , N/A ,$146.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204252,C1773,HC DEVICE RETRIEVAL INSERTABLE T7,272,1 ,$300.00 ,$195.00 ,$130.20 ,$300.00 ,$223.50 ,$196.50 , N/A ,$158.10 , N/A ,$189.30 ,$189.30 ,$189.30 ,$189.30 ,$270.00 ,$225.00 , N/A ,$264.00 , N/A ,$225.00 ,$225.00 ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$237.00 ,$237.00 ,$237.00 ,$270.00 , N/A ,$270.00 , N/A ,$300.00 ,$196.50 , N/A ,$130.20 , N/A , N/A ,$270.00 , N/A ,$189.30 ,$180.00 ,$270.00 , N/A ,$270.00 ,$270.00 , N/A ,$195.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204253,C1773,HC DEVICE RETRIEVAL INSERTABLE T8,272,1 ,$375.00 ,$243.75 ,$162.75 ,$375.00 ,$279.38 ,$245.63 , N/A ,$197.63 , N/A ,$236.63 ,$236.63 ,$236.63 ,$236.63 ,$337.50 ,$281.25 , N/A ,$330.00 , N/A ,$281.25 ,$281.25 ,$318.75 ,$318.75 , N/A ,$318.75 , N/A ,$296.25 ,$296.25 ,$296.25 ,$337.50 , N/A ,$337.50 , N/A ,$375.00 ,$245.63 , N/A ,$162.75 , N/A , N/A ,$337.50 , N/A ,$236.63 ,$225.00 ,$337.50 , N/A ,$337.50 ,$337.50 , N/A ,$243.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204254,C1773,HC DEVICE RETRIEVAL INSERTABLE T9,272,1 ,$450.00 ,$292.50 ,$195.30 ,$450.00 ,$335.25 ,$294.75 , N/A ,$237.15 , N/A ,$283.95 ,$283.95 ,$283.95 ,$283.95 ,$405.00 ,$337.50 , N/A ,$396.00 , N/A ,$337.50 ,$337.50 ,$382.50 ,$382.50 , N/A ,$382.50 , N/A ,$355.50 ,$355.50 ,$355.50 ,$405.00 , N/A ,$405.00 , N/A ,$450.00 ,$294.75 , N/A ,$195.30 , N/A , N/A ,$405.00 , N/A ,$283.95 ,$270.00 ,$405.00 , N/A ,$405.00 ,$405.00 , N/A ,$292.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204255,C1773,HC DEVICE RETRIEVAL INSERTABLE T10,272,1 ,$525.00 ,$341.25 ,$227.85 ,$525.00 ,$391.13 ,$343.88 , N/A ,$276.68 , N/A ,$331.28 ,$331.28 ,$331.28 ,$331.28 ,$472.50 ,$393.75 , N/A ,$462.00 , N/A ,$393.75 ,$393.75 ,$446.25 ,$446.25 , N/A ,$446.25 , N/A ,$414.75 ,$414.75 ,$414.75 ,$472.50 , N/A ,$472.50 , N/A ,$525.00 ,$343.88 , N/A ,$227.85 , N/A , N/A ,$472.50 , N/A ,$331.28 ,$315.00 ,$472.50 , N/A ,$472.50 ,$472.50 , N/A ,$341.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204256,C1773,HC DEVICE RETRIEVAL INSERTABLE T11,272,1 ,$600.00 ,$390.00 ,$260.40 ,$600.00 ,$447.00 ,$393.00 , N/A ,$316.20 , N/A ,$378.60 ,$378.60 ,$378.60 ,$378.60 ,$540.00 ,$450.00 , N/A ,$528.00 , N/A ,$450.00 ,$450.00 ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$474.00 ,$474.00 ,$474.00 ,$540.00 , N/A ,$540.00 , N/A ,$600.00 ,$393.00 , N/A ,$260.40 , N/A , N/A ,$540.00 , N/A ,$378.60 ,$360.00 ,$540.00 , N/A ,$540.00 ,$540.00 , N/A ,$390.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204257,C1773,HC DEVICE RETRIEVAL INSERTABLE T12,272,1 ,$750.00 ,$487.50 ,$325.50 ,$750.00 ,$558.75 ,$491.25 , N/A ,$395.25 , N/A ,$473.25 ,$473.25 ,$473.25 ,$473.25 ,$675.00 ,$562.50 , N/A ,$660.00 , N/A ,$562.50 ,$562.50 ,$637.50 ,$637.50 , N/A ,$637.50 , N/A ,$592.50 ,$592.50 ,$592.50 ,$675.00 , N/A ,$675.00 , N/A ,$750.00 ,$491.25 , N/A ,$325.50 , N/A , N/A ,$675.00 , N/A ,$473.25 ,$450.00 ,$675.00 , N/A ,$675.00 ,$675.00 , N/A ,$487.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204258,C1773,HC DEVICE RETRIEVAL INSERTABLE T13,272,1 ,$900.00 ,$585.00 ,$390.60 ,$900.00 ,$670.50 ,$589.50 , N/A ,$474.30 , N/A ,$567.90 ,$567.90 ,$567.90 ,$567.90 ,$810.00 ,$675.00 , N/A ,$792.00 , N/A ,$675.00 ,$675.00 ,$765.00 ,$765.00 , N/A ,$765.00 , N/A ,$711.00 ,$711.00 ,$711.00 ,$810.00 , N/A ,$810.00 , N/A ,$900.00 ,$589.50 , N/A ,$390.60 , N/A , N/A ,$810.00 , N/A ,$567.90 ,$540.00 ,$810.00 , N/A ,$810.00 ,$810.00 , N/A ,$585.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204259,C1773,HC DEVICE RETRIEVAL INSERTABLE T14,272,1 ,"$1,050.00 ",$682.50 ,$455.70 ,"$1,050.00 ",$782.25 ,$687.75 , N/A ,$553.35 , N/A ,$662.55 ,$662.55 ,$662.55 ,$662.55 ,$945.00 ,$787.50 , N/A ,$924.00 , N/A ,$787.50 ,$787.50 ,$892.50 ,$892.50 , N/A ,$892.50 , N/A ,$829.50 ,$829.50 ,$829.50 ,$945.00 , N/A ,$945.00 , N/A ,"$1,050.00 ",$687.75 , N/A ,$455.70 , N/A , N/A ,$945.00 , N/A ,$662.55 ,$630.00 ,$945.00 , N/A ,$945.00 ,$945.00 , N/A ,$682.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204260,C1773,HC DEVICE RETRIEVAL INSERTABLE T15,272,1 ,"$1,200.00 ",$780.00 ,$520.80 ,"$1,200.00 ",$894.00 ,$786.00 , N/A ,$632.40 , N/A ,$757.20 ,$757.20 ,$757.20 ,$757.20 ,"$1,080.00 ",$900.00 , N/A ,"$1,056.00 ", N/A ,$900.00 ,$900.00 ,"$1,020.00 ","$1,020.00 ", N/A ,"$1,020.00 ", N/A ,$948.00 ,$948.00 ,$948.00 ,"$1,080.00 ", N/A ,"$1,080.00 ", N/A ,"$1,200.00 ",$786.00 , N/A ,$520.80 , N/A , N/A ,"$1,080.00 ", N/A ,$757.20 ,$720.00 ,"$1,080.00 ", N/A ,"$1,080.00 ","$1,080.00 ", N/A ,$780.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204289,C1884,HC SYSTEM EMBOLIZATION PROTECTIVE T12,272,1 ,$750.00 ,$487.50 ,$325.50 ,$750.00 ,$558.75 ,$491.25 , N/A ,$395.25 , N/A ,$473.25 ,$473.25 ,$473.25 ,$473.25 ,$675.00 ,$562.50 , N/A ,$660.00 , N/A ,$562.50 ,$562.50 ,$637.50 ,$637.50 , N/A ,$637.50 , N/A ,$592.50 ,$592.50 ,$592.50 ,$675.00 , N/A ,$675.00 , N/A ,$750.00 ,$491.25 , N/A ,$325.50 , N/A , N/A ,$675.00 , N/A ,$473.25 ,$450.00 ,$675.00 , N/A ,$675.00 ,$675.00 , N/A ,$487.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204290,C1884,HC SYSTEM EMBOLIZATION PROTECTIVE T13,272,1 ,$900.00 ,$585.00 ,$390.60 ,$900.00 ,$670.50 ,$589.50 , N/A ,$474.30 , N/A ,$567.90 ,$567.90 ,$567.90 ,$567.90 ,$810.00 ,$675.00 , N/A ,$792.00 , N/A ,$675.00 ,$675.00 ,$765.00 ,$765.00 , N/A ,$765.00 , N/A ,$711.00 ,$711.00 ,$711.00 ,$810.00 , N/A ,$810.00 , N/A ,$900.00 ,$589.50 , N/A ,$390.60 , N/A , N/A ,$810.00 , N/A ,$567.90 ,$540.00 ,$810.00 , N/A ,$810.00 ,$810.00 , N/A ,$585.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204291,C1884,HC SYSTEM EMBOLIZATION PROTECTIVE T14,272,1 ,"$1,050.00 ",$682.50 ,$455.70 ,"$1,050.00 ",$782.25 ,$687.75 , N/A ,$553.35 , N/A ,$662.55 ,$662.55 ,$662.55 ,$662.55 ,$945.00 ,$787.50 , N/A ,$924.00 , N/A ,$787.50 ,$787.50 ,$892.50 ,$892.50 , N/A ,$892.50 , N/A ,$829.50 ,$829.50 ,$829.50 ,$945.00 , N/A ,$945.00 , N/A ,"$1,050.00 ",$687.75 , N/A ,$455.70 , N/A , N/A ,$945.00 , N/A ,$662.55 ,$630.00 ,$945.00 , N/A ,$945.00 ,$945.00 , N/A ,$682.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204292,C1884,HC SYSTEM EMBOLIZATION PROTECTIVE T15,272,1 ,"$1,200.00 ",$780.00 ,$520.80 ,"$1,200.00 ",$894.00 ,$786.00 , N/A ,$632.40 , N/A ,$757.20 ,$757.20 ,$757.20 ,$757.20 ,"$1,080.00 ",$900.00 , N/A ,"$1,056.00 ", N/A ,$900.00 ,$900.00 ,"$1,020.00 ","$1,020.00 ", N/A ,"$1,020.00 ", N/A ,$948.00 ,$948.00 ,$948.00 ,"$1,080.00 ", N/A ,"$1,080.00 ", N/A ,"$1,200.00 ",$786.00 , N/A ,$520.80 , N/A , N/A ,"$1,080.00 ", N/A ,$757.20 ,$720.00 ,"$1,080.00 ", N/A ,"$1,080.00 ","$1,080.00 ", N/A ,$780.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204293,C1884,HC SYSTEM EMBOLIZATION PROTECTIVE T16,272,1 ,"$1,350.00 ",$877.50 ,$585.90 ,"$1,350.00 ","$1,005.75 ",$884.25 , N/A ,$711.45 , N/A ,$851.85 ,$851.85 ,$851.85 ,$851.85 ,"$1,215.00 ","$1,012.50 ", N/A ,"$1,188.00 ", N/A ,"$1,012.50 ","$1,012.50 ","$1,147.50 ","$1,147.50 ", N/A ,"$1,147.50 ", N/A ,"$1,066.50 ","$1,066.50 ","$1,066.50 ","$1,215.00 ", N/A ,"$1,215.00 ", N/A ,"$1,350.00 ",$884.25 , N/A ,$585.90 , N/A , N/A ,"$1,215.00 ", N/A ,$851.85 ,$810.00 ,"$1,215.00 ", N/A ,"$1,215.00 ","$1,215.00 ", N/A ,$877.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204294,C1884,HC SYSTEM EMBOLIZATION PROTECTIVE T17,272,1 ,"$1,500.00 ",$975.00 ,$651.00 ,"$1,500.00 ","$1,117.50 ",$982.50 , N/A ,$790.50 , N/A ,$946.50 ,$946.50 ,$946.50 ,$946.50 ,"$1,350.00 ","$1,125.00 ", N/A ,"$1,320.00 ", N/A ,"$1,125.00 ","$1,125.00 ","$1,275.00 ","$1,275.00 ", N/A ,"$1,275.00 ", N/A ,"$1,185.00 ","$1,185.00 ","$1,185.00 ","$1,350.00 ", N/A ,"$1,350.00 ", N/A ,"$1,500.00 ",$982.50 , N/A ,$651.00 , N/A , N/A ,"$1,350.00 ", N/A ,$946.50 ,$900.00 ,"$1,350.00 ", N/A ,"$1,350.00 ","$1,350.00 ", N/A ,$975.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204295,C1884,HC SYSTEM EMBOLIZATION PROTECTIVE T18,272,1 ,"$2,100.00 ","$1,365.00 ",$911.40 ,"$2,100.00 ","$1,564.50 ","$1,375.50 ", N/A ,"$1,106.70 ", N/A ,"$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,890.00 ","$1,575.00 ", N/A ,"$1,848.00 ", N/A ,"$1,575.00 ","$1,575.00 ","$1,785.00 ","$1,785.00 ", N/A ,"$1,785.00 ", N/A ,"$1,659.00 ","$1,659.00 ","$1,659.00 ","$1,890.00 ", N/A ,"$1,890.00 ", N/A ,"$2,100.00 ","$1,375.50 ", N/A ,$911.40 , N/A , N/A ,"$1,890.00 ", N/A ,"$1,325.10 ","$1,260.00 ","$1,890.00 ", N/A ,"$1,890.00 ","$1,890.00 ", N/A ,"$1,365.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204296,C1884,HC SYSTEM EMBOLIZATION PROTECTIVE T19,272,1 ,"$2,700.00 ","$1,755.00 ","$1,171.80 ","$2,700.00 ","$2,011.50 ","$1,768.50 ", N/A ,"$1,422.90 ", N/A ,"$1,703.70 ","$1,703.70 ","$1,703.70 ","$1,703.70 ","$2,430.00 ","$2,025.00 ", N/A ,"$2,376.00 ", N/A ,"$2,025.00 ","$2,025.00 ","$2,295.00 ","$2,295.00 ", N/A ,"$2,295.00 ", N/A ,"$2,133.00 ","$2,133.00 ","$2,133.00 ","$2,430.00 ", N/A ,"$2,430.00 ", N/A ,"$2,700.00 ","$1,768.50 ", N/A ,"$1,171.80 ", N/A , N/A ,"$2,430.00 ", N/A ,"$1,703.70 ","$1,620.00 ","$2,430.00 ", N/A ,"$2,430.00 ","$2,430.00 ", N/A ,"$1,755.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204297,C1884,HC SYSTEM EMBOLIZATION PROTECTIVE T20,272,1 ,"$3,300.00 ","$2,145.00 ","$1,432.20 ","$3,300.00 ","$2,458.50 ","$2,161.50 ", N/A ,"$1,739.10 ", N/A ,"$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,970.00 ","$2,475.00 ", N/A ,"$2,904.00 ", N/A ,"$2,475.00 ","$2,475.00 ","$2,805.00 ","$2,805.00 ", N/A ,"$2,805.00 ", N/A ,"$2,607.00 ","$2,607.00 ","$2,607.00 ","$2,970.00 ", N/A ,"$2,970.00 ", N/A ,"$3,300.00 ","$2,161.50 ", N/A ,"$1,432.20 ", N/A , N/A ,"$2,970.00 ", N/A ,"$2,082.30 ","$1,980.00 ","$2,970.00 ", N/A ,"$2,970.00 ","$2,970.00 ", N/A ,"$2,145.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204298,C1884,HC SYSTEM EMBOLIZATION PROTECTIVE T21,272,1 ,"$3,900.00 ","$2,535.00 ","$1,692.60 ","$3,900.00 ","$2,905.50 ","$2,554.50 ", N/A ,"$2,055.30 ", N/A ,"$2,460.90 ","$2,460.90 ","$2,460.90 ","$2,460.90 ","$3,510.00 ","$2,925.00 ", N/A ,"$3,432.00 ", N/A ,"$2,925.00 ","$2,925.00 ","$3,315.00 ","$3,315.00 ", N/A ,"$3,315.00 ", N/A ,"$3,081.00 ","$3,081.00 ","$3,081.00 ","$3,510.00 ", N/A ,"$3,510.00 ", N/A ,"$3,900.00 ","$2,554.50 ", N/A ,"$1,692.60 ", N/A , N/A ,"$3,510.00 ", N/A ,"$2,460.90 ","$2,340.00 ","$3,510.00 ", N/A ,"$3,510.00 ","$3,510.00 ", N/A ,"$2,535.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204299,C1884,HC SYSTEM EMBOLIZATION PROTECTIVE T22,272,1 ,"$4,500.00 ","$2,925.00 ","$1,953.00 ","$4,500.00 ","$3,352.50 ","$2,947.50 ", N/A ,"$2,371.50 ", N/A ,"$2,839.50 ","$2,839.50 ","$2,839.50 ","$2,839.50 ","$4,050.00 ","$3,375.00 ", N/A ,"$3,960.00 ", N/A ,"$3,375.00 ","$3,375.00 ","$3,825.00 ","$3,825.00 ", N/A ,"$3,825.00 ", N/A ,"$3,555.00 ","$3,555.00 ","$3,555.00 ","$4,050.00 ", N/A ,"$4,050.00 ", N/A ,"$4,500.00 ","$2,947.50 ", N/A ,"$1,953.00 ", N/A , N/A ,"$4,050.00 ", N/A ,"$2,839.50 ","$2,700.00 ","$4,050.00 ", N/A ,"$4,050.00 ","$4,050.00 ", N/A ,"$2,925.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204326,C1887,HC CATHETER GUIDING T2,272,1 ,$20.00 ,$13.00 ,$8.68 ,$20.00 ,$14.90 ,$13.10 , N/A ,$10.54 , N/A ,$12.62 ,$12.62 ,$12.62 ,$12.62 ,$18.00 ,$15.00 , N/A ,$17.60 , N/A ,$15.00 ,$15.00 ,$17.00 ,$17.00 , N/A ,$17.00 , N/A ,$15.80 ,$15.80 ,$15.80 ,$18.00 , N/A ,$18.00 , N/A ,$20.00 ,$13.10 , N/A ,$8.68 , N/A , N/A ,$18.00 , N/A ,$12.62 ,$12.00 ,$18.00 , N/A ,$18.00 ,$18.00 , N/A ,$13.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204327,C1887,HC CATHETER GUIDING T3,272,1 ,$30.00 ,$19.50 ,$13.02 ,$30.00 ,$22.35 ,$19.65 , N/A ,$15.81 , N/A ,$18.93 ,$18.93 ,$18.93 ,$18.93 ,$27.00 ,$22.50 , N/A ,$26.40 , N/A ,$22.50 ,$22.50 ,$25.50 ,$25.50 , N/A ,$25.50 , N/A ,$23.70 ,$23.70 ,$23.70 ,$27.00 , N/A ,$27.00 , N/A ,$30.00 ,$19.65 , N/A ,$13.02 , N/A , N/A ,$27.00 , N/A ,$18.93 ,$18.00 ,$27.00 , N/A ,$27.00 ,$27.00 , N/A ,$19.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204328,C1887,HC CATHETER GUIDING T4,272,1 ,$75.00 ,$48.75 ,$32.55 ,$75.00 ,$55.88 ,$49.13 , N/A ,$39.53 , N/A ,$47.33 ,$47.33 ,$47.33 ,$47.33 ,$67.50 ,$56.25 , N/A ,$66.00 , N/A ,$56.25 ,$56.25 ,$63.75 ,$63.75 , N/A ,$63.75 , N/A ,$59.25 ,$59.25 ,$59.25 ,$67.50 , N/A ,$67.50 , N/A ,$75.00 ,$49.13 , N/A ,$32.55 , N/A , N/A ,$67.50 , N/A ,$47.33 ,$45.00 ,$67.50 , N/A ,$67.50 ,$67.50 , N/A ,$48.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204329,C1887,HC CATHETER GUIDING T5,272,1 ,$150.00 ,$97.50 ,$65.10 ,$150.00 ,$111.75 ,$98.25 , N/A ,$79.05 , N/A ,$94.65 ,$94.65 ,$94.65 ,$94.65 ,$135.00 ,$112.50 , N/A ,$132.00 , N/A ,$112.50 ,$112.50 ,$127.50 ,$127.50 , N/A ,$127.50 , N/A ,$118.50 ,$118.50 ,$118.50 ,$135.00 , N/A ,$135.00 , N/A ,$150.00 ,$98.25 , N/A ,$65.10 , N/A , N/A ,$135.00 , N/A ,$94.65 ,$90.00 ,$135.00 , N/A ,$135.00 ,$135.00 , N/A ,$97.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204330,C1887,HC CATHETER GUIDING T6,272,1 ,$225.00 ,$146.25 ,$97.65 ,$225.00 ,$167.63 ,$147.38 , N/A ,$118.58 , N/A ,$141.98 ,$141.98 ,$141.98 ,$141.98 ,$202.50 ,$168.75 , N/A ,$198.00 , N/A ,$168.75 ,$168.75 ,$191.25 ,$191.25 , N/A ,$191.25 , N/A ,$177.75 ,$177.75 ,$177.75 ,$202.50 , N/A ,$202.50 , N/A ,$225.00 ,$147.38 , N/A ,$97.65 , N/A , N/A ,$202.50 , N/A ,$141.98 ,$135.00 ,$202.50 , N/A ,$202.50 ,$202.50 , N/A ,$146.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204331,C1887,HC CATHETER GUIDING T7,272,1 ,$300.00 ,$195.00 ,$130.20 ,$300.00 ,$223.50 ,$196.50 , N/A ,$158.10 , N/A ,$189.30 ,$189.30 ,$189.30 ,$189.30 ,$270.00 ,$225.00 , N/A ,$264.00 , N/A ,$225.00 ,$225.00 ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$237.00 ,$237.00 ,$237.00 ,$270.00 , N/A ,$270.00 , N/A ,$300.00 ,$196.50 , N/A ,$130.20 , N/A , N/A ,$270.00 , N/A ,$189.30 ,$180.00 ,$270.00 , N/A ,$270.00 ,$270.00 , N/A ,$195.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204332,C1887,HC CATHETER GUIDING T8,272,1 ,$375.00 ,$243.75 ,$162.75 ,$375.00 ,$279.38 ,$245.63 , N/A ,$197.63 , N/A ,$236.63 ,$236.63 ,$236.63 ,$236.63 ,$337.50 ,$281.25 , N/A ,$330.00 , N/A ,$281.25 ,$281.25 ,$318.75 ,$318.75 , N/A ,$318.75 , N/A ,$296.25 ,$296.25 ,$296.25 ,$337.50 , N/A ,$337.50 , N/A ,$375.00 ,$245.63 , N/A ,$162.75 , N/A , N/A ,$337.50 , N/A ,$236.63 ,$225.00 ,$337.50 , N/A ,$337.50 ,$337.50 , N/A ,$243.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204333,C1887,HC CATHETER GUIDING T9,272,1 ,$450.00 ,$292.50 ,$195.30 ,$450.00 ,$335.25 ,$294.75 , N/A ,$237.15 , N/A ,$283.95 ,$283.95 ,$283.95 ,$283.95 ,$405.00 ,$337.50 , N/A ,$396.00 , N/A ,$337.50 ,$337.50 ,$382.50 ,$382.50 , N/A ,$382.50 , N/A ,$355.50 ,$355.50 ,$355.50 ,$405.00 , N/A ,$405.00 , N/A ,$450.00 ,$294.75 , N/A ,$195.30 , N/A , N/A ,$405.00 , N/A ,$283.95 ,$270.00 ,$405.00 , N/A ,$405.00 ,$405.00 , N/A ,$292.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204334,C1887,HC CATHETER GUIDING T10,272,1 ,$525.00 ,$341.25 ,$227.85 ,$525.00 ,$391.13 ,$343.88 , N/A ,$276.68 , N/A ,$331.28 ,$331.28 ,$331.28 ,$331.28 ,$472.50 ,$393.75 , N/A ,$462.00 , N/A ,$393.75 ,$393.75 ,$446.25 ,$446.25 , N/A ,$446.25 , N/A ,$414.75 ,$414.75 ,$414.75 ,$472.50 , N/A ,$472.50 , N/A ,$525.00 ,$343.88 , N/A ,$227.85 , N/A , N/A ,$472.50 , N/A ,$331.28 ,$315.00 ,$472.50 , N/A ,$472.50 ,$472.50 , N/A ,$341.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204335,C1887,HC CATHETER GUIDING T11,272,1 ,$600.00 ,$390.00 ,$260.40 ,$600.00 ,$447.00 ,$393.00 , N/A ,$316.20 , N/A ,$378.60 ,$378.60 ,$378.60 ,$378.60 ,$540.00 ,$450.00 , N/A ,$528.00 , N/A ,$450.00 ,$450.00 ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$474.00 ,$474.00 ,$474.00 ,$540.00 , N/A ,$540.00 , N/A ,$600.00 ,$393.00 , N/A ,$260.40 , N/A , N/A ,$540.00 , N/A ,$378.60 ,$360.00 ,$540.00 , N/A ,$540.00 ,$540.00 , N/A ,$390.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204336,C1887,HC CATHETER GUIDING T12,272,1 ,$750.00 ,$487.50 ,$325.50 ,$750.00 ,$558.75 ,$491.25 , N/A ,$395.25 , N/A ,$473.25 ,$473.25 ,$473.25 ,$473.25 ,$675.00 ,$562.50 , N/A ,$660.00 , N/A ,$562.50 ,$562.50 ,$637.50 ,$637.50 , N/A ,$637.50 , N/A ,$592.50 ,$592.50 ,$592.50 ,$675.00 , N/A ,$675.00 , N/A ,$750.00 ,$491.25 , N/A ,$325.50 , N/A , N/A ,$675.00 , N/A ,$473.25 ,$450.00 ,$675.00 , N/A ,$675.00 ,$675.00 , N/A ,$487.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204337,C1887,HC CATHETER GUIDING T13,272,1 ,$900.00 ,$585.00 ,$390.60 ,$900.00 ,$670.50 ,$589.50 , N/A ,$474.30 , N/A ,$567.90 ,$567.90 ,$567.90 ,$567.90 ,$810.00 ,$675.00 , N/A ,$792.00 , N/A ,$675.00 ,$675.00 ,$765.00 ,$765.00 , N/A ,$765.00 , N/A ,$711.00 ,$711.00 ,$711.00 ,$810.00 , N/A ,$810.00 , N/A ,$900.00 ,$589.50 , N/A ,$390.60 , N/A , N/A ,$810.00 , N/A ,$567.90 ,$540.00 ,$810.00 , N/A ,$810.00 ,$810.00 , N/A ,$585.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204338,C1887,HC CATHETER GUIDING T14,272,1 ,"$1,050.00 ",$682.50 ,$455.70 ,"$1,050.00 ",$782.25 ,$687.75 , N/A ,$553.35 , N/A ,$662.55 ,$662.55 ,$662.55 ,$662.55 ,$945.00 ,$787.50 , N/A ,$924.00 , N/A ,$787.50 ,$787.50 ,$892.50 ,$892.50 , N/A ,$892.50 , N/A ,$829.50 ,$829.50 ,$829.50 ,$945.00 , N/A ,$945.00 , N/A ,"$1,050.00 ",$687.75 , N/A ,$455.70 , N/A , N/A ,$945.00 , N/A ,$662.55 ,$630.00 ,$945.00 , N/A ,$945.00 ,$945.00 , N/A ,$682.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204339,C1887,HC CATHETER GUIDING T15,272,1 ,"$1,200.00 ",$780.00 ,$520.80 ,"$1,200.00 ",$894.00 ,$786.00 , N/A ,$632.40 , N/A ,$757.20 ,$757.20 ,$757.20 ,$757.20 ,"$1,080.00 ",$900.00 , N/A ,"$1,056.00 ", N/A ,$900.00 ,$900.00 ,"$1,020.00 ","$1,020.00 ", N/A ,"$1,020.00 ", N/A ,$948.00 ,$948.00 ,$948.00 ,"$1,080.00 ", N/A ,"$1,080.00 ", N/A ,"$1,200.00 ",$786.00 , N/A ,$520.80 , N/A , N/A ,"$1,080.00 ", N/A ,$757.20 ,$720.00 ,"$1,080.00 ", N/A ,"$1,080.00 ","$1,080.00 ", N/A ,$780.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204340,C1887,HC CATHETER GUIDING T16,272,1 ,"$1,350.00 ",$877.50 ,$585.90 ,"$1,350.00 ","$1,005.75 ",$884.25 , N/A ,$711.45 , N/A ,$851.85 ,$851.85 ,$851.85 ,$851.85 ,"$1,215.00 ","$1,012.50 ", N/A ,"$1,188.00 ", N/A ,"$1,012.50 ","$1,012.50 ","$1,147.50 ","$1,147.50 ", N/A ,"$1,147.50 ", N/A ,"$1,066.50 ","$1,066.50 ","$1,066.50 ","$1,215.00 ", N/A ,"$1,215.00 ", N/A ,"$1,350.00 ",$884.25 , N/A ,$585.90 , N/A , N/A ,"$1,215.00 ", N/A ,$851.85 ,$810.00 ,"$1,215.00 ", N/A ,"$1,215.00 ","$1,215.00 ", N/A ,$877.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204341,C1887,HC CATHETER GUIDING T17,272,1 ,"$1,500.00 ",$975.00 ,$651.00 ,"$1,500.00 ","$1,117.50 ",$982.50 , N/A ,$790.50 , N/A ,$946.50 ,$946.50 ,$946.50 ,$946.50 ,"$1,350.00 ","$1,125.00 ", N/A ,"$1,320.00 ", N/A ,"$1,125.00 ","$1,125.00 ","$1,275.00 ","$1,275.00 ", N/A ,"$1,275.00 ", N/A ,"$1,185.00 ","$1,185.00 ","$1,185.00 ","$1,350.00 ", N/A ,"$1,350.00 ", N/A ,"$1,500.00 ",$982.50 , N/A ,$651.00 , N/A , N/A ,"$1,350.00 ", N/A ,$946.50 ,$900.00 ,"$1,350.00 ", N/A ,"$1,350.00 ","$1,350.00 ", N/A ,$975.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204342,C1887,HC CATHETER GUIDING T18,272,1 ,"$2,100.00 ","$1,365.00 ",$911.40 ,"$2,100.00 ","$1,564.50 ","$1,375.50 ", N/A ,"$1,106.70 ", N/A ,"$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,890.00 ","$1,575.00 ", N/A ,"$1,848.00 ", N/A ,"$1,575.00 ","$1,575.00 ","$1,785.00 ","$1,785.00 ", N/A ,"$1,785.00 ", N/A ,"$1,659.00 ","$1,659.00 ","$1,659.00 ","$1,890.00 ", N/A ,"$1,890.00 ", N/A ,"$2,100.00 ","$1,375.50 ", N/A ,$911.40 , N/A , N/A ,"$1,890.00 ", N/A ,"$1,325.10 ","$1,260.00 ","$1,890.00 ", N/A ,"$1,890.00 ","$1,890.00 ", N/A ,"$1,365.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204343,C1887,HC CATHETER GUIDING T19,272,1 ,"$2,700.00 ","$1,755.00 ","$1,171.80 ","$2,700.00 ","$2,011.50 ","$1,768.50 ", N/A ,"$1,422.90 ", N/A ,"$1,703.70 ","$1,703.70 ","$1,703.70 ","$1,703.70 ","$2,430.00 ","$2,025.00 ", N/A ,"$2,376.00 ", N/A ,"$2,025.00 ","$2,025.00 ","$2,295.00 ","$2,295.00 ", N/A ,"$2,295.00 ", N/A ,"$2,133.00 ","$2,133.00 ","$2,133.00 ","$2,430.00 ", N/A ,"$2,430.00 ", N/A ,"$2,700.00 ","$1,768.50 ", N/A ,"$1,171.80 ", N/A , N/A ,"$2,430.00 ", N/A ,"$1,703.70 ","$1,620.00 ","$2,430.00 ", N/A ,"$2,430.00 ","$2,430.00 ", N/A ,"$1,755.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204370,C1892,HC INTRODUCER/SHEATH FIXED PEEL-AWAY T5,272,1 ,$150.00 ,$97.50 ,$65.10 ,$150.00 ,$111.75 ,$98.25 , N/A ,$79.05 , N/A ,$94.65 ,$94.65 ,$94.65 ,$94.65 ,$135.00 ,$112.50 , N/A ,$132.00 , N/A ,$112.50 ,$112.50 ,$127.50 ,$127.50 , N/A ,$127.50 , N/A ,$118.50 ,$118.50 ,$118.50 ,$135.00 , N/A ,$135.00 , N/A ,$150.00 ,$98.25 , N/A ,$65.10 , N/A , N/A ,$135.00 , N/A ,$94.65 ,$90.00 ,$135.00 , N/A ,$135.00 ,$135.00 , N/A ,$97.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204371,C1892,HC INTRODUCER/SHEATH FIXED PEEL-AWAY T6,272,1 ,$225.00 ,$146.25 ,$97.65 ,$225.00 ,$167.63 ,$147.38 , N/A ,$118.58 , N/A ,$141.98 ,$141.98 ,$141.98 ,$141.98 ,$202.50 ,$168.75 , N/A ,$198.00 , N/A ,$168.75 ,$168.75 ,$191.25 ,$191.25 , N/A ,$191.25 , N/A ,$177.75 ,$177.75 ,$177.75 ,$202.50 , N/A ,$202.50 , N/A ,$225.00 ,$147.38 , N/A ,$97.65 , N/A , N/A ,$202.50 , N/A ,$141.98 ,$135.00 ,$202.50 , N/A ,$202.50 ,$202.50 , N/A ,$146.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204372,C1892,HC INTRODUCER/SHEATH FIXED PEEL-AWAY T7,272,1 ,$300.00 ,$195.00 ,$130.20 ,$300.00 ,$223.50 ,$196.50 , N/A ,$158.10 , N/A ,$189.30 ,$189.30 ,$189.30 ,$189.30 ,$270.00 ,$225.00 , N/A ,$264.00 , N/A ,$225.00 ,$225.00 ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$237.00 ,$237.00 ,$237.00 ,$270.00 , N/A ,$270.00 , N/A ,$300.00 ,$196.50 , N/A ,$130.20 , N/A , N/A ,$270.00 , N/A ,$189.30 ,$180.00 ,$270.00 , N/A ,$270.00 ,$270.00 , N/A ,$195.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204373,C1892,HC INTRODUCER/SHEATH FIXED PEEL-AWAY T8,272,1 ,$375.00 ,$243.75 ,$162.75 ,$375.00 ,$279.38 ,$245.63 , N/A ,$197.63 , N/A ,$236.63 ,$236.63 ,$236.63 ,$236.63 ,$337.50 ,$281.25 , N/A ,$330.00 , N/A ,$281.25 ,$281.25 ,$318.75 ,$318.75 , N/A ,$318.75 , N/A ,$296.25 ,$296.25 ,$296.25 ,$337.50 , N/A ,$337.50 , N/A ,$375.00 ,$245.63 , N/A ,$162.75 , N/A , N/A ,$337.50 , N/A ,$236.63 ,$225.00 ,$337.50 , N/A ,$337.50 ,$337.50 , N/A ,$243.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204374,C1892,HC INTRODUCER/SHEATH FIXED PEEL-AWAY T9,272,1 ,$450.00 ,$292.50 ,$195.30 ,$450.00 ,$335.25 ,$294.75 , N/A ,$237.15 , N/A ,$283.95 ,$283.95 ,$283.95 ,$283.95 ,$405.00 ,$337.50 , N/A ,$396.00 , N/A ,$337.50 ,$337.50 ,$382.50 ,$382.50 , N/A ,$382.50 , N/A ,$355.50 ,$355.50 ,$355.50 ,$405.00 , N/A ,$405.00 , N/A ,$450.00 ,$294.75 , N/A ,$195.30 , N/A , N/A ,$405.00 , N/A ,$283.95 ,$270.00 ,$405.00 , N/A ,$405.00 ,$405.00 , N/A ,$292.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204406,C1894,HC INTRODUCER/SHEATH NON-GUIDING NON-LASER T1,272,1 ,$10.00 ,$6.50 ,$4.34 ,$10.00 ,$7.45 ,$6.55 , N/A ,$5.27 , N/A ,$6.31 ,$6.31 ,$6.31 ,$6.31 ,$9.00 ,$7.50 , N/A ,$8.80 , N/A ,$7.50 ,$7.50 ,$8.50 ,$8.50 , N/A ,$8.50 , N/A ,$7.90 ,$7.90 ,$7.90 ,$9.00 , N/A ,$9.00 , N/A ,$10.00 ,$6.55 , N/A ,$4.34 , N/A , N/A ,$9.00 , N/A ,$6.31 ,$6.00 ,$9.00 , N/A ,$9.00 ,$9.00 , N/A ,$6.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204407,C1894,HC INTRODUCER/SHEATH NON-GUIDING NON-LASER T2,272,1 ,$20.00 ,$13.00 ,$8.68 ,$20.00 ,$14.90 ,$13.10 , N/A ,$10.54 , N/A ,$12.62 ,$12.62 ,$12.62 ,$12.62 ,$18.00 ,$15.00 , N/A ,$17.60 , N/A ,$15.00 ,$15.00 ,$17.00 ,$17.00 , N/A ,$17.00 , N/A ,$15.80 ,$15.80 ,$15.80 ,$18.00 , N/A ,$18.00 , N/A ,$20.00 ,$13.10 , N/A ,$8.68 , N/A , N/A ,$18.00 , N/A ,$12.62 ,$12.00 ,$18.00 , N/A ,$18.00 ,$18.00 , N/A ,$13.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204408,C1894,HC INTRODUCER/SHEATH NON-GUIDING NON-LASER T3,272,1 ,$30.00 ,$19.50 ,$13.02 ,$30.00 ,$22.35 ,$19.65 , N/A ,$15.81 , N/A ,$18.93 ,$18.93 ,$18.93 ,$18.93 ,$27.00 ,$22.50 , N/A ,$26.40 , N/A ,$22.50 ,$22.50 ,$25.50 ,$25.50 , N/A ,$25.50 , N/A ,$23.70 ,$23.70 ,$23.70 ,$27.00 , N/A ,$27.00 , N/A ,$30.00 ,$19.65 , N/A ,$13.02 , N/A , N/A ,$27.00 , N/A ,$18.93 ,$18.00 ,$27.00 , N/A ,$27.00 ,$27.00 , N/A ,$19.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204409,C1894,HC INTRODUCER/SHEATH NON-GUIDING NON-LASER T4,272,1 ,$75.00 ,$48.75 ,$32.55 ,$75.00 ,$55.88 ,$49.13 , N/A ,$39.53 , N/A ,$47.33 ,$47.33 ,$47.33 ,$47.33 ,$67.50 ,$56.25 , N/A ,$66.00 , N/A ,$56.25 ,$56.25 ,$63.75 ,$63.75 , N/A ,$63.75 , N/A ,$59.25 ,$59.25 ,$59.25 ,$67.50 , N/A ,$67.50 , N/A ,$75.00 ,$49.13 , N/A ,$32.55 , N/A , N/A ,$67.50 , N/A ,$47.33 ,$45.00 ,$67.50 , N/A ,$67.50 ,$67.50 , N/A ,$48.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204410,C1894,HC INTRODUCER/SHEATH NON-GUIDING NON-LASER T5,272,1 ,$150.00 ,$97.50 ,$65.10 ,$150.00 ,$111.75 ,$98.25 , N/A ,$79.05 , N/A ,$94.65 ,$94.65 ,$94.65 ,$94.65 ,$135.00 ,$112.50 , N/A ,$132.00 , N/A ,$112.50 ,$112.50 ,$127.50 ,$127.50 , N/A ,$127.50 , N/A ,$118.50 ,$118.50 ,$118.50 ,$135.00 , N/A ,$135.00 , N/A ,$150.00 ,$98.25 , N/A ,$65.10 , N/A , N/A ,$135.00 , N/A ,$94.65 ,$90.00 ,$135.00 , N/A ,$135.00 ,$135.00 , N/A ,$97.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204411,C1894,HC INTRODUCER/SHEATH NON-GUIDING NON-LASER T6,272,1 ,$225.00 ,$146.25 ,$97.65 ,$225.00 ,$167.63 ,$147.38 , N/A ,$118.58 , N/A ,$141.98 ,$141.98 ,$141.98 ,$141.98 ,$202.50 ,$168.75 , N/A ,$198.00 , N/A ,$168.75 ,$168.75 ,$191.25 ,$191.25 , N/A ,$191.25 , N/A ,$177.75 ,$177.75 ,$177.75 ,$202.50 , N/A ,$202.50 , N/A ,$225.00 ,$147.38 , N/A ,$97.65 , N/A , N/A ,$202.50 , N/A ,$141.98 ,$135.00 ,$202.50 , N/A ,$202.50 ,$202.50 , N/A ,$146.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204412,C1894,HC INTRODUCER/SHEATH NON-GUIDING NON-LASER T7,272,1 ,$300.00 ,$195.00 ,$130.20 ,$300.00 ,$223.50 ,$196.50 , N/A ,$158.10 , N/A ,$189.30 ,$189.30 ,$189.30 ,$189.30 ,$270.00 ,$225.00 , N/A ,$264.00 , N/A ,$225.00 ,$225.00 ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$237.00 ,$237.00 ,$237.00 ,$270.00 , N/A ,$270.00 , N/A ,$300.00 ,$196.50 , N/A ,$130.20 , N/A , N/A ,$270.00 , N/A ,$189.30 ,$180.00 ,$270.00 , N/A ,$270.00 ,$270.00 , N/A ,$195.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204413,C1894,HC INTRODUCER/SHEATH NON-GUIDING NON-LASER T8,272,1 ,$375.00 ,$243.75 ,$162.75 ,$375.00 ,$279.38 ,$245.63 , N/A ,$197.63 , N/A ,$236.63 ,$236.63 ,$236.63 ,$236.63 ,$337.50 ,$281.25 , N/A ,$330.00 , N/A ,$281.25 ,$281.25 ,$318.75 ,$318.75 , N/A ,$318.75 , N/A ,$296.25 ,$296.25 ,$296.25 ,$337.50 , N/A ,$337.50 , N/A ,$375.00 ,$245.63 , N/A ,$162.75 , N/A , N/A ,$337.50 , N/A ,$236.63 ,$225.00 ,$337.50 , N/A ,$337.50 ,$337.50 , N/A ,$243.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204414,C1894,HC INTRODUCER/SHEATH NON-GUIDING NON-LASER T9,272,1 ,$450.00 ,$292.50 ,$195.30 ,$450.00 ,$335.25 ,$294.75 , N/A ,$237.15 , N/A ,$283.95 ,$283.95 ,$283.95 ,$283.95 ,$405.00 ,$337.50 , N/A ,$396.00 , N/A ,$337.50 ,$337.50 ,$382.50 ,$382.50 , N/A ,$382.50 , N/A ,$355.50 ,$355.50 ,$355.50 ,$405.00 , N/A ,$405.00 , N/A ,$450.00 ,$294.75 , N/A ,$195.30 , N/A , N/A ,$405.00 , N/A ,$283.95 ,$270.00 ,$405.00 , N/A ,$405.00 ,$405.00 , N/A ,$292.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204415,C1894,HC INTRODUCER/SHEATH NON-GUIDING NON-LASER T10,272,1 ,$525.00 ,$341.25 ,$227.85 ,$525.00 ,$391.13 ,$343.88 , N/A ,$276.68 , N/A ,$331.28 ,$331.28 ,$331.28 ,$331.28 ,$472.50 ,$393.75 , N/A ,$462.00 , N/A ,$393.75 ,$393.75 ,$446.25 ,$446.25 , N/A ,$446.25 , N/A ,$414.75 ,$414.75 ,$414.75 ,$472.50 , N/A ,$472.50 , N/A ,$525.00 ,$343.88 , N/A ,$227.85 , N/A , N/A ,$472.50 , N/A ,$331.28 ,$315.00 ,$472.50 , N/A ,$472.50 ,$472.50 , N/A ,$341.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204416,C1894,HC INTRODUCER/SHEATH NON-GUIDING NON-LASER T11,272,1 ,$600.00 ,$390.00 ,$260.40 ,$600.00 ,$447.00 ,$393.00 , N/A ,$316.20 , N/A ,$378.60 ,$378.60 ,$378.60 ,$378.60 ,$540.00 ,$450.00 , N/A ,$528.00 , N/A ,$450.00 ,$450.00 ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$474.00 ,$474.00 ,$474.00 ,$540.00 , N/A ,$540.00 , N/A ,$600.00 ,$393.00 , N/A ,$260.40 , N/A , N/A ,$540.00 , N/A ,$378.60 ,$360.00 ,$540.00 , N/A ,$540.00 ,$540.00 , N/A ,$390.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204417,C1894,HC INTRODUCER/SHEATH NON-GUIDING NON-LASER T12,272,1 ,$750.00 ,$487.50 ,$325.50 ,$750.00 ,$558.75 ,$491.25 , N/A ,$395.25 , N/A ,$473.25 ,$473.25 ,$473.25 ,$473.25 ,$675.00 ,$562.50 , N/A ,$660.00 , N/A ,$562.50 ,$562.50 ,$637.50 ,$637.50 , N/A ,$637.50 , N/A ,$592.50 ,$592.50 ,$592.50 ,$675.00 , N/A ,$675.00 , N/A ,$750.00 ,$491.25 , N/A ,$325.50 , N/A , N/A ,$675.00 , N/A ,$473.25 ,$450.00 ,$675.00 , N/A ,$675.00 ,$675.00 , N/A ,$487.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204418,C1894,HC INTRODUCER/SHEATH NON-GUIDING NON-LASER T13,272,1 ,$900.00 ,$585.00 ,$390.60 ,$900.00 ,$670.50 ,$589.50 , N/A ,$474.30 , N/A ,$567.90 ,$567.90 ,$567.90 ,$567.90 ,$810.00 ,$675.00 , N/A ,$792.00 , N/A ,$675.00 ,$675.00 ,$765.00 ,$765.00 , N/A ,$765.00 , N/A ,$711.00 ,$711.00 ,$711.00 ,$810.00 , N/A ,$810.00 , N/A ,$900.00 ,$589.50 , N/A ,$390.60 , N/A , N/A ,$810.00 , N/A ,$567.90 ,$540.00 ,$810.00 , N/A ,$810.00 ,$810.00 , N/A ,$585.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204419,C1894,HC INTRODUCER/SHEATH NON-GUIDING NON-LASER T14,272,1 ,"$1,050.00 ",$682.50 ,$455.70 ,"$1,050.00 ",$782.25 ,$687.75 , N/A ,$553.35 , N/A ,$662.55 ,$662.55 ,$662.55 ,$662.55 ,$945.00 ,$787.50 , N/A ,$924.00 , N/A ,$787.50 ,$787.50 ,$892.50 ,$892.50 , N/A ,$892.50 , N/A ,$829.50 ,$829.50 ,$829.50 ,$945.00 , N/A ,$945.00 , N/A ,"$1,050.00 ",$687.75 , N/A ,$455.70 , N/A , N/A ,$945.00 , N/A ,$662.55 ,$630.00 ,$945.00 , N/A ,$945.00 ,$945.00 , N/A ,$682.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204420,C1894,HC INTRODUCER/SHEATH NON-GUIDING NON-LASER T15,272,1 ,"$1,200.00 ",$780.00 ,$520.80 ,"$1,200.00 ",$894.00 ,$786.00 , N/A ,$632.40 , N/A ,$757.20 ,$757.20 ,$757.20 ,$757.20 ,"$1,080.00 ",$900.00 , N/A ,"$1,056.00 ", N/A ,$900.00 ,$900.00 ,"$1,020.00 ","$1,020.00 ", N/A ,"$1,020.00 ", N/A ,$948.00 ,$948.00 ,$948.00 ,"$1,080.00 ", N/A ,"$1,080.00 ", N/A ,"$1,200.00 ",$786.00 , N/A ,$520.80 , N/A , N/A ,"$1,080.00 ", N/A ,$757.20 ,$720.00 ,"$1,080.00 ", N/A ,"$1,080.00 ","$1,080.00 ", N/A ,$780.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204447,N/A,HC SUTURE T1,272,1 ,$10.00 ,$6.50 ,$4.34 ,$10.00 ,$7.45 ,$6.55 , N/A ,$5.27 , N/A ,$6.31 ,$6.31 ,$6.31 ,$6.31 ,$9.00 ,$7.50 , N/A ,$8.80 , N/A ,$7.50 ,$7.50 ,$8.50 ,$8.50 , N/A ,$8.50 , N/A ,$7.90 ,$7.90 ,$7.90 ,$9.00 , N/A ,$9.00 , N/A ,$10.00 ,$6.55 , N/A ,$4.34 , N/A , N/A ,$9.00 , N/A ,$6.31 ,$6.00 ,$9.00 , N/A ,$9.00 ,$9.00 , N/A ,$6.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204448,N/A,HC SUTURE T2,272,1 ,$20.00 ,$13.00 ,$8.68 ,$20.00 ,$14.90 ,$13.10 , N/A ,$10.54 , N/A ,$12.62 ,$12.62 ,$12.62 ,$12.62 ,$18.00 ,$15.00 , N/A ,$17.60 , N/A ,$15.00 ,$15.00 ,$17.00 ,$17.00 , N/A ,$17.00 , N/A ,$15.80 ,$15.80 ,$15.80 ,$18.00 , N/A ,$18.00 , N/A ,$20.00 ,$13.10 , N/A ,$8.68 , N/A , N/A ,$18.00 , N/A ,$12.62 ,$12.00 ,$18.00 , N/A ,$18.00 ,$18.00 , N/A ,$13.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204449,N/A,HC SUTURE T3,272,1 ,$30.00 ,$19.50 ,$13.02 ,$30.00 ,$22.35 ,$19.65 , N/A ,$15.81 , N/A ,$18.93 ,$18.93 ,$18.93 ,$18.93 ,$27.00 ,$22.50 , N/A ,$26.40 , N/A ,$22.50 ,$22.50 ,$25.50 ,$25.50 , N/A ,$25.50 , N/A ,$23.70 ,$23.70 ,$23.70 ,$27.00 , N/A ,$27.00 , N/A ,$30.00 ,$19.65 , N/A ,$13.02 , N/A , N/A ,$27.00 , N/A ,$18.93 ,$18.00 ,$27.00 , N/A ,$27.00 ,$27.00 , N/A ,$19.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204450,N/A,HC SUTURE T4,272,1 ,$75.00 ,$48.75 ,$32.55 ,$75.00 ,$55.88 ,$49.13 , N/A ,$39.53 , N/A ,$47.33 ,$47.33 ,$47.33 ,$47.33 ,$67.50 ,$56.25 , N/A ,$66.00 , N/A ,$56.25 ,$56.25 ,$63.75 ,$63.75 , N/A ,$63.75 , N/A ,$59.25 ,$59.25 ,$59.25 ,$67.50 , N/A ,$67.50 , N/A ,$75.00 ,$49.13 , N/A ,$32.55 , N/A , N/A ,$67.50 , N/A ,$47.33 ,$45.00 ,$67.50 , N/A ,$67.50 ,$67.50 , N/A ,$48.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204451,N/A,HC SURGICAL STERILE SUPPLY T1,272,1 ,$10.00 ,$6.50 ,$4.34 ,$10.00 ,$7.45 ,$6.55 , N/A ,$5.27 , N/A ,$6.31 ,$6.31 ,$6.31 ,$6.31 ,$9.00 ,$7.50 , N/A ,$8.80 , N/A ,$7.50 ,$7.50 ,$8.50 ,$8.50 , N/A ,$8.50 , N/A ,$7.90 ,$7.90 ,$7.90 ,$9.00 , N/A ,$9.00 , N/A ,$10.00 ,$6.55 , N/A ,$4.34 , N/A , N/A ,$9.00 , N/A ,$6.31 ,$6.00 ,$9.00 , N/A ,$9.00 ,$9.00 , N/A ,$6.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204452,N/A,HC SURGICAL STERILE SUPPLY T2,272,1 ,$20.00 ,$13.00 ,$8.68 ,$20.00 ,$14.90 ,$13.10 , N/A ,$10.54 , N/A ,$12.62 ,$12.62 ,$12.62 ,$12.62 ,$18.00 ,$15.00 , N/A ,$17.60 , N/A ,$15.00 ,$15.00 ,$17.00 ,$17.00 , N/A ,$17.00 , N/A ,$15.80 ,$15.80 ,$15.80 ,$18.00 , N/A ,$18.00 , N/A ,$20.00 ,$13.10 , N/A ,$8.68 , N/A , N/A ,$18.00 , N/A ,$12.62 ,$12.00 ,$18.00 , N/A ,$18.00 ,$18.00 , N/A ,$13.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204453,N/A,HC SURGICAL STERILE SUPPLY T3,272,1 ,$30.00 ,$19.50 ,$13.02 ,$30.00 ,$22.35 ,$19.65 , N/A ,$15.81 , N/A ,$18.93 ,$18.93 ,$18.93 ,$18.93 ,$27.00 ,$22.50 , N/A ,$26.40 , N/A ,$22.50 ,$22.50 ,$25.50 ,$25.50 , N/A ,$25.50 , N/A ,$23.70 ,$23.70 ,$23.70 ,$27.00 , N/A ,$27.00 , N/A ,$30.00 ,$19.65 , N/A ,$13.02 , N/A , N/A ,$27.00 , N/A ,$18.93 ,$18.00 ,$27.00 , N/A ,$27.00 ,$27.00 , N/A ,$19.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204454,N/A,HC SURGICAL STERILE SUPPLY T4,272,1 ,$75.00 ,$48.75 ,$32.55 ,$75.00 ,$55.88 ,$49.13 , N/A ,$39.53 , N/A ,$47.33 ,$47.33 ,$47.33 ,$47.33 ,$67.50 ,$56.25 , N/A ,$66.00 , N/A ,$56.25 ,$56.25 ,$63.75 ,$63.75 , N/A ,$63.75 , N/A ,$59.25 ,$59.25 ,$59.25 ,$67.50 , N/A ,$67.50 , N/A ,$75.00 ,$49.13 , N/A ,$32.55 , N/A , N/A ,$67.50 , N/A ,$47.33 ,$45.00 ,$67.50 , N/A ,$67.50 ,$67.50 , N/A ,$48.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204455,N/A,HC SURGICAL STERILE SUPPLY T5,272,1 ,$150.00 ,$97.50 ,$65.10 ,$150.00 ,$111.75 ,$98.25 , N/A ,$79.05 , N/A ,$94.65 ,$94.65 ,$94.65 ,$94.65 ,$135.00 ,$112.50 , N/A ,$132.00 , N/A ,$112.50 ,$112.50 ,$127.50 ,$127.50 , N/A ,$127.50 , N/A ,$118.50 ,$118.50 ,$118.50 ,$135.00 , N/A ,$135.00 , N/A ,$150.00 ,$98.25 , N/A ,$65.10 , N/A , N/A ,$135.00 , N/A ,$94.65 ,$90.00 ,$135.00 , N/A ,$135.00 ,$135.00 , N/A ,$97.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204456,N/A,HC SURGICAL STERILE SUPPLY T6,272,1 ,$225.00 ,$146.25 ,$97.65 ,$225.00 ,$167.63 ,$147.38 , N/A ,$118.58 , N/A ,$141.98 ,$141.98 ,$141.98 ,$141.98 ,$202.50 ,$168.75 , N/A ,$198.00 , N/A ,$168.75 ,$168.75 ,$191.25 ,$191.25 , N/A ,$191.25 , N/A ,$177.75 ,$177.75 ,$177.75 ,$202.50 , N/A ,$202.50 , N/A ,$225.00 ,$147.38 , N/A ,$97.65 , N/A , N/A ,$202.50 , N/A ,$141.98 ,$135.00 ,$202.50 , N/A ,$202.50 ,$202.50 , N/A ,$146.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204457,N/A,HC SURGICAL STERILE SUPPLY T7,272,1 ,$300.00 ,$195.00 ,$130.20 ,$300.00 ,$223.50 ,$196.50 , N/A ,$158.10 , N/A ,$189.30 ,$189.30 ,$189.30 ,$189.30 ,$270.00 ,$225.00 , N/A ,$264.00 , N/A ,$225.00 ,$225.00 ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$237.00 ,$237.00 ,$237.00 ,$270.00 , N/A ,$270.00 , N/A ,$300.00 ,$196.50 , N/A ,$130.20 , N/A , N/A ,$270.00 , N/A ,$189.30 ,$180.00 ,$270.00 , N/A ,$270.00 ,$270.00 , N/A ,$195.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204458,N/A,HC SURGICAL STERILE SUPPLY T8,272,1 ,$375.00 ,$243.75 ,$162.75 ,$375.00 ,$279.38 ,$245.63 , N/A ,$197.63 , N/A ,$236.63 ,$236.63 ,$236.63 ,$236.63 ,$337.50 ,$281.25 , N/A ,$330.00 , N/A ,$281.25 ,$281.25 ,$318.75 ,$318.75 , N/A ,$318.75 , N/A ,$296.25 ,$296.25 ,$296.25 ,$337.50 , N/A ,$337.50 , N/A ,$375.00 ,$245.63 , N/A ,$162.75 , N/A , N/A ,$337.50 , N/A ,$236.63 ,$225.00 ,$337.50 , N/A ,$337.50 ,$337.50 , N/A ,$243.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204459,N/A,HC SURGICAL STERILE SUPPLY T9,272,1 ,$450.00 ,$292.50 ,$195.30 ,$450.00 ,$335.25 ,$294.75 , N/A ,$237.15 , N/A ,$283.95 ,$283.95 ,$283.95 ,$283.95 ,$405.00 ,$337.50 , N/A ,$396.00 , N/A ,$337.50 ,$337.50 ,$382.50 ,$382.50 , N/A ,$382.50 , N/A ,$355.50 ,$355.50 ,$355.50 ,$405.00 , N/A ,$405.00 , N/A ,$450.00 ,$294.75 , N/A ,$195.30 , N/A , N/A ,$405.00 , N/A ,$283.95 ,$270.00 ,$405.00 , N/A ,$405.00 ,$405.00 , N/A ,$292.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204460,N/A,HC SURGICAL STERILE SUPPLY T10,272,1 ,$525.00 ,$341.25 ,$227.85 ,$525.00 ,$391.13 ,$343.88 , N/A ,$276.68 , N/A ,$331.28 ,$331.28 ,$331.28 ,$331.28 ,$472.50 ,$393.75 , N/A ,$462.00 , N/A ,$393.75 ,$393.75 ,$446.25 ,$446.25 , N/A ,$446.25 , N/A ,$414.75 ,$414.75 ,$414.75 ,$472.50 , N/A ,$472.50 , N/A ,$525.00 ,$343.88 , N/A ,$227.85 , N/A , N/A ,$472.50 , N/A ,$331.28 ,$315.00 ,$472.50 , N/A ,$472.50 ,$472.50 , N/A ,$341.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204461,N/A,HC SURGICAL STERILE SUPPLY T11,272,1 ,$600.00 ,$390.00 ,$260.40 ,$600.00 ,$447.00 ,$393.00 , N/A ,$316.20 , N/A ,$378.60 ,$378.60 ,$378.60 ,$378.60 ,$540.00 ,$450.00 , N/A ,$528.00 , N/A ,$450.00 ,$450.00 ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$474.00 ,$474.00 ,$474.00 ,$540.00 , N/A ,$540.00 , N/A ,$600.00 ,$393.00 , N/A ,$260.40 , N/A , N/A ,$540.00 , N/A ,$378.60 ,$360.00 ,$540.00 , N/A ,$540.00 ,$540.00 , N/A ,$390.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204462,N/A,HC SURGICAL STERILE SUPPLY T12,272,1 ,$750.00 ,$487.50 ,$325.50 ,$750.00 ,$558.75 ,$491.25 , N/A ,$395.25 , N/A ,$473.25 ,$473.25 ,$473.25 ,$473.25 ,$675.00 ,$562.50 , N/A ,$660.00 , N/A ,$562.50 ,$562.50 ,$637.50 ,$637.50 , N/A ,$637.50 , N/A ,$592.50 ,$592.50 ,$592.50 ,$675.00 , N/A ,$675.00 , N/A ,$750.00 ,$491.25 , N/A ,$325.50 , N/A , N/A ,$675.00 , N/A ,$473.25 ,$450.00 ,$675.00 , N/A ,$675.00 ,$675.00 , N/A ,$487.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204463,N/A,HC SURGICAL STERILE SUPPLY T13,272,1 ,$900.00 ,$585.00 ,$390.60 ,$900.00 ,$670.50 ,$589.50 , N/A ,$474.30 , N/A ,$567.90 ,$567.90 ,$567.90 ,$567.90 ,$810.00 ,$675.00 , N/A ,$792.00 , N/A ,$675.00 ,$675.00 ,$765.00 ,$765.00 , N/A ,$765.00 , N/A ,$711.00 ,$711.00 ,$711.00 ,$810.00 , N/A ,$810.00 , N/A ,$900.00 ,$589.50 , N/A ,$390.60 , N/A , N/A ,$810.00 , N/A ,$567.90 ,$540.00 ,$810.00 , N/A ,$810.00 ,$810.00 , N/A ,$585.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204464,N/A,HC SURGICAL STERILE SUPPLY T14,272,1 ,"$1,050.00 ",$682.50 ,$455.70 ,"$1,050.00 ",$782.25 ,$687.75 , N/A ,$553.35 , N/A ,$662.55 ,$662.55 ,$662.55 ,$662.55 ,$945.00 ,$787.50 , N/A ,$924.00 , N/A ,$787.50 ,$787.50 ,$892.50 ,$892.50 , N/A ,$892.50 , N/A ,$829.50 ,$829.50 ,$829.50 ,$945.00 , N/A ,$945.00 , N/A ,"$1,050.00 ",$687.75 , N/A ,$455.70 , N/A , N/A ,$945.00 , N/A ,$662.55 ,$630.00 ,$945.00 , N/A ,$945.00 ,$945.00 , N/A ,$682.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204465,N/A,HC SURGICAL STERILE SUPPLY T15,272,1 ,"$1,200.00 ",$780.00 ,$520.80 ,"$1,200.00 ",$894.00 ,$786.00 , N/A ,$632.40 , N/A ,$757.20 ,$757.20 ,$757.20 ,$757.20 ,"$1,080.00 ",$900.00 , N/A ,"$1,056.00 ", N/A ,$900.00 ,$900.00 ,"$1,020.00 ","$1,020.00 ", N/A ,"$1,020.00 ", N/A ,$948.00 ,$948.00 ,$948.00 ,"$1,080.00 ", N/A ,"$1,080.00 ", N/A ,"$1,200.00 ",$786.00 , N/A ,$520.80 , N/A , N/A ,"$1,080.00 ", N/A ,$757.20 ,$720.00 ,"$1,080.00 ", N/A ,"$1,080.00 ","$1,080.00 ", N/A ,$780.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204466,N/A,HC SURGICAL STERILE SUPPLY T16,272,1 ,"$1,350.00 ",$877.50 ,$585.90 ,"$1,350.00 ","$1,005.75 ",$884.25 , N/A ,$711.45 , N/A ,$851.85 ,$851.85 ,$851.85 ,$851.85 ,"$1,215.00 ","$1,012.50 ", N/A ,"$1,188.00 ", N/A ,"$1,012.50 ","$1,012.50 ","$1,147.50 ","$1,147.50 ", N/A ,"$1,147.50 ", N/A ,"$1,066.50 ","$1,066.50 ","$1,066.50 ","$1,215.00 ", N/A ,"$1,215.00 ", N/A ,"$1,350.00 ",$884.25 , N/A ,$585.90 , N/A , N/A ,"$1,215.00 ", N/A ,$851.85 ,$810.00 ,"$1,215.00 ", N/A ,"$1,215.00 ","$1,215.00 ", N/A ,$877.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204467,N/A,HC SURGICAL STERILE SUPPLY T17,272,1 ,"$1,500.00 ",$975.00 ,$651.00 ,"$1,500.00 ","$1,117.50 ",$982.50 , N/A ,$790.50 , N/A ,$946.50 ,$946.50 ,$946.50 ,$946.50 ,"$1,350.00 ","$1,125.00 ", N/A ,"$1,320.00 ", N/A ,"$1,125.00 ","$1,125.00 ","$1,275.00 ","$1,275.00 ", N/A ,"$1,275.00 ", N/A ,"$1,185.00 ","$1,185.00 ","$1,185.00 ","$1,350.00 ", N/A ,"$1,350.00 ", N/A ,"$1,500.00 ",$982.50 , N/A ,$651.00 , N/A , N/A ,"$1,350.00 ", N/A ,$946.50 ,$900.00 ,"$1,350.00 ", N/A ,"$1,350.00 ","$1,350.00 ", N/A ,$975.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204468,N/A,HC SURGICAL STERILE SUPPLY T18,272,1 ,"$2,100.00 ","$1,365.00 ",$911.40 ,"$2,100.00 ","$1,564.50 ","$1,375.50 ", N/A ,"$1,106.70 ", N/A ,"$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,890.00 ","$1,575.00 ", N/A ,"$1,848.00 ", N/A ,"$1,575.00 ","$1,575.00 ","$1,785.00 ","$1,785.00 ", N/A ,"$1,785.00 ", N/A ,"$1,659.00 ","$1,659.00 ","$1,659.00 ","$1,890.00 ", N/A ,"$1,890.00 ", N/A ,"$2,100.00 ","$1,375.50 ", N/A ,$911.40 , N/A , N/A ,"$1,890.00 ", N/A ,"$1,325.10 ","$1,260.00 ","$1,890.00 ", N/A ,"$1,890.00 ","$1,890.00 ", N/A ,"$1,365.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204469,N/A,HC SURGICAL STERILE SUPPLY T19,272,1 ,"$2,700.00 ","$1,755.00 ","$1,171.80 ","$2,700.00 ","$2,011.50 ","$1,768.50 ", N/A ,"$1,422.90 ", N/A ,"$1,703.70 ","$1,703.70 ","$1,703.70 ","$1,703.70 ","$2,430.00 ","$2,025.00 ", N/A ,"$2,376.00 ", N/A ,"$2,025.00 ","$2,025.00 ","$2,295.00 ","$2,295.00 ", N/A ,"$2,295.00 ", N/A ,"$2,133.00 ","$2,133.00 ","$2,133.00 ","$2,430.00 ", N/A ,"$2,430.00 ", N/A ,"$2,700.00 ","$1,768.50 ", N/A ,"$1,171.80 ", N/A , N/A ,"$2,430.00 ", N/A ,"$1,703.70 ","$1,620.00 ","$2,430.00 ", N/A ,"$2,430.00 ","$2,430.00 ", N/A ,"$1,755.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204470,N/A,HC SURGICAL STERILE SUPPLY T20,272,1 ,"$3,300.00 ","$2,145.00 ","$1,432.20 ","$3,300.00 ","$2,458.50 ","$2,161.50 ", N/A ,"$1,739.10 ", N/A ,"$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,970.00 ","$2,475.00 ", N/A ,"$2,904.00 ", N/A ,"$2,475.00 ","$2,475.00 ","$2,805.00 ","$2,805.00 ", N/A ,"$2,805.00 ", N/A ,"$2,607.00 ","$2,607.00 ","$2,607.00 ","$2,970.00 ", N/A ,"$2,970.00 ", N/A ,"$3,300.00 ","$2,161.50 ", N/A ,"$1,432.20 ", N/A , N/A ,"$2,970.00 ", N/A ,"$2,082.30 ","$1,980.00 ","$2,970.00 ", N/A ,"$2,970.00 ","$2,970.00 ", N/A ,"$2,145.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204477,N/A,HC SURGICAL STERILE SUPPLY T27,272,1 ,"$7,500.00 ","$4,875.00 ","$3,255.00 ","$7,500.00 ","$5,587.50 ","$4,912.50 ", N/A ,"$3,952.50 ", N/A ,"$4,732.50 ","$4,732.50 ","$4,732.50 ","$4,732.50 ","$6,750.00 ","$5,625.00 ", N/A ,"$6,600.00 ", N/A ,"$5,625.00 ","$5,625.00 ","$6,375.00 ","$6,375.00 ", N/A ,"$6,375.00 ", N/A ,"$5,925.00 ","$5,925.00 ","$5,925.00 ","$6,750.00 ", N/A ,"$6,750.00 ", N/A ,"$7,500.00 ","$4,912.50 ", N/A ,"$3,255.00 ", N/A , N/A ,"$6,750.00 ", N/A ,"$4,732.50 ","$4,500.00 ","$6,750.00 ", N/A ,"$6,750.00 ","$6,750.00 ", N/A ,"$4,875.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204551,C1752,HC CATHETER HEMODIALYSIS/PERITONEAL SHORT TERM T7,272,1 ,$900.00 ,$585.00 ,$390.60 ,$900.00 ,$670.50 ,$589.50 , N/A ,$474.30 , N/A ,$567.90 ,$567.90 ,$567.90 ,$567.90 ,$810.00 ,$675.00 , N/A ,$792.00 , N/A ,$675.00 ,$675.00 ,$765.00 ,$765.00 , N/A ,$765.00 , N/A ,$711.00 ,$711.00 ,$711.00 ,$810.00 , N/A ,$810.00 , N/A ,$900.00 ,$589.50 , N/A ,$390.60 , N/A , N/A ,$810.00 , N/A ,$567.90 ,$540.00 ,$810.00 , N/A ,$810.00 ,$810.00 , N/A ,$585.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204560,C1729,HC CATHETER DRAINAGE T4,272,1 ,$75.00 ,$48.75 ,$32.55 ,$75.00 ,$55.88 ,$49.13 , N/A ,$39.53 , N/A ,$47.33 ,$47.33 ,$47.33 ,$47.33 ,$67.50 ,$56.25 , N/A ,$66.00 , N/A ,$56.25 ,$56.25 ,$63.75 ,$63.75 , N/A ,$63.75 , N/A ,$59.25 ,$59.25 ,$59.25 ,$67.50 , N/A ,$67.50 , N/A ,$75.00 ,$49.13 , N/A ,$32.55 , N/A , N/A ,$67.50 , N/A ,$47.33 ,$45.00 ,$67.50 , N/A ,$67.50 ,$67.50 , N/A ,$48.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204561,C1729,HC CATHETER DRAINAGE T5,272,1 ,$150.00 ,$97.50 ,$65.10 ,$150.00 ,$111.75 ,$98.25 , N/A ,$79.05 , N/A ,$94.65 ,$94.65 ,$94.65 ,$94.65 ,$135.00 ,$112.50 , N/A ,$132.00 , N/A ,$112.50 ,$112.50 ,$127.50 ,$127.50 , N/A ,$127.50 , N/A ,$118.50 ,$118.50 ,$118.50 ,$135.00 , N/A ,$135.00 , N/A ,$150.00 ,$98.25 , N/A ,$65.10 , N/A , N/A ,$135.00 , N/A ,$94.65 ,$90.00 ,$135.00 , N/A ,$135.00 ,$135.00 , N/A ,$97.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204562,C1729,HC CATHETER DRAINAGE T6,272,1 ,$225.00 ,$146.25 ,$97.65 ,$225.00 ,$167.63 ,$147.38 , N/A ,$118.58 , N/A ,$141.98 ,$141.98 ,$141.98 ,$141.98 ,$202.50 ,$168.75 , N/A ,$198.00 , N/A ,$168.75 ,$168.75 ,$191.25 ,$191.25 , N/A ,$191.25 , N/A ,$177.75 ,$177.75 ,$177.75 ,$202.50 , N/A ,$202.50 , N/A ,$225.00 ,$147.38 , N/A ,$97.65 , N/A , N/A ,$202.50 , N/A ,$141.98 ,$135.00 ,$202.50 , N/A ,$202.50 ,$202.50 , N/A ,$146.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204563,C1729,HC CATHETER DRAINAGE T7,272,1 ,$300.00 ,$195.00 ,$130.20 ,$300.00 ,$223.50 ,$196.50 , N/A ,$158.10 , N/A ,$189.30 ,$189.30 ,$189.30 ,$189.30 ,$270.00 ,$225.00 , N/A ,$264.00 , N/A ,$225.00 ,$225.00 ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$237.00 ,$237.00 ,$237.00 ,$270.00 , N/A ,$270.00 , N/A ,$300.00 ,$196.50 , N/A ,$130.20 , N/A , N/A ,$270.00 , N/A ,$189.30 ,$180.00 ,$270.00 , N/A ,$270.00 ,$270.00 , N/A ,$195.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204564,C1729,HC CATHETER DRAINAGE T8,272,1 ,$375.00 ,$243.75 ,$162.75 ,$375.00 ,$279.38 ,$245.63 , N/A ,$197.63 , N/A ,$236.63 ,$236.63 ,$236.63 ,$236.63 ,$337.50 ,$281.25 , N/A ,$330.00 , N/A ,$281.25 ,$281.25 ,$318.75 ,$318.75 , N/A ,$318.75 , N/A ,$296.25 ,$296.25 ,$296.25 ,$337.50 , N/A ,$337.50 , N/A ,$375.00 ,$245.63 , N/A ,$162.75 , N/A , N/A ,$337.50 , N/A ,$236.63 ,$225.00 ,$337.50 , N/A ,$337.50 ,$337.50 , N/A ,$243.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204565,C1729,HC CATHETER DRAINAGE T9,272,1 ,$450.00 ,$292.50 ,$195.30 ,$450.00 ,$335.25 ,$294.75 , N/A ,$237.15 , N/A ,$283.95 ,$283.95 ,$283.95 ,$283.95 ,$405.00 ,$337.50 , N/A ,$396.00 , N/A ,$337.50 ,$337.50 ,$382.50 ,$382.50 , N/A ,$382.50 , N/A ,$355.50 ,$355.50 ,$355.50 ,$405.00 , N/A ,$405.00 , N/A ,$450.00 ,$294.75 , N/A ,$195.30 , N/A , N/A ,$405.00 , N/A ,$283.95 ,$270.00 ,$405.00 , N/A ,$405.00 ,$405.00 , N/A ,$292.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204566,C1729,HC CATHETER DRAINAGE T10,272,1 ,$525.00 ,$341.25 ,$227.85 ,$525.00 ,$391.13 ,$343.88 , N/A ,$276.68 , N/A ,$331.28 ,$331.28 ,$331.28 ,$331.28 ,$472.50 ,$393.75 , N/A ,$462.00 , N/A ,$393.75 ,$393.75 ,$446.25 ,$446.25 , N/A ,$446.25 , N/A ,$414.75 ,$414.75 ,$414.75 ,$472.50 , N/A ,$472.50 , N/A ,$525.00 ,$343.88 , N/A ,$227.85 , N/A , N/A ,$472.50 , N/A ,$331.28 ,$315.00 ,$472.50 , N/A ,$472.50 ,$472.50 , N/A ,$341.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204567,C1729,HC CATHETER DRAINAGE T11,272,1 ,$600.00 ,$390.00 ,$260.40 ,$600.00 ,$447.00 ,$393.00 , N/A ,$316.20 , N/A ,$378.60 ,$378.60 ,$378.60 ,$378.60 ,$540.00 ,$450.00 , N/A ,$528.00 , N/A ,$450.00 ,$450.00 ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$474.00 ,$474.00 ,$474.00 ,$540.00 , N/A ,$540.00 , N/A ,$600.00 ,$393.00 , N/A ,$260.40 , N/A , N/A ,$540.00 , N/A ,$378.60 ,$360.00 ,$540.00 , N/A ,$540.00 ,$540.00 , N/A ,$390.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204568,C1729,HC CATHETER DRAINAGE T12,272,1 ,$750.00 ,$487.50 ,$325.50 ,$750.00 ,$558.75 ,$491.25 , N/A ,$395.25 , N/A ,$473.25 ,$473.25 ,$473.25 ,$473.25 ,$675.00 ,$562.50 , N/A ,$660.00 , N/A ,$562.50 ,$562.50 ,$637.50 ,$637.50 , N/A ,$637.50 , N/A ,$592.50 ,$592.50 ,$592.50 ,$675.00 , N/A ,$675.00 , N/A ,$750.00 ,$491.25 , N/A ,$325.50 , N/A , N/A ,$675.00 , N/A ,$473.25 ,$450.00 ,$675.00 , N/A ,$675.00 ,$675.00 , N/A ,$487.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204569,C1729,HC CATHETER DRAINAGE T13,272,1 ,$900.00 ,$585.00 ,$390.60 ,$900.00 ,$670.50 ,$589.50 , N/A ,$474.30 , N/A ,$567.90 ,$567.90 ,$567.90 ,$567.90 ,$810.00 ,$675.00 , N/A ,$792.00 , N/A ,$675.00 ,$675.00 ,$765.00 ,$765.00 , N/A ,$765.00 , N/A ,$711.00 ,$711.00 ,$711.00 ,$810.00 , N/A ,$810.00 , N/A ,$900.00 ,$589.50 , N/A ,$390.60 , N/A , N/A ,$810.00 , N/A ,$567.90 ,$540.00 ,$810.00 , N/A ,$810.00 ,$810.00 , N/A ,$585.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204570,C1729,HC CATHETER DRAINAGE T14,272,1 ,"$1,050.00 ",$682.50 ,$455.70 ,"$1,050.00 ",$782.25 ,$687.75 , N/A ,$553.35 , N/A ,$662.55 ,$662.55 ,$662.55 ,$662.55 ,$945.00 ,$787.50 , N/A ,$924.00 , N/A ,$787.50 ,$787.50 ,$892.50 ,$892.50 , N/A ,$892.50 , N/A ,$829.50 ,$829.50 ,$829.50 ,$945.00 , N/A ,$945.00 , N/A ,"$1,050.00 ",$687.75 , N/A ,$455.70 , N/A , N/A ,$945.00 , N/A ,$662.55 ,$630.00 ,$945.00 , N/A ,$945.00 ,$945.00 , N/A ,$682.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204571,C1729,HC CATHETER DRAINAGE T15,272,1 ,"$1,200.00 ",$780.00 ,$520.80 ,"$1,200.00 ",$894.00 ,$786.00 , N/A ,$632.40 , N/A ,$757.20 ,$757.20 ,$757.20 ,$757.20 ,"$1,080.00 ",$900.00 , N/A ,"$1,056.00 ", N/A ,$900.00 ,$900.00 ,"$1,020.00 ","$1,020.00 ", N/A ,"$1,020.00 ", N/A ,$948.00 ,$948.00 ,$948.00 ,"$1,080.00 ", N/A ,"$1,080.00 ", N/A ,"$1,200.00 ",$786.00 , N/A ,$520.80 , N/A , N/A ,"$1,080.00 ", N/A ,$757.20 ,$720.00 ,"$1,080.00 ", N/A ,"$1,080.00 ","$1,080.00 ", N/A ,$780.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204572,C1729,HC CATHETER DRAINAGE T16,272,1 ,"$1,350.00 ",$877.50 ,$585.90 ,"$1,350.00 ","$1,005.75 ",$884.25 , N/A ,$711.45 , N/A ,$851.85 ,$851.85 ,$851.85 ,$851.85 ,"$1,215.00 ","$1,012.50 ", N/A ,"$1,188.00 ", N/A ,"$1,012.50 ","$1,012.50 ","$1,147.50 ","$1,147.50 ", N/A ,"$1,147.50 ", N/A ,"$1,066.50 ","$1,066.50 ","$1,066.50 ","$1,215.00 ", N/A ,"$1,215.00 ", N/A ,"$1,350.00 ",$884.25 , N/A ,$585.90 , N/A , N/A ,"$1,215.00 ", N/A ,$851.85 ,$810.00 ,"$1,215.00 ", N/A ,"$1,215.00 ","$1,215.00 ", N/A ,$877.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204573,C1729,HC CATHETER DRAINAGE T17,272,1 ,"$1,500.00 ",$975.00 ,$651.00 ,"$1,500.00 ","$1,117.50 ",$982.50 , N/A ,$790.50 , N/A ,$946.50 ,$946.50 ,$946.50 ,$946.50 ,"$1,350.00 ","$1,125.00 ", N/A ,"$1,320.00 ", N/A ,"$1,125.00 ","$1,125.00 ","$1,275.00 ","$1,275.00 ", N/A ,"$1,275.00 ", N/A ,"$1,185.00 ","$1,185.00 ","$1,185.00 ","$1,350.00 ", N/A ,"$1,350.00 ", N/A ,"$1,500.00 ",$982.50 , N/A ,$651.00 , N/A , N/A ,"$1,350.00 ", N/A ,$946.50 ,$900.00 ,"$1,350.00 ", N/A ,"$1,350.00 ","$1,350.00 ", N/A ,$975.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204575,N/A,HC LARYNGEAL MASK AIRWAY SUPREME,272,1 ,$192.47 ,$125.11 ,$83.53 ,$192.47 ,$143.39 ,$126.07 , N/A ,$101.43 , N/A ,$121.45 ,$121.45 ,$121.45 ,$121.45 ,$173.22 ,$144.35 , N/A ,$169.37 , N/A ,$144.35 ,$144.35 ,$163.60 ,$163.60 , N/A ,$163.60 , N/A ,$152.05 ,$152.05 ,$152.05 ,$173.22 , N/A ,$173.22 , N/A ,$192.47 ,$126.07 , N/A ,$83.53 , N/A , N/A ,$173.22 , N/A ,$121.45 ,$115.48 ,$173.22 , N/A ,$173.22 ,$173.22 , N/A ,$125.11 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204578,N/A,HC CONNECTOR ANESTHESIA SWIVEL,272,1 ,$1.57 ,$1.02 ,$0.68 ,$1.57 ,$1.17 ,$1.03 , N/A ,$0.83 , N/A ,$0.99 ,$0.99 ,$0.99 ,$0.99 ,$1.41 ,$1.18 , N/A ,$1.38 , N/A ,$1.18 ,$1.18 ,$1.33 ,$1.33 , N/A ,$1.33 , N/A ,$1.24 ,$1.24 ,$1.24 ,$1.41 , N/A ,$1.41 , N/A ,$1.57 ,$1.03 , N/A ,$0.68 , N/A , N/A ,$1.41 , N/A ,$0.99 ,$0.94 ,$1.41 , N/A ,$1.41 ,$1.41 , N/A ,$1.02 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204579,N/A,HC DIALYZER,272,1 ,$27.30 ,$17.75 ,$11.85 ,$27.30 ,$20.34 ,$17.88 , N/A ,$14.39 , N/A ,$17.23 ,$17.23 ,$17.23 ,$17.23 ,$24.57 ,$20.48 , N/A ,$24.02 , N/A ,$20.48 ,$20.48 ,$23.21 ,$23.21 , N/A ,$23.21 , N/A ,$21.57 ,$21.57 ,$21.57 ,$24.57 , N/A ,$24.57 , N/A ,$27.30 ,$17.88 , N/A ,$11.85 , N/A , N/A ,$24.57 , N/A ,$17.23 ,$16.38 ,$24.57 , N/A ,$24.57 ,$24.57 , N/A ,$17.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204582,N/A,HC FILTER IV,272,1 ,$8.58 ,$5.58 ,$3.72 ,$8.58 ,$6.39 ,$5.62 , N/A ,$4.52 , N/A ,$5.41 ,$5.41 ,$5.41 ,$5.41 ,$7.72 ,$6.44 , N/A ,$7.55 , N/A ,$6.44 ,$6.44 ,$7.29 ,$7.29 , N/A ,$7.29 , N/A ,$6.78 ,$6.78 ,$6.78 ,$7.72 , N/A ,$7.72 , N/A ,$8.58 ,$5.62 , N/A ,$3.72 , N/A , N/A ,$7.72 , N/A ,$5.41 ,$5.15 ,$7.72 , N/A ,$7.72 ,$7.72 , N/A ,$5.58 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204583,N/A,HC LARYNGOSCOPE GLIDESCOPE,272,1 ,$24.00 ,$15.60 ,$10.42 ,$24.00 ,$17.88 ,$15.72 , N/A ,$12.65 , N/A ,$15.14 ,$15.14 ,$15.14 ,$15.14 ,$21.60 ,$18.00 , N/A ,$21.12 , N/A ,$18.00 ,$18.00 ,$20.40 ,$20.40 , N/A ,$20.40 , N/A ,$18.96 ,$18.96 ,$18.96 ,$21.60 , N/A ,$21.60 , N/A ,$24.00 ,$15.72 , N/A ,$10.42 , N/A , N/A ,$21.60 , N/A ,$15.14 ,$14.40 ,$21.60 , N/A ,$21.60 ,$21.60 , N/A ,$15.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204590,N/A,HC PACK C-SECTION,272,1 ,$153.37 ,$99.69 ,$66.56 ,$153.37 ,$114.26 ,$100.46 , N/A ,$80.83 , N/A ,$96.78 ,$96.78 ,$96.78 ,$96.78 ,$138.03 ,$115.03 , N/A ,$134.97 , N/A ,$115.03 ,$115.03 ,$130.36 ,$130.36 , N/A ,$130.36 , N/A ,$121.16 ,$121.16 ,$121.16 ,$138.03 , N/A ,$138.03 , N/A ,$153.37 ,$100.46 , N/A ,$66.56 , N/A , N/A ,$138.03 , N/A ,$96.78 ,$92.02 ,$138.03 , N/A ,$138.03 ,$138.03 , N/A ,$99.69 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204607,N/A,HC TUBE NASOGASTRIC,272,1 ,$50.16 ,$32.60 ,$21.77 ,$50.16 ,$37.37 ,$32.85 , N/A ,$26.43 , N/A ,$31.65 ,$31.65 ,$31.65 ,$31.65 ,$45.14 ,$37.62 , N/A ,$44.14 , N/A ,$37.62 ,$37.62 ,$42.64 ,$42.64 , N/A ,$42.64 , N/A ,$39.63 ,$39.63 ,$39.63 ,$45.14 , N/A ,$45.14 , N/A ,$50.16 ,$32.85 , N/A ,$21.77 , N/A , N/A ,$45.14 , N/A ,$31.65 ,$30.10 ,$45.14 , N/A ,$45.14 ,$45.14 , N/A ,$32.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204616,N/A,HC TUBING SUCTION,272,1 ,$35.89 ,$23.33 ,$15.58 ,$35.89 ,$26.74 ,$23.51 , N/A ,$18.91 , N/A ,$22.65 ,$22.65 ,$22.65 ,$22.65 ,$32.30 ,$26.92 , N/A ,$31.58 , N/A ,$26.92 ,$26.92 ,$30.51 ,$30.51 , N/A ,$30.51 , N/A ,$28.35 ,$28.35 ,$28.35 ,$32.30 , N/A ,$32.30 , N/A ,$35.89 ,$23.51 , N/A ,$15.58 , N/A , N/A ,$32.30 , N/A ,$22.65 ,$21.53 ,$32.30 , N/A ,$32.30 ,$32.30 , N/A ,$23.33 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204622,N/A,HC MARKER BIOPSY SITE,272,1 ,$175.91 ,$114.34 ,$76.34 ,$175.91 ,$131.05 ,$115.22 , N/A ,$92.70 , N/A ,$111.00 ,$111.00 ,$111.00 ,$111.00 ,$158.32 ,$131.93 , N/A ,$154.80 , N/A ,$131.93 ,$131.93 ,$149.52 ,$149.52 , N/A ,$149.52 , N/A ,$138.97 ,$138.97 ,$138.97 ,$158.32 , N/A ,$158.32 , N/A ,$175.91 ,$115.22 , N/A ,$76.34 , N/A , N/A ,$158.32 , N/A ,$111.00 ,$105.55 ,$158.32 , N/A ,$158.32 ,$158.32 , N/A ,$114.34 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204623,N/A,HC NEEDLE GUIDE,272,1 ,$32.66 ,$21.23 ,$14.17 ,$32.66 ,$24.33 ,$21.39 , N/A ,$17.21 , N/A ,$20.61 ,$20.61 ,$20.61 ,$20.61 ,$29.39 ,$24.50 , N/A ,$28.74 , N/A ,$24.50 ,$24.50 ,$27.76 ,$27.76 , N/A ,$27.76 , N/A ,$25.80 ,$25.80 ,$25.80 ,$29.39 , N/A ,$29.39 , N/A ,$32.66 ,$21.39 , N/A ,$14.17 , N/A , N/A ,$29.39 , N/A ,$20.61 ,$19.60 ,$29.39 , N/A ,$29.39 ,$29.39 , N/A ,$21.23 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204625,N/A,HC TRAY BREAST BIOPSY,272,1 ,$41.69 ,$27.10 ,$18.09 ,$41.69 ,$31.06 ,$27.31 , N/A ,$21.97 , N/A ,$26.31 ,$26.31 ,$26.31 ,$26.31 ,$37.52 ,$31.27 , N/A ,$36.69 , N/A ,$31.27 ,$31.27 ,$35.44 ,$35.44 , N/A ,$35.44 , N/A ,$32.94 ,$32.94 ,$32.94 ,$37.52 , N/A ,$37.52 , N/A ,$41.69 ,$27.31 , N/A ,$18.09 , N/A , N/A ,$37.52 , N/A ,$26.31 ,$25.01 ,$37.52 , N/A ,$37.52 ,$37.52 , N/A ,$27.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204654,N/A,HC BAG RESUSCITATE INFANT,272,1 ,$33.00 ,$21.45 ,$14.32 ,$33.00 ,$24.59 ,$21.62 , N/A ,$17.39 , N/A ,$20.82 ,$20.82 ,$20.82 ,$20.82 ,$29.70 ,$24.75 , N/A ,$29.04 , N/A ,$24.75 ,$24.75 ,$28.05 ,$28.05 , N/A ,$28.05 , N/A ,$26.07 ,$26.07 ,$26.07 ,$29.70 , N/A ,$29.70 , N/A ,$33.00 ,$21.62 , N/A ,$14.32 , N/A , N/A ,$29.70 , N/A ,$20.82 ,$19.80 ,$29.70 , N/A ,$29.70 ,$29.70 , N/A ,$21.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204656,N/A,HC BAG RESUSCITOR,272,1 ,$90.70 ,$58.96 ,$39.36 ,$90.70 ,$67.57 ,$59.41 , N/A ,$47.80 , N/A ,$57.23 ,$57.23 ,$57.23 ,$57.23 ,$81.63 ,$68.03 , N/A ,$79.82 , N/A ,$68.03 ,$68.03 ,$77.10 ,$77.10 , N/A ,$77.10 , N/A ,$71.65 ,$71.65 ,$71.65 ,$81.63 , N/A ,$81.63 , N/A ,$90.70 ,$59.41 , N/A ,$39.36 , N/A , N/A ,$81.63 , N/A ,$57.23 ,$54.42 ,$81.63 , N/A ,$81.63 ,$81.63 , N/A ,$58.96 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204657,N/A,HC CANISTER V.A.C.,272,1 ,$387.47 ,$251.86 ,$168.16 ,$387.47 ,$288.67 ,$253.79 , N/A ,$204.20 , N/A ,$244.49 ,$244.49 ,$244.49 ,$244.49 ,$348.72 ,$290.60 , N/A ,$340.97 , N/A ,$290.60 ,$290.60 ,$329.35 ,$329.35 , N/A ,$329.35 , N/A ,$306.10 ,$306.10 ,$306.10 ,$348.72 , N/A ,$348.72 , N/A ,$387.47 ,$253.79 , N/A ,$168.16 , N/A , N/A ,$348.72 , N/A ,$244.49 ,$232.48 ,$348.72 , N/A ,$348.72 ,$348.72 , N/A ,$251.86 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204660,N/A,HC CANNULA NASAL OXYGEN,272,1 ,$23.40 ,$15.21 ,$10.16 ,$23.40 ,$17.43 ,$15.33 , N/A ,$12.33 , N/A ,$14.77 ,$14.77 ,$14.77 ,$14.77 ,$21.06 ,$17.55 , N/A ,$20.59 , N/A ,$17.55 ,$17.55 ,$19.89 ,$19.89 , N/A ,$19.89 , N/A ,$18.49 ,$18.49 ,$18.49 ,$21.06 , N/A ,$21.06 , N/A ,$23.40 ,$15.33 , N/A ,$10.16 , N/A , N/A ,$21.06 , N/A ,$14.77 ,$14.04 ,$21.06 , N/A ,$21.06 ,$21.06 , N/A ,$15.21 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204675,N/A,HC ELECTRODE ADULT,272,1 ,$7.28 ,$4.73 ,$3.16 ,$7.28 ,$5.42 ,$4.77 , N/A ,$3.84 , N/A ,$4.59 ,$4.59 ,$4.59 ,$4.59 ,$6.55 ,$5.46 , N/A ,$6.41 , N/A ,$5.46 ,$5.46 ,$6.19 ,$6.19 , N/A ,$6.19 , N/A ,$5.75 ,$5.75 ,$5.75 ,$6.55 , N/A ,$6.55 , N/A ,$7.28 ,$4.77 , N/A ,$3.16 , N/A , N/A ,$6.55 , N/A ,$4.59 ,$4.37 ,$6.55 , N/A ,$6.55 ,$6.55 , N/A ,$4.73 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204707,N/A,HC PAD DEFRIBILLATOR GEL,272,1 ,$21.36 ,$13.88 ,$9.27 ,$21.36 ,$15.91 ,$13.99 , N/A ,$11.26 , N/A ,$13.48 ,$13.48 ,$13.48 ,$13.48 ,$19.22 ,$16.02 , N/A ,$18.80 , N/A ,$16.02 ,$16.02 ,$18.16 ,$18.16 , N/A ,$18.16 , N/A ,$16.87 ,$16.87 ,$16.87 ,$19.22 , N/A ,$19.22 , N/A ,$21.36 ,$13.99 , N/A ,$9.27 , N/A , N/A ,$19.22 , N/A ,$13.48 ,$12.82 ,$19.22 , N/A ,$19.22 ,$19.22 , N/A ,$13.88 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204737,C1729,HC CATHETER DRAINAGE T18,272,1 ,"$2,100.00 ","$1,365.00 ",$911.40 ,"$2,100.00 ","$1,564.50 ","$1,375.50 ", N/A ,"$1,106.70 ", N/A ,"$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,890.00 ","$1,575.00 ", N/A ,"$1,848.00 ", N/A ,"$1,575.00 ","$1,575.00 ","$1,785.00 ","$1,785.00 ", N/A ,"$1,785.00 ", N/A ,"$1,659.00 ","$1,659.00 ","$1,659.00 ","$1,890.00 ", N/A ,"$1,890.00 ", N/A ,"$2,100.00 ","$1,375.50 ", N/A ,$911.40 , N/A , N/A ,"$1,890.00 ", N/A ,"$1,325.10 ","$1,260.00 ","$1,890.00 ", N/A ,"$1,890.00 ","$1,890.00 ", N/A ,"$1,365.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204738,C1729,HC CATHETER DRAINAGE T19,272,1 ,"$2,700.00 ","$1,755.00 ","$1,171.80 ","$2,700.00 ","$2,011.50 ","$1,768.50 ", N/A ,"$1,422.90 ", N/A ,"$1,703.70 ","$1,703.70 ","$1,703.70 ","$1,703.70 ","$2,430.00 ","$2,025.00 ", N/A ,"$2,376.00 ", N/A ,"$2,025.00 ","$2,025.00 ","$2,295.00 ","$2,295.00 ", N/A ,"$2,295.00 ", N/A ,"$2,133.00 ","$2,133.00 ","$2,133.00 ","$2,430.00 ", N/A ,"$2,430.00 ", N/A ,"$2,700.00 ","$1,768.50 ", N/A ,"$1,171.80 ", N/A , N/A ,"$2,430.00 ", N/A ,"$1,703.70 ","$1,620.00 ","$2,430.00 ", N/A ,"$2,430.00 ","$2,430.00 ", N/A ,"$1,755.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204739,C1729,HC CATHETER DRAINAGE T20,272,1 ,"$3,300.00 ","$2,145.00 ","$1,432.20 ","$3,300.00 ","$2,458.50 ","$2,161.50 ", N/A ,"$1,739.10 ", N/A ,"$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,970.00 ","$2,475.00 ", N/A ,"$2,904.00 ", N/A ,"$2,475.00 ","$2,475.00 ","$2,805.00 ","$2,805.00 ", N/A ,"$2,805.00 ", N/A ,"$2,607.00 ","$2,607.00 ","$2,607.00 ","$2,970.00 ", N/A ,"$2,970.00 ", N/A ,"$3,300.00 ","$2,161.50 ", N/A ,"$1,432.20 ", N/A , N/A ,"$2,970.00 ", N/A ,"$2,082.30 ","$1,980.00 ","$2,970.00 ", N/A ,"$2,970.00 ","$2,970.00 ", N/A ,"$2,145.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204740,C1729,HC CATHETER DRAINAGE T21,272,1 ,"$3,900.00 ","$2,535.00 ","$1,692.60 ","$3,900.00 ","$2,905.50 ","$2,554.50 ", N/A ,"$2,055.30 ", N/A ,"$2,460.90 ","$2,460.90 ","$2,460.90 ","$2,460.90 ","$3,510.00 ","$2,925.00 ", N/A ,"$3,432.00 ", N/A ,"$2,925.00 ","$2,925.00 ","$3,315.00 ","$3,315.00 ", N/A ,"$3,315.00 ", N/A ,"$3,081.00 ","$3,081.00 ","$3,081.00 ","$3,510.00 ", N/A ,"$3,510.00 ", N/A ,"$3,900.00 ","$2,554.50 ", N/A ,"$1,692.60 ", N/A , N/A ,"$3,510.00 ", N/A ,"$2,460.90 ","$2,340.00 ","$3,510.00 ", N/A ,"$3,510.00 ","$3,510.00 ", N/A ,"$2,535.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204756,N/A,HC CLIP BREAST BIOPSY,272,1 ,$132.18 ,$85.92 ,$57.37 ,$132.18 ,$98.47 ,$86.58 , N/A ,$69.66 , N/A ,$83.41 ,$83.41 ,$83.41 ,$83.41 ,$118.96 ,$99.14 , N/A ,$116.32 , N/A ,$99.14 ,$99.14 ,$112.35 ,$112.35 , N/A ,$112.35 , N/A ,$104.42 ,$104.42 ,$104.42 ,$118.96 , N/A ,$118.96 , N/A ,$132.18 ,$86.58 , N/A ,$57.37 , N/A , N/A ,$118.96 , N/A ,$83.41 ,$79.31 ,$118.96 , N/A ,$118.96 ,$118.96 , N/A ,$85.92 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204760,N/A,HC BLANKET BAIR HUGGER,272,1 ,$39.00 ,$25.35 ,$16.93 ,$39.00 ,$29.06 ,$25.55 , N/A ,$20.55 , N/A ,$24.61 ,$24.61 ,$24.61 ,$24.61 ,$35.10 ,$29.25 , N/A ,$34.32 , N/A ,$29.25 ,$29.25 ,$33.15 ,$33.15 , N/A ,$33.15 , N/A ,$30.81 ,$30.81 ,$30.81 ,$35.10 , N/A ,$35.10 , N/A ,$39.00 ,$25.55 , N/A ,$16.93 , N/A , N/A ,$35.10 , N/A ,$24.61 ,$23.40 ,$35.10 , N/A ,$35.10 ,$35.10 , N/A ,$25.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204771,N/A,HC BLADE LARYNGOSCOPE,272,1 ,$56.70 ,$36.86 ,$24.61 ,$56.70 ,$42.24 ,$37.14 , N/A ,$29.88 , N/A ,$35.78 ,$35.78 ,$35.78 ,$35.78 ,$51.03 ,$42.53 , N/A ,$49.90 , N/A ,$42.53 ,$42.53 ,$48.20 ,$48.20 , N/A ,$48.20 , N/A ,$44.79 ,$44.79 ,$44.79 ,$51.03 , N/A ,$51.03 , N/A ,$56.70 ,$37.14 , N/A ,$24.61 , N/A , N/A ,$51.03 , N/A ,$35.78 ,$34.02 ,$51.03 , N/A ,$51.03 ,$51.03 , N/A ,$36.86 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204772,N/A,HC BLADE LARYNGEAL,272,1 ,$24.34 ,$15.82 ,$10.56 ,$24.34 ,$18.13 ,$15.94 , N/A ,$12.83 , N/A ,$15.36 ,$15.36 ,$15.36 ,$15.36 ,$21.91 ,$18.26 , N/A ,$21.42 , N/A ,$18.26 ,$18.26 ,$20.69 ,$20.69 , N/A ,$20.69 , N/A ,$19.23 ,$19.23 ,$19.23 ,$21.91 , N/A ,$21.91 , N/A ,$24.34 ,$15.94 , N/A ,$10.56 , N/A , N/A ,$21.91 , N/A ,$15.36 ,$14.60 ,$21.91 , N/A ,$21.91 ,$21.91 , N/A ,$15.82 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204773,N/A,HC CAUTERY PEN HIGH TEMP,272,1 ,$74.42 ,$48.37 ,$32.30 ,$74.42 ,$55.44 ,$48.75 , N/A ,$39.22 , N/A ,$46.96 ,$46.96 ,$46.96 ,$46.96 ,$66.98 ,$55.82 , N/A ,$65.49 , N/A ,$55.82 ,$55.82 ,$63.26 ,$63.26 , N/A ,$63.26 , N/A ,$58.79 ,$58.79 ,$58.79 ,$66.98 , N/A ,$66.98 , N/A ,$74.42 ,$48.75 , N/A ,$32.30 , N/A , N/A ,$66.98 , N/A ,$46.96 ,$44.65 ,$66.98 , N/A ,$66.98 ,$66.98 , N/A ,$48.37 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204774,N/A,HC SENSOR OXIMETRY CEREBRAL,272,1 ,$27.00 ,$17.55 ,$11.72 ,$27.00 ,$20.12 ,$17.69 , N/A ,$14.23 , N/A ,$17.04 ,$17.04 ,$17.04 ,$17.04 ,$24.30 ,$20.25 , N/A ,$23.76 , N/A ,$20.25 ,$20.25 ,$22.95 ,$22.95 , N/A ,$22.95 , N/A ,$21.33 ,$21.33 ,$21.33 ,$24.30 , N/A ,$24.30 , N/A ,$27.00 ,$17.69 , N/A ,$11.72 , N/A , N/A ,$24.30 , N/A ,$17.04 ,$16.20 ,$24.30 , N/A ,$24.30 ,$24.30 , N/A ,$17.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204818,N/A,HC COMPRESSION COBAN 2 LAYER,272,1 ,$104.31 ,$67.80 ,$45.27 ,$104.31 ,$77.71 ,$68.32 , N/A ,$54.97 , N/A ,$65.82 ,$65.82 ,$65.82 ,$65.82 ,$93.88 ,$78.23 , N/A ,$91.79 , N/A ,$78.23 ,$78.23 ,$88.66 ,$88.66 , N/A ,$88.66 , N/A ,$82.40 ,$82.40 ,$82.40 ,$93.88 , N/A ,$93.88 , N/A ,$104.31 ,$68.32 , N/A ,$45.27 , N/A , N/A ,$93.88 , N/A ,$65.82 ,$62.59 ,$93.88 , N/A ,$93.88 ,$93.88 , N/A ,$67.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204819,N/A,HC COMPRESSION WRAP SETOPRESS,272,1 ,$301.56 ,$196.01 ,$130.88 ,$301.56 ,$224.66 ,$197.52 , N/A ,$158.92 , N/A ,$190.28 ,$190.28 ,$190.28 ,$190.28 ,$271.40 ,$226.17 , N/A ,$265.37 , N/A ,$226.17 ,$226.17 ,$256.33 ,$256.33 , N/A ,$256.33 , N/A ,$238.23 ,$238.23 ,$238.23 ,$271.40 , N/A ,$271.40 , N/A ,$301.56 ,$197.52 , N/A ,$130.88 , N/A , N/A ,$271.40 , N/A ,$190.28 ,$180.94 ,$271.40 , N/A ,$271.40 ,$271.40 , N/A ,$196.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204833,N/A,HC CANNULA NASAL ETCO2 LONG TERM,272,1 ,$45.00 ,$29.25 ,$19.53 ,$45.00 ,$33.53 ,$29.48 , N/A ,$23.72 , N/A ,$28.40 ,$28.40 ,$28.40 ,$28.40 ,$40.50 ,$33.75 , N/A ,$39.60 , N/A ,$33.75 ,$33.75 ,$38.25 ,$38.25 , N/A ,$38.25 , N/A ,$35.55 ,$35.55 ,$35.55 ,$40.50 , N/A ,$40.50 , N/A ,$45.00 ,$29.48 , N/A ,$19.53 , N/A , N/A ,$40.50 , N/A ,$28.40 ,$27.00 ,$40.50 , N/A ,$40.50 ,$40.50 , N/A ,$29.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204858,N/A,HC HEEL PROTECTOR WAFFLE CUSTOM,270,1 ,$235.99 ,$153.39 ,$102.42 ,$235.99 ,$175.81 ,$154.57 , N/A ,$124.37 , N/A ,$148.91 ,$148.91 ,$148.91 ,$148.91 ,$212.39 ,$176.99 , N/A ,$207.67 , N/A ,$176.99 ,$176.99 ,$200.59 ,$200.59 , N/A ,$200.59 , N/A ,$186.43 ,$186.43 ,$186.43 ,$212.39 , N/A ,$212.39 , N/A ,$235.99 ,$154.57 , N/A ,$102.42 , N/A , N/A ,$212.39 , N/A ,$148.91 ,$141.59 ,$212.39 , N/A ,$212.39 ,$212.39 , N/A ,$153.39 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204859,N/A,HC HEMOSTAT SURGICAL,272,1 ,$883.00 ,$573.95 ,$383.22 ,$883.00 ,$657.84 ,$578.37 , N/A ,$465.34 , N/A ,$557.17 ,$557.17 ,$557.17 ,$557.17 ,$794.70 ,$662.25 , N/A ,$777.04 , N/A ,$662.25 ,$662.25 ,$750.55 ,$750.55 , N/A ,$750.55 , N/A ,$697.57 ,$697.57 ,$697.57 ,$794.70 , N/A ,$794.70 , N/A ,$883.00 ,$578.37 , N/A ,$383.22 , N/A , N/A ,$794.70 , N/A ,$557.17 ,$529.80 ,$794.70 , N/A ,$794.70 ,$794.70 , N/A ,$573.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204860,N/A,HC HEMOSTAT MATRIX,272,1 ,$300.00 ,$195.00 ,$130.20 ,$300.00 ,$223.50 ,$196.50 , N/A ,$158.10 , N/A ,$189.30 ,$189.30 ,$189.30 ,$189.30 ,$270.00 ,$225.00 , N/A ,$264.00 , N/A ,$225.00 ,$225.00 ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$237.00 ,$237.00 ,$237.00 ,$270.00 , N/A ,$270.00 , N/A ,$300.00 ,$196.50 , N/A ,$130.20 , N/A , N/A ,$270.00 , N/A ,$189.30 ,$180.00 ,$270.00 , N/A ,$270.00 ,$270.00 , N/A ,$195.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204865,N/A,HC INTRODUCER/SHEATH,272,1 ,$4.53 ,$2.94 ,$1.97 ,$4.53 ,$3.37 ,$2.97 , N/A ,$2.39 , N/A ,$2.86 ,$2.86 ,$2.86 ,$2.86 ,$4.08 ,$3.40 , N/A ,$3.99 , N/A ,$3.40 ,$3.40 ,$3.85 ,$3.85 , N/A ,$3.85 , N/A ,$3.58 ,$3.58 ,$3.58 ,$4.08 , N/A ,$4.08 , N/A ,$4.53 ,$2.97 , N/A ,$1.97 , N/A , N/A ,$4.08 , N/A ,$2.86 ,$2.72 ,$4.08 , N/A ,$4.08 ,$4.08 , N/A ,$2.94 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204866,N/A,HC AIRWAY INTUBATING W/OXYGEN DELIVERY,272,1 ,$145.09 ,$94.31 ,$62.97 ,$145.09 ,$108.09 ,$95.03 , N/A ,$76.46 , N/A ,$91.55 ,$91.55 ,$91.55 ,$91.55 ,$130.58 ,$108.82 , N/A ,$127.68 , N/A ,$108.82 ,$108.82 ,$123.33 ,$123.33 , N/A ,$123.33 , N/A ,$114.62 ,$114.62 ,$114.62 ,$130.58 , N/A ,$130.58 , N/A ,$145.09 ,$95.03 , N/A ,$62.97 , N/A , N/A ,$130.58 , N/A ,$91.55 ,$87.05 ,$130.58 , N/A ,$130.58 ,$130.58 , N/A ,$94.31 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204869,N/A,HC IV ANGIOCATH,272,1 ,$9.44 ,$6.14 ,$4.10 ,$9.44 ,$7.03 ,$6.18 , N/A ,$4.97 , N/A ,$5.96 ,$5.96 ,$5.96 ,$5.96 ,$8.50 ,$7.08 , N/A ,$8.31 , N/A ,$7.08 ,$7.08 ,$8.02 ,$8.02 , N/A ,$8.02 , N/A ,$7.46 ,$7.46 ,$7.46 ,$8.50 , N/A ,$8.50 , N/A ,$9.44 ,$6.18 , N/A ,$4.10 , N/A , N/A ,$8.50 , N/A ,$5.96 ,$5.66 ,$8.50 , N/A ,$8.50 ,$8.50 , N/A ,$6.14 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204887,N/A,HC KIT CATHETER FEMALE,272,1 ,$20.78 ,$13.51 ,$9.02 ,$20.78 ,$15.48 ,$13.61 , N/A ,$10.95 , N/A ,$13.11 ,$13.11 ,$13.11 ,$13.11 ,$18.70 ,$15.59 , N/A ,$18.29 , N/A ,$15.59 ,$15.59 ,$17.66 ,$17.66 , N/A ,$17.66 , N/A ,$16.42 ,$16.42 ,$16.42 ,$18.70 , N/A ,$18.70 , N/A ,$20.78 ,$13.61 , N/A ,$9.02 , N/A , N/A ,$18.70 , N/A ,$13.11 ,$12.47 ,$18.70 , N/A ,$18.70 ,$18.70 , N/A ,$13.51 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204936,N/A,HC NEEDLE NERVE BLOCK ECHOGENIC,272,1 ,$119.74 ,$77.83 ,$51.97 ,$119.74 ,$89.21 ,$78.43 , N/A ,$63.10 , N/A ,$75.56 ,$75.56 ,$75.56 ,$75.56 ,$107.77 ,$89.81 , N/A ,$105.37 , N/A ,$89.81 ,$89.81 ,$101.78 ,$101.78 , N/A ,$101.78 , N/A ,$94.59 ,$94.59 ,$94.59 ,$107.77 , N/A ,$107.77 , N/A ,$119.74 ,$78.43 , N/A ,$51.97 , N/A , N/A ,$107.77 , N/A ,$75.56 ,$71.84 ,$107.77 , N/A ,$107.77 ,$107.77 , N/A ,$77.83 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204941,N/A,HC NEEDLE EPIDURAL,272,1 ,$22.53 ,$14.64 ,$9.78 ,$22.53 ,$16.78 ,$14.76 , N/A ,$11.87 , N/A ,$14.22 ,$14.22 ,$14.22 ,$14.22 ,$20.28 ,$16.90 , N/A ,$19.83 , N/A ,$16.90 ,$16.90 ,$19.15 ,$19.15 , N/A ,$19.15 , N/A ,$17.80 ,$17.80 ,$17.80 ,$20.28 , N/A ,$20.28 , N/A ,$22.53 ,$14.76 , N/A ,$9.78 , N/A , N/A ,$20.28 , N/A ,$14.22 ,$13.52 ,$20.28 , N/A ,$20.28 ,$20.28 , N/A ,$14.64 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204948,N/A,HC NEEDLE MONOPTY,272,1 ,$41.36 ,$26.88 ,$17.95 ,$41.36 ,$30.81 ,$27.09 , N/A ,$21.80 , N/A ,$26.10 ,$26.10 ,$26.10 ,$26.10 ,$37.22 ,$31.02 , N/A ,$36.40 , N/A ,$31.02 ,$31.02 ,$35.16 ,$35.16 , N/A ,$35.16 , N/A ,$32.67 ,$32.67 ,$32.67 ,$37.22 , N/A ,$37.22 , N/A ,$41.36 ,$27.09 , N/A ,$17.95 , N/A , N/A ,$37.22 , N/A ,$26.10 ,$24.82 ,$37.22 , N/A ,$37.22 ,$37.22 , N/A ,$26.88 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204949,N/A,HC HOLDER ENDOTRACH NEOBAR,272,1 ,$81.14 ,$52.74 ,$35.21 ,$81.14 ,$60.45 ,$53.15 , N/A ,$42.76 , N/A ,$51.20 ,$51.20 ,$51.20 ,$51.20 ,$73.03 ,$60.86 , N/A ,$71.40 , N/A ,$60.86 ,$60.86 ,$68.97 ,$68.97 , N/A ,$68.97 , N/A ,$64.10 ,$64.10 ,$64.10 ,$73.03 , N/A ,$73.03 , N/A ,$81.14 ,$53.15 , N/A ,$35.21 , N/A , N/A ,$73.03 , N/A ,$51.20 ,$48.68 ,$73.03 , N/A ,$73.03 ,$73.03 , N/A ,$52.74 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204965,N/A,HC OSTOMY CONE IRRIGATOR KIT,272,1 ,$15.48 ,$10.06 ,$6.72 ,$15.48 ,$11.53 ,$10.14 , N/A ,$8.16 , N/A ,$9.77 ,$9.77 ,$9.77 ,$9.77 ,$13.93 ,$11.61 , N/A ,$13.62 , N/A ,$11.61 ,$11.61 ,$13.16 ,$13.16 , N/A ,$13.16 , N/A ,$12.23 ,$12.23 ,$12.23 ,$13.93 , N/A ,$13.93 , N/A ,$15.48 ,$10.14 , N/A ,$6.72 , N/A , N/A ,$13.93 , N/A ,$9.77 ,$9.29 ,$13.93 , N/A ,$13.93 ,$13.93 , N/A ,$10.06 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204988,N/A,HC BAG INFUSION PRESSURE,272,1 ,$192.00 ,$124.80 ,$83.33 ,$192.00 ,$143.04 ,$125.76 , N/A ,$101.18 , N/A ,$121.15 ,$121.15 ,$121.15 ,$121.15 ,$172.80 ,$144.00 , N/A ,$168.96 , N/A ,$144.00 ,$144.00 ,$163.20 ,$163.20 , N/A ,$163.20 , N/A ,$151.68 ,$151.68 ,$151.68 ,$172.80 , N/A ,$172.80 , N/A ,$192.00 ,$125.76 , N/A ,$83.33 , N/A , N/A ,$172.80 , N/A ,$121.15 ,$115.20 ,$172.80 , N/A ,$172.80 ,$172.80 , N/A ,$124.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204996,N/A,HC PROBE TEMP SENSOR,272,1 ,$20.00 ,$13.00 ,$8.68 ,$20.00 ,$14.90 ,$13.10 , N/A ,$10.54 , N/A ,$12.62 ,$12.62 ,$12.62 ,$12.62 ,$18.00 ,$15.00 , N/A ,$17.60 , N/A ,$15.00 ,$15.00 ,$17.00 ,$17.00 , N/A ,$17.00 , N/A ,$15.80 ,$15.80 ,$15.80 ,$18.00 , N/A ,$18.00 , N/A ,$20.00 ,$13.10 , N/A ,$8.68 , N/A , N/A ,$18.00 , N/A ,$12.62 ,$12.00 ,$18.00 , N/A ,$18.00 ,$18.00 , N/A ,$13.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27204999,N/A,HC SENSOR PULSE OX,272,1 ,$129.41 ,$84.12 ,$56.16 ,$129.41 ,$96.41 ,$84.76 , N/A ,$68.20 , N/A ,$81.66 ,$81.66 ,$81.66 ,$81.66 ,$116.47 ,$97.06 , N/A ,$113.88 , N/A ,$97.06 ,$97.06 ,$110.00 ,$110.00 , N/A ,$110.00 , N/A ,$102.23 ,$102.23 ,$102.23 ,$116.47 , N/A ,$116.47 , N/A ,$129.41 ,$84.76 , N/A ,$56.16 , N/A , N/A ,$116.47 , N/A ,$81.66 ,$77.65 ,$116.47 , N/A ,$116.47 ,$116.47 , N/A ,$84.12 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205010,N/A,HC VALVE ANTI-REFLUX SALEM,272,1 ,$57.41 ,$37.32 ,$24.92 ,$57.41 ,$42.77 ,$37.60 , N/A ,$30.26 , N/A ,$36.23 ,$36.23 ,$36.23 ,$36.23 ,$51.67 ,$43.06 , N/A ,$50.52 , N/A ,$43.06 ,$43.06 ,$48.80 ,$48.80 , N/A ,$48.80 , N/A ,$45.35 ,$45.35 ,$45.35 ,$51.67 , N/A ,$51.67 , N/A ,$57.41 ,$37.60 , N/A ,$24.92 , N/A , N/A ,$51.67 , N/A ,$36.23 ,$34.45 ,$51.67 , N/A ,$51.67 ,$51.67 , N/A ,$37.32 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205019,N/A,HC PROTECTOR SHEEPSKIN,272,1 ,$58.00 ,$37.70 ,$25.17 ,$58.00 ,$43.21 ,$37.99 , N/A ,$30.57 , N/A ,$36.60 ,$36.60 ,$36.60 ,$36.60 ,$52.20 ,$43.50 , N/A ,$51.04 , N/A ,$43.50 ,$43.50 ,$49.30 ,$49.30 , N/A ,$49.30 , N/A ,$45.82 ,$45.82 ,$45.82 ,$52.20 , N/A ,$52.20 , N/A ,$58.00 ,$37.99 , N/A ,$25.17 , N/A , N/A ,$52.20 , N/A ,$36.60 ,$34.80 ,$52.20 , N/A ,$52.20 ,$52.20 , N/A ,$37.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205026,N/A,HC SPLINT CAST CONFORMABLE MEDIUM,272,1 ,$31.00 ,$20.15 ,$13.45 ,$31.00 ,$23.10 ,$20.31 , N/A ,$16.34 , N/A ,$19.56 ,$19.56 ,$19.56 ,$19.56 ,$27.90 ,$23.25 , N/A ,$27.28 , N/A ,$23.25 ,$23.25 ,$26.35 ,$26.35 , N/A ,$26.35 , N/A ,$24.49 ,$24.49 ,$24.49 ,$27.90 , N/A ,$27.90 , N/A ,$31.00 ,$20.31 , N/A ,$13.45 , N/A , N/A ,$27.90 , N/A ,$19.56 ,$18.60 ,$27.90 , N/A ,$27.90 ,$27.90 , N/A ,$20.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205034,N/A,HC SET INFUSION SUBCUTANEOUS,272,1 ,$62.81 ,$40.83 ,$27.26 ,$62.81 ,$46.79 ,$41.14 , N/A ,$33.10 , N/A ,$39.63 ,$39.63 ,$39.63 ,$39.63 ,$56.53 ,$47.11 , N/A ,$55.27 , N/A ,$47.11 ,$47.11 ,$53.39 ,$53.39 , N/A ,$53.39 , N/A ,$49.62 ,$49.62 ,$49.62 ,$56.53 , N/A ,$56.53 , N/A ,$62.81 ,$41.14 , N/A ,$27.26 , N/A , N/A ,$56.53 , N/A ,$39.63 ,$37.69 ,$56.53 , N/A ,$56.53 ,$56.53 , N/A ,$40.83 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205046,N/A,HC SYRINGE ATOMIZER MUCOSAL,272,1 ,$26.91 ,$17.49 ,$11.68 ,$26.91 ,$20.05 ,$17.63 , N/A ,$14.18 , N/A ,$16.98 ,$16.98 ,$16.98 ,$16.98 ,$24.22 ,$20.18 , N/A ,$23.68 , N/A ,$20.18 ,$20.18 ,$22.87 ,$22.87 , N/A ,$22.87 , N/A ,$21.26 ,$21.26 ,$21.26 ,$24.22 , N/A ,$24.22 , N/A ,$26.91 ,$17.63 , N/A ,$11.68 , N/A , N/A ,$24.22 , N/A ,$16.98 ,$16.15 ,$24.22 , N/A ,$24.22 ,$24.22 , N/A ,$17.49 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205059,N/A,HC TRAY HYSTEROSALPINGOGRAM,272,1 ,$97.86 ,$63.61 ,$42.47 ,$97.86 ,$72.91 ,$64.10 , N/A ,$51.57 , N/A ,$61.75 ,$61.75 ,$61.75 ,$61.75 ,$88.07 ,$73.40 , N/A ,$86.12 , N/A ,$73.40 ,$73.40 ,$83.18 ,$83.18 , N/A ,$83.18 , N/A ,$77.31 ,$77.31 ,$77.31 ,$88.07 , N/A ,$88.07 , N/A ,$97.86 ,$64.10 , N/A ,$42.47 , N/A , N/A ,$88.07 , N/A ,$61.75 ,$58.72 ,$88.07 , N/A ,$88.07 ,$88.07 , N/A ,$63.61 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205060,N/A,HC TRAY PICC LINE,272,1 ,$109.75 ,$71.34 ,$47.63 ,$109.75 ,$81.76 ,$71.89 , N/A ,$57.84 , N/A ,$69.25 ,$69.25 ,$69.25 ,$69.25 ,$98.78 ,$82.31 , N/A ,$96.58 , N/A ,$82.31 ,$82.31 ,$93.29 ,$93.29 , N/A ,$93.29 , N/A ,$86.70 ,$86.70 ,$86.70 ,$98.78 , N/A ,$98.78 , N/A ,$109.75 ,$71.89 , N/A ,$47.63 , N/A , N/A ,$98.78 , N/A ,$69.25 ,$65.85 ,$98.78 , N/A ,$98.78 ,$98.78 , N/A ,$71.34 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205074,N/A,HC TUBE TRACH,272,1 ,$372.48 ,$242.11 ,$161.66 ,$372.48 ,$277.50 ,$243.97 , N/A ,$196.30 , N/A ,$235.03 ,$235.03 ,$235.03 ,$235.03 ,$335.23 ,$279.36 , N/A ,$327.78 , N/A ,$279.36 ,$279.36 ,$316.61 ,$316.61 , N/A ,$316.61 , N/A ,$294.26 ,$294.26 ,$294.26 ,$335.23 , N/A ,$335.23 , N/A ,$372.48 ,$243.97 , N/A ,$161.66 , N/A , N/A ,$335.23 , N/A ,$235.03 ,$223.49 ,$335.23 , N/A ,$335.23 ,$335.23 , N/A ,$242.11 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205078,N/A,HC TUBE RECTAL,272,1 ,$141.94 ,$92.26 ,$61.60 ,$141.94 ,$105.75 ,$92.97 , N/A ,$74.80 , N/A ,$89.56 ,$89.56 ,$89.56 ,$89.56 ,$127.75 ,$106.46 , N/A ,$124.91 , N/A ,$106.46 ,$106.46 ,$120.65 ,$120.65 , N/A ,$120.65 , N/A ,$112.13 ,$112.13 ,$112.13 ,$127.75 , N/A ,$127.75 , N/A ,$141.94 ,$92.97 , N/A ,$61.60 , N/A , N/A ,$127.75 , N/A ,$89.56 ,$85.16 ,$127.75 , N/A ,$127.75 ,$127.75 , N/A ,$92.26 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205083,N/A,HC TUBING BLOOD WARMING,272,1 ,$179.63 ,$116.76 ,$77.96 ,$179.63 ,$133.82 ,$117.66 , N/A ,$94.67 , N/A ,$113.35 ,$113.35 ,$113.35 ,$113.35 ,$161.67 ,$134.72 , N/A ,$158.07 , N/A ,$134.72 ,$134.72 ,$152.69 ,$152.69 , N/A ,$152.69 , N/A ,$141.91 ,$141.91 ,$141.91 ,$161.67 , N/A ,$161.67 , N/A ,$179.63 ,$117.66 , N/A ,$77.96 , N/A , N/A ,$161.67 , N/A ,$113.35 ,$107.78 ,$161.67 , N/A ,$161.67 ,$161.67 , N/A ,$116.76 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205086,N/A,HC CANISTER WOUND VAC,272,1 ,$69.15 ,$44.95 ,$30.01 ,$69.15 ,$51.52 ,$45.29 , N/A ,$36.44 , N/A ,$43.63 ,$43.63 ,$43.63 ,$43.63 ,$62.24 ,$51.86 , N/A ,$60.85 , N/A ,$51.86 ,$51.86 ,$58.78 ,$58.78 , N/A ,$58.78 , N/A ,$54.63 ,$54.63 ,$54.63 ,$62.24 , N/A ,$62.24 , N/A ,$69.15 ,$45.29 , N/A ,$30.01 , N/A , N/A ,$62.24 , N/A ,$43.63 ,$41.49 ,$62.24 , N/A ,$62.24 ,$62.24 , N/A ,$44.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205091,N/A,HC KIT DRESSING WOUND VAC PREVENA PEEL N PLACE,272,1 ,"$1,200.00 ",$780.00 ,$520.80 ,"$1,200.00 ",$894.00 ,$786.00 , N/A ,$632.40 , N/A ,$757.20 ,$757.20 ,$757.20 ,$757.20 ,"$1,080.00 ",$900.00 , N/A ,"$1,056.00 ", N/A ,$900.00 ,$900.00 ,"$1,020.00 ","$1,020.00 ", N/A ,"$1,020.00 ", N/A ,$948.00 ,$948.00 ,$948.00 ,"$1,080.00 ", N/A ,"$1,080.00 ", N/A ,"$1,200.00 ",$786.00 , N/A ,$520.80 , N/A , N/A ,"$1,080.00 ", N/A ,$757.20 ,$720.00 ,"$1,080.00 ", N/A ,"$1,080.00 ","$1,080.00 ", N/A ,$780.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205111,N/A,HC DRESSING HYDROFERA BLUE,272,1 ,$18.09 ,$11.76 ,$7.85 ,$18.09 ,$13.48 ,$11.85 , N/A ,$9.53 , N/A ,$11.41 ,$11.41 ,$11.41 ,$11.41 ,$16.28 ,$13.57 , N/A ,$15.92 , N/A ,$13.57 ,$13.57 ,$15.38 ,$15.38 , N/A ,$15.38 , N/A ,$14.29 ,$14.29 ,$14.29 ,$16.28 , N/A ,$16.28 , N/A ,$18.09 ,$11.85 , N/A ,$7.85 , N/A , N/A ,$16.28 , N/A ,$11.41 ,$10.85 ,$16.28 , N/A ,$16.28 ,$16.28 , N/A ,$11.76 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205181,N/A,HC STRYKER AIR 2 MATTRESS OVERLAY,272,1 ,$111.00 ,$72.15 ,$48.17 ,$111.00 ,$82.70 ,$72.71 , N/A ,$58.50 , N/A ,$70.04 ,$70.04 ,$70.04 ,$70.04 ,$99.90 ,$83.25 , N/A ,$97.68 , N/A ,$83.25 ,$83.25 ,$94.35 ,$94.35 , N/A ,$94.35 , N/A ,$87.69 ,$87.69 ,$87.69 ,$99.90 , N/A ,$99.90 , N/A ,$111.00 ,$72.71 , N/A ,$48.17 , N/A , N/A ,$99.90 , N/A ,$70.04 ,$66.60 ,$99.90 , N/A ,$99.90 ,$99.90 , N/A ,$72.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205201,N/A,HC SUTURE T5,272,1 ,$150.00 ,$97.50 ,$65.10 ,$150.00 ,$111.75 ,$98.25 , N/A ,$79.05 , N/A ,$94.65 ,$94.65 ,$94.65 ,$94.65 ,$135.00 ,$112.50 , N/A ,$132.00 , N/A ,$112.50 ,$112.50 ,$127.50 ,$127.50 , N/A ,$127.50 , N/A ,$118.50 ,$118.50 ,$118.50 ,$135.00 , N/A ,$135.00 , N/A ,$150.00 ,$98.25 , N/A ,$65.10 , N/A , N/A ,$135.00 , N/A ,$94.65 ,$90.00 ,$135.00 , N/A ,$135.00 ,$135.00 , N/A ,$97.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205202,N/A,HC SUTURE T6,272,1 ,$225.00 ,$146.25 ,$97.65 ,$225.00 ,$167.63 ,$147.38 , N/A ,$118.58 , N/A ,$141.98 ,$141.98 ,$141.98 ,$141.98 ,$202.50 ,$168.75 , N/A ,$198.00 , N/A ,$168.75 ,$168.75 ,$191.25 ,$191.25 , N/A ,$191.25 , N/A ,$177.75 ,$177.75 ,$177.75 ,$202.50 , N/A ,$202.50 , N/A ,$225.00 ,$147.38 , N/A ,$97.65 , N/A , N/A ,$202.50 , N/A ,$141.98 ,$135.00 ,$202.50 , N/A ,$202.50 ,$202.50 , N/A ,$146.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205203,N/A,HC SUTURE T7,272,1 ,$300.00 ,$195.00 ,$130.20 ,$300.00 ,$223.50 ,$196.50 , N/A ,$158.10 , N/A ,$189.30 ,$189.30 ,$189.30 ,$189.30 ,$270.00 ,$225.00 , N/A ,$264.00 , N/A ,$225.00 ,$225.00 ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$237.00 ,$237.00 ,$237.00 ,$270.00 , N/A ,$270.00 , N/A ,$300.00 ,$196.50 , N/A ,$130.20 , N/A , N/A ,$270.00 , N/A ,$189.30 ,$180.00 ,$270.00 , N/A ,$270.00 ,$270.00 , N/A ,$195.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205204,N/A,HC SUTURE T8,272,1 ,$375.00 ,$243.75 ,$162.75 ,$375.00 ,$279.38 ,$245.63 , N/A ,$197.63 , N/A ,$236.63 ,$236.63 ,$236.63 ,$236.63 ,$337.50 ,$281.25 , N/A ,$330.00 , N/A ,$281.25 ,$281.25 ,$318.75 ,$318.75 , N/A ,$318.75 , N/A ,$296.25 ,$296.25 ,$296.25 ,$337.50 , N/A ,$337.50 , N/A ,$375.00 ,$245.63 , N/A ,$162.75 , N/A , N/A ,$337.50 , N/A ,$236.63 ,$225.00 ,$337.50 , N/A ,$337.50 ,$337.50 , N/A ,$243.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205205,N/A,HC SUTURE T9,272,1 ,$450.00 ,$292.50 ,$195.30 ,$450.00 ,$335.25 ,$294.75 , N/A ,$237.15 , N/A ,$283.95 ,$283.95 ,$283.95 ,$283.95 ,$405.00 ,$337.50 , N/A ,$396.00 , N/A ,$337.50 ,$337.50 ,$382.50 ,$382.50 , N/A ,$382.50 , N/A ,$355.50 ,$355.50 ,$355.50 ,$405.00 , N/A ,$405.00 , N/A ,$450.00 ,$294.75 , N/A ,$195.30 , N/A , N/A ,$405.00 , N/A ,$283.95 ,$270.00 ,$405.00 , N/A ,$405.00 ,$405.00 , N/A ,$292.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205206,N/A,HC SUTURE T10,272,1 ,$525.00 ,$341.25 ,$227.85 ,$525.00 ,$391.13 ,$343.88 , N/A ,$276.68 , N/A ,$331.28 ,$331.28 ,$331.28 ,$331.28 ,$472.50 ,$393.75 , N/A ,$462.00 , N/A ,$393.75 ,$393.75 ,$446.25 ,$446.25 , N/A ,$446.25 , N/A ,$414.75 ,$414.75 ,$414.75 ,$472.50 , N/A ,$472.50 , N/A ,$525.00 ,$343.88 , N/A ,$227.85 , N/A , N/A ,$472.50 , N/A ,$331.28 ,$315.00 ,$472.50 , N/A ,$472.50 ,$472.50 , N/A ,$341.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205250,N/A,HC DEVICE FASTENER CATHETER,272,1 ,$47.87 ,$31.12 ,$20.78 ,$47.87 ,$35.66 ,$31.35 , N/A ,$25.23 , N/A ,$30.21 ,$30.21 ,$30.21 ,$30.21 ,$43.08 ,$35.90 , N/A ,$42.13 , N/A ,$35.90 ,$35.90 ,$40.69 ,$40.69 , N/A ,$40.69 , N/A ,$37.82 ,$37.82 ,$37.82 ,$43.08 , N/A ,$43.08 , N/A ,$47.87 ,$31.35 , N/A ,$20.78 , N/A , N/A ,$43.08 , N/A ,$30.21 ,$28.72 ,$43.08 , N/A ,$43.08 ,$43.08 , N/A ,$31.12 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205267,N/A,HC SYSTEM CIRCUIT BREATHING W/NEB KIT,272,1 ,$63.60 ,$41.34 ,$27.60 ,$63.60 ,$47.38 ,$41.66 , N/A ,$33.52 , N/A ,$40.13 ,$40.13 ,$40.13 ,$40.13 ,$57.24 ,$47.70 , N/A ,$55.97 , N/A ,$47.70 ,$47.70 ,$54.06 ,$54.06 , N/A ,$54.06 , N/A ,$50.24 ,$50.24 ,$50.24 ,$57.24 , N/A ,$57.24 , N/A ,$63.60 ,$41.66 , N/A ,$27.60 , N/A , N/A ,$57.24 , N/A ,$40.13 ,$38.16 ,$57.24 , N/A ,$57.24 ,$57.24 , N/A ,$41.34 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205278,N/A,HC ADAPTER URETERAL DRAINAGE,272,1 ,$286.14 ,$185.99 ,$124.18 ,$286.14 ,$213.17 ,$187.42 , N/A ,$150.80 , N/A ,$180.55 ,$180.55 ,$180.55 ,$180.55 ,$257.53 ,$214.61 , N/A ,$251.80 , N/A ,$214.61 ,$214.61 ,$243.22 ,$243.22 , N/A ,$243.22 , N/A ,$226.05 ,$226.05 ,$226.05 ,$257.53 , N/A ,$257.53 , N/A ,$286.14 ,$187.42 , N/A ,$124.18 , N/A , N/A ,$257.53 , N/A ,$180.55 ,$171.68 ,$257.53 , N/A ,$257.53 ,$257.53 , N/A ,$185.99 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205280,N/A,HC ADAPTER VENTILATOR,272,1 ,$18.83 ,$12.24 ,$8.17 ,$18.83 ,$14.03 ,$12.33 , N/A ,$9.92 , N/A ,$11.88 ,$11.88 ,$11.88 ,$11.88 ,$16.95 ,$14.12 , N/A ,$16.57 , N/A ,$14.12 ,$14.12 ,$16.01 ,$16.01 , N/A ,$16.01 , N/A ,$14.88 ,$14.88 ,$14.88 ,$16.95 , N/A ,$16.95 , N/A ,$18.83 ,$12.33 , N/A ,$8.17 , N/A , N/A ,$16.95 , N/A ,$11.88 ,$11.30 ,$16.95 , N/A ,$16.95 ,$16.95 , N/A ,$12.24 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205281,N/A,HC ADAPTER Y,272,1 ,$68.44 ,$44.49 ,$29.70 ,$68.44 ,$50.99 ,$44.83 , N/A ,$36.07 , N/A ,$43.19 ,$43.19 ,$43.19 ,$43.19 ,$61.60 ,$51.33 , N/A ,$60.23 , N/A ,$51.33 ,$51.33 ,$58.17 ,$58.17 , N/A ,$58.17 , N/A ,$54.07 ,$54.07 ,$54.07 ,$61.60 , N/A ,$61.60 , N/A ,$68.44 ,$44.83 , N/A ,$29.70 , N/A , N/A ,$61.60 , N/A ,$43.19 ,$41.06 ,$61.60 , N/A ,$61.60 ,$61.60 , N/A ,$44.49 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205284,N/A,HC APPLICATOR SEPP,272,1 ,$12.34 ,$8.02 ,$5.36 ,$12.34 ,$9.19 ,$8.08 , N/A ,$6.50 , N/A ,$7.79 ,$7.79 ,$7.79 ,$7.79 ,$11.11 ,$9.26 , N/A ,$10.86 , N/A ,$9.26 ,$9.26 ,$10.49 ,$10.49 , N/A ,$10.49 , N/A ,$9.75 ,$9.75 ,$9.75 ,$11.11 , N/A ,$11.11 , N/A ,$12.34 ,$8.08 , N/A ,$5.36 , N/A , N/A ,$11.11 , N/A ,$7.79 ,$7.40 ,$11.11 , N/A ,$11.11 ,$11.11 , N/A ,$8.02 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205285,N/A,HC DRESSING ARTIFLEX,272,1 ,$5.51 ,$3.58 ,$2.39 ,$5.51 ,$4.11 ,$3.61 , N/A ,$2.90 , N/A ,$3.48 ,$3.48 ,$3.48 ,$3.48 ,$4.96 ,$4.13 , N/A ,$4.85 , N/A ,$4.13 ,$4.13 ,$4.68 ,$4.68 , N/A ,$4.68 , N/A ,$4.35 ,$4.35 ,$4.35 ,$4.96 , N/A ,$4.96 , N/A ,$5.51 ,$3.61 , N/A ,$2.39 , N/A , N/A ,$4.96 , N/A ,$3.48 ,$3.31 ,$4.96 , N/A ,$4.96 ,$4.96 , N/A ,$3.58 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205286,N/A,HC BAG INFUSION PRESSURE SMALL,272,1 ,$107.00 ,$69.55 ,$46.44 ,$107.00 ,$79.72 ,$70.09 , N/A ,$56.39 , N/A ,$67.52 ,$67.52 ,$67.52 ,$67.52 ,$96.30 ,$80.25 , N/A ,$94.16 , N/A ,$80.25 ,$80.25 ,$90.95 ,$90.95 , N/A ,$90.95 , N/A ,$84.53 ,$84.53 ,$84.53 ,$96.30 , N/A ,$96.30 , N/A ,$107.00 ,$70.09 , N/A ,$46.44 , N/A , N/A ,$96.30 , N/A ,$67.52 ,$64.20 ,$96.30 , N/A ,$96.30 ,$96.30 , N/A ,$69.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205296,C1729,HC CATHETER URETHRAL SPIRAL TIP,272,1 ,$538.75 ,$350.19 ,$233.82 ,$538.75 ,$401.37 ,$352.88 , N/A ,$283.92 , N/A ,$339.95 ,$339.95 ,$339.95 ,$339.95 ,$484.88 ,$404.06 , N/A ,$474.10 , N/A ,$404.06 ,$404.06 ,$457.94 ,$457.94 , N/A ,$457.94 , N/A ,$425.61 ,$425.61 ,$425.61 ,$484.88 , N/A ,$484.88 , N/A ,$538.75 ,$352.88 , N/A ,$233.82 , N/A , N/A ,$484.88 , N/A ,$339.95 ,$323.25 ,$484.88 , N/A ,$484.88 ,$484.88 , N/A ,$350.19 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205297,C1758,HC CATHETER URETERAL FLEXI-TIP,272,1 ,$150.78 ,$98.01 ,$65.44 ,$150.78 ,$112.33 ,$98.76 , N/A ,$79.46 , N/A ,$95.14 ,$95.14 ,$95.14 ,$95.14 ,$135.70 ,$113.09 , N/A ,$132.69 , N/A ,$113.09 ,$113.09 ,$128.16 ,$128.16 , N/A ,$128.16 , N/A ,$119.12 ,$119.12 ,$119.12 ,$135.70 , N/A ,$135.70 , N/A ,$150.78 ,$98.76 , N/A ,$65.44 , N/A , N/A ,$135.70 , N/A ,$95.14 ,$90.47 ,$135.70 , N/A ,$135.70 ,$135.70 , N/A ,$98.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205298,N/A,HC CATHETER FOLEY COUDE,272,1 ,$112.86 ,$73.36 ,$48.98 ,$112.86 ,$84.08 ,$73.92 , N/A ,$59.48 , N/A ,$71.21 ,$71.21 ,$71.21 ,$71.21 ,$101.57 ,$84.65 , N/A ,$99.32 , N/A ,$84.65 ,$84.65 ,$95.93 ,$95.93 , N/A ,$95.93 , N/A ,$89.16 ,$89.16 ,$89.16 ,$101.57 , N/A ,$101.57 , N/A ,$112.86 ,$73.92 , N/A ,$48.98 , N/A , N/A ,$101.57 , N/A ,$71.21 ,$67.72 ,$101.57 , N/A ,$101.57 ,$101.57 , N/A ,$73.36 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205299,C1726,HC CATHETER DILATION FOLLOWER,272,1 ,$291.69 ,$189.60 ,$126.59 ,$291.69 ,$217.31 ,$191.06 , N/A ,$153.72 , N/A ,$184.06 ,$184.06 ,$184.06 ,$184.06 ,$262.52 ,$218.77 , N/A ,$256.69 , N/A ,$218.77 ,$218.77 ,$247.94 ,$247.94 , N/A ,$247.94 , N/A ,$230.44 ,$230.44 ,$230.44 ,$262.52 , N/A ,$262.52 , N/A ,$291.69 ,$191.06 , N/A ,$126.59 , N/A , N/A ,$262.52 , N/A ,$184.06 ,$175.01 ,$262.52 , N/A ,$262.52 ,$262.52 , N/A ,$189.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205300,N/A,HC CAUTERY PEN LOW TEMP,272,1 ,$63.70 ,$41.41 ,$27.65 ,$63.70 ,$47.46 ,$41.72 , N/A ,$33.57 , N/A ,$40.19 ,$40.19 ,$40.19 ,$40.19 ,$57.33 ,$47.78 , N/A ,$56.06 , N/A ,$47.78 ,$47.78 ,$54.15 ,$54.15 , N/A ,$54.15 , N/A ,$50.32 ,$50.32 ,$50.32 ,$57.33 , N/A ,$57.33 , N/A ,$63.70 ,$41.72 , N/A ,$27.65 , N/A , N/A ,$57.33 , N/A ,$40.19 ,$38.22 ,$57.33 , N/A ,$57.33 ,$57.33 , N/A ,$41.41 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205308,N/A,HC TUBING LUER LOCK,272,1 ,$62.00 ,$40.30 ,$26.91 ,$62.00 ,$46.19 ,$40.61 , N/A ,$32.67 , N/A ,$39.12 ,$39.12 ,$39.12 ,$39.12 ,$55.80 ,$46.50 , N/A ,$54.56 , N/A ,$46.50 ,$46.50 ,$52.70 ,$52.70 , N/A ,$52.70 , N/A ,$48.98 ,$48.98 ,$48.98 ,$55.80 , N/A ,$55.80 , N/A ,$62.00 ,$40.61 , N/A ,$26.91 , N/A , N/A ,$55.80 , N/A ,$39.12 ,$37.20 ,$55.80 , N/A ,$55.80 ,$55.80 , N/A ,$40.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205309,N/A,HC NEEDLE BLUNT HAWKINS,272,1 ,$95.09 ,$61.81 ,$41.27 ,$95.09 ,$70.84 ,$62.28 , N/A ,$50.11 , N/A ,$60.00 ,$60.00 ,$60.00 ,$60.00 ,$85.58 ,$71.32 , N/A ,$83.68 , N/A ,$71.32 ,$71.32 ,$80.83 ,$80.83 , N/A ,$80.83 , N/A ,$75.12 ,$75.12 ,$75.12 ,$85.58 , N/A ,$85.58 , N/A ,$95.09 ,$62.28 , N/A ,$41.27 , N/A , N/A ,$85.58 , N/A ,$60.00 ,$57.05 ,$85.58 , N/A ,$85.58 ,$85.58 , N/A ,$61.81 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205311,N/A,HC KIT HOLTER MONITOR,272,1 ,$39.72 ,$25.82 ,$17.24 ,$39.72 ,$29.59 ,$26.02 , N/A ,$20.93 , N/A ,$25.06 ,$25.06 ,$25.06 ,$25.06 ,$35.75 ,$29.79 , N/A ,$34.95 , N/A ,$29.79 ,$29.79 ,$33.76 ,$33.76 , N/A ,$33.76 , N/A ,$31.38 ,$31.38 ,$31.38 ,$35.75 , N/A ,$35.75 , N/A ,$39.72 ,$26.02 , N/A ,$17.24 , N/A , N/A ,$35.75 , N/A ,$25.06 ,$23.83 ,$35.75 , N/A ,$35.75 ,$35.75 , N/A ,$25.82 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205314,N/A,HC KIT RT APNEA MONITORING,272,1 ,$25.38 ,$16.50 ,$11.01 ,$25.38 ,$18.91 ,$16.62 , N/A ,$13.38 , N/A ,$16.01 ,$16.01 ,$16.01 ,$16.01 ,$22.84 ,$19.04 , N/A ,$22.33 , N/A ,$19.04 ,$19.04 ,$21.57 ,$21.57 , N/A ,$21.57 , N/A ,$20.05 ,$20.05 ,$20.05 ,$22.84 , N/A ,$22.84 , N/A ,$25.38 ,$16.62 , N/A ,$11.01 , N/A , N/A ,$22.84 , N/A ,$16.01 ,$15.23 ,$22.84 , N/A ,$22.84 ,$22.84 , N/A ,$16.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205315,N/A,HC KIT RT NONINVASIVE VENT,272,1 ,$108.16 ,$70.30 ,$46.94 ,$108.16 ,$80.58 ,$70.84 , N/A ,$57.00 , N/A ,$68.25 ,$68.25 ,$68.25 ,$68.25 ,$97.34 ,$81.12 , N/A ,$95.18 , N/A ,$81.12 ,$81.12 ,$91.94 ,$91.94 , N/A ,$91.94 , N/A ,$85.45 ,$85.45 ,$85.45 ,$97.34 , N/A ,$97.34 , N/A ,$108.16 ,$70.84 , N/A ,$46.94 , N/A , N/A ,$97.34 , N/A ,$68.25 ,$64.90 ,$97.34 , N/A ,$97.34 ,$97.34 , N/A ,$70.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205316,N/A,HC KIT RT VENTILATOR,272,1 ,$101.47 ,$65.96 ,$44.04 ,$101.47 ,$75.60 ,$66.46 , N/A ,$53.47 , N/A ,$64.03 ,$64.03 ,$64.03 ,$64.03 ,$91.32 ,$76.10 , N/A ,$89.29 , N/A ,$76.10 ,$76.10 ,$86.25 ,$86.25 , N/A ,$86.25 , N/A ,$80.16 ,$80.16 ,$80.16 ,$91.32 , N/A ,$91.32 , N/A ,$101.47 ,$66.46 , N/A ,$44.04 , N/A , N/A ,$91.32 , N/A ,$64.03 ,$60.88 ,$91.32 , N/A ,$91.32 ,$91.32 , N/A ,$65.96 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205319,N/A,HC NEEDLE KOPANS LOCAL,272,1 ,$81.49 ,$52.97 ,$35.37 ,$81.49 ,$60.71 ,$53.38 , N/A ,$42.95 , N/A ,$51.42 ,$51.42 ,$51.42 ,$51.42 ,$73.34 ,$61.12 , N/A ,$71.71 , N/A ,$61.12 ,$61.12 ,$69.27 ,$69.27 , N/A ,$69.27 , N/A ,$64.38 ,$64.38 ,$64.38 ,$73.34 , N/A ,$73.34 , N/A ,$81.49 ,$53.38 , N/A ,$35.37 , N/A , N/A ,$73.34 , N/A ,$51.42 ,$48.89 ,$73.34 , N/A ,$73.34 ,$73.34 , N/A ,$52.97 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205323,N/A,HC NEEDLE TEMNO,272,1 ,$189.83 ,$123.39 ,$82.39 ,$189.83 ,$141.42 ,$124.34 , N/A ,$100.04 , N/A ,$119.78 ,$119.78 ,$119.78 ,$119.78 ,$170.85 ,$142.37 , N/A ,$167.05 , N/A ,$142.37 ,$142.37 ,$161.36 ,$161.36 , N/A ,$161.36 , N/A ,$149.97 ,$149.97 ,$149.97 ,$170.85 , N/A ,$170.85 , N/A ,$189.83 ,$124.34 , N/A ,$82.39 , N/A , N/A ,$170.85 , N/A ,$119.78 ,$113.90 ,$170.85 , N/A ,$170.85 ,$170.85 , N/A ,$123.39 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205326,N/A,HC SENSOR INFANT ADHESIVE,272,1 ,$165.40 ,$107.51 ,$71.78 ,$165.40 ,$123.22 ,$108.34 , N/A ,$87.17 , N/A ,$104.37 ,$104.37 ,$104.37 ,$104.37 ,$148.86 ,$124.05 , N/A ,$145.55 , N/A ,$124.05 ,$124.05 ,$140.59 ,$140.59 , N/A ,$140.59 , N/A ,$130.67 ,$130.67 ,$130.67 ,$148.86 , N/A ,$148.86 , N/A ,$165.40 ,$108.34 , N/A ,$71.78 , N/A , N/A ,$148.86 , N/A ,$104.37 ,$99.24 ,$148.86 , N/A ,$148.86 ,$148.86 , N/A ,$107.51 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205328,N/A,HC SUTURE ETHILON,272,1 ,$73.63 ,$47.86 ,$31.96 ,$73.63 ,$54.85 ,$48.23 , N/A ,$38.80 , N/A ,$46.46 ,$46.46 ,$46.46 ,$46.46 ,$66.27 ,$55.22 , N/A ,$64.79 , N/A ,$55.22 ,$55.22 ,$62.59 ,$62.59 , N/A ,$62.59 , N/A ,$58.17 ,$58.17 ,$58.17 ,$66.27 , N/A ,$66.27 , N/A ,$73.63 ,$48.23 , N/A ,$31.96 , N/A , N/A ,$66.27 , N/A ,$46.46 ,$44.18 ,$66.27 , N/A ,$66.27 ,$66.27 , N/A ,$47.86 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205331,N/A,HC SYRINGE BRACCO CONTRAST,272,1 ,$47.83 ,$31.09 ,$20.76 ,$47.83 ,$35.63 ,$31.33 , N/A ,$25.21 , N/A ,$30.18 ,$30.18 ,$30.18 ,$30.18 ,$43.05 ,$35.87 , N/A ,$42.09 , N/A ,$35.87 ,$35.87 ,$40.66 ,$40.66 , N/A ,$40.66 , N/A ,$37.79 ,$37.79 ,$37.79 ,$43.05 , N/A ,$43.05 , N/A ,$47.83 ,$31.33 , N/A ,$20.76 , N/A , N/A ,$43.05 , N/A ,$30.18 ,$28.70 ,$43.05 , N/A ,$43.05 ,$43.05 , N/A ,$31.09 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205337,N/A,HC TUBE TRACH NASAL,272,1 ,$39.00 ,$25.35 ,$16.93 ,$39.00 ,$29.06 ,$25.55 , N/A ,$20.55 , N/A ,$24.61 ,$24.61 ,$24.61 ,$24.61 ,$35.10 ,$29.25 , N/A ,$34.32 , N/A ,$29.25 ,$29.25 ,$33.15 ,$33.15 , N/A ,$33.15 , N/A ,$30.81 ,$30.81 ,$30.81 ,$35.10 , N/A ,$35.10 , N/A ,$39.00 ,$25.55 , N/A ,$16.93 , N/A , N/A ,$35.10 , N/A ,$24.61 ,$23.40 ,$35.10 , N/A ,$35.10 ,$35.10 , N/A ,$25.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205342,N/A,HC DRESSING TEGADERM,272,1 ,$16.23 ,$10.55 ,$7.04 ,$16.23 ,$12.09 ,$10.63 , N/A ,$8.55 , N/A ,$10.24 ,$10.24 ,$10.24 ,$10.24 ,$14.61 ,$12.17 , N/A ,$14.28 , N/A ,$12.17 ,$12.17 ,$13.80 ,$13.80 , N/A ,$13.80 , N/A ,$12.82 ,$12.82 ,$12.82 ,$14.61 , N/A ,$14.61 , N/A ,$16.23 ,$10.63 , N/A ,$7.04 , N/A , N/A ,$14.61 , N/A ,$10.24 ,$9.74 ,$14.61 , N/A ,$14.61 ,$14.61 , N/A ,$10.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205343,N/A,HC DRESSING COMPRILAN,272,1 ,$15.00 ,$9.75 ,$6.51 ,$15.00 ,$11.18 ,$9.83 , N/A ,$7.91 , N/A ,$9.47 ,$9.47 ,$9.47 ,$9.47 ,$13.50 ,$11.25 , N/A ,$13.20 , N/A ,$11.25 ,$11.25 ,$12.75 ,$12.75 , N/A ,$12.75 , N/A ,$11.85 ,$11.85 ,$11.85 ,$13.50 , N/A ,$13.50 , N/A ,$15.00 ,$9.83 , N/A ,$6.51 , N/A , N/A ,$13.50 , N/A ,$9.47 ,$9.00 ,$13.50 , N/A ,$13.50 ,$13.50 , N/A ,$9.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205344,N/A,HC DRESSING MEPILEX,272,1 ,$77.68 ,$50.49 ,$33.71 ,$77.68 ,$57.87 ,$50.88 , N/A ,$40.94 , N/A ,$49.02 ,$49.02 ,$49.02 ,$49.02 ,$69.91 ,$58.26 , N/A ,$68.36 , N/A ,$58.26 ,$58.26 ,$66.03 ,$66.03 , N/A ,$66.03 , N/A ,$61.37 ,$61.37 ,$61.37 ,$69.91 , N/A ,$69.91 , N/A ,$77.68 ,$50.88 , N/A ,$33.71 , N/A , N/A ,$69.91 , N/A ,$49.02 ,$46.61 ,$69.91 , N/A ,$69.91 ,$69.91 , N/A ,$50.49 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205345,N/A,HC DRESSING GAUZE STRETCH,272,1 ,$6.27 ,$4.08 ,$2.72 ,$6.27 ,$4.67 ,$4.11 , N/A ,$3.30 , N/A ,$3.96 ,$3.96 ,$3.96 ,$3.96 ,$5.64 ,$4.70 , N/A ,$5.52 , N/A ,$4.70 ,$4.70 ,$5.33 ,$5.33 , N/A ,$5.33 , N/A ,$4.95 ,$4.95 ,$4.95 ,$5.64 , N/A ,$5.64 , N/A ,$6.27 ,$4.11 , N/A ,$2.72 , N/A , N/A ,$5.64 , N/A ,$3.96 ,$3.76 ,$5.64 , N/A ,$5.64 ,$5.64 , N/A ,$4.08 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205366,N/A,HC SENSOR NASAL PULSE OX ALAR,272,1 ,$75.00 ,$48.75 ,$32.55 ,$75.00 ,$55.88 ,$49.13 , N/A ,$39.53 , N/A ,$47.33 ,$47.33 ,$47.33 ,$47.33 ,$67.50 ,$56.25 , N/A ,$66.00 , N/A ,$56.25 ,$56.25 ,$63.75 ,$63.75 , N/A ,$63.75 , N/A ,$59.25 ,$59.25 ,$59.25 ,$67.50 , N/A ,$67.50 , N/A ,$75.00 ,$49.13 , N/A ,$32.55 , N/A , N/A ,$67.50 , N/A ,$47.33 ,$45.00 ,$67.50 , N/A ,$67.50 ,$67.50 , N/A ,$48.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205374,C1751,HC KIT IV RADIAL ARTERY W/GUIDEWIRE,272,1 ,$34.00 ,$22.10 ,$14.76 ,$34.00 ,$25.33 ,$22.27 , N/A ,$17.92 , N/A ,$21.45 ,$21.45 ,$21.45 ,$21.45 ,$30.60 ,$25.50 , N/A ,$29.92 , N/A ,$25.50 ,$25.50 ,$28.90 ,$28.90 , N/A ,$28.90 , N/A ,$26.86 ,$26.86 ,$26.86 ,$30.60 , N/A ,$30.60 , N/A ,$34.00 ,$22.27 , N/A ,$14.76 , N/A , N/A ,$30.60 , N/A ,$21.45 ,$20.40 ,$30.60 , N/A ,$30.60 ,$30.60 , N/A ,$22.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205378,N/A,HC MARKER BIOPSY BREAST STEREOTATIC,272,1 ,$546.00 ,$354.90 ,$236.96 ,$546.00 ,$406.77 ,$357.63 , N/A ,$287.74 , N/A ,$344.53 ,$344.53 ,$344.53 ,$344.53 ,$491.40 ,$409.50 , N/A ,$480.48 , N/A ,$409.50 ,$409.50 ,$464.10 ,$464.10 , N/A ,$464.10 , N/A ,$431.34 ,$431.34 ,$431.34 ,$491.40 , N/A ,$491.40 , N/A ,$546.00 ,$357.63 , N/A ,$236.96 , N/A , N/A ,$491.40 , N/A ,$344.53 ,$327.60 ,$491.40 , N/A ,$491.40 ,$491.40 , N/A ,$354.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205379,N/A,HC SYSTEM BIOPSY BREAST STEREOTATIC,272,1 ,$481.00 ,$312.65 ,$208.75 ,$481.00 ,$358.35 ,$315.06 , N/A ,$253.49 , N/A ,$303.51 ,$303.51 ,$303.51 ,$303.51 ,$432.90 ,$360.75 , N/A ,$423.28 , N/A ,$360.75 ,$360.75 ,$408.85 ,$408.85 , N/A ,$408.85 , N/A ,$379.99 ,$379.99 ,$379.99 ,$432.90 , N/A ,$432.90 , N/A ,$481.00 ,$315.06 , N/A ,$208.75 , N/A , N/A ,$432.90 , N/A ,$303.51 ,$288.60 ,$432.90 , N/A ,$432.90 ,$432.90 , N/A ,$312.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205380,N/A,HC FILTER BIOPSY BREAST STEREOTATIC,272,1 ,$26.00 ,$16.90 ,$11.28 ,$26.00 ,$19.37 ,$17.03 , N/A ,$13.70 , N/A ,$16.41 ,$16.41 ,$16.41 ,$16.41 ,$23.40 ,$19.50 , N/A ,$22.88 , N/A ,$19.50 ,$19.50 ,$22.10 ,$22.10 , N/A ,$22.10 , N/A ,$20.54 ,$20.54 ,$20.54 ,$23.40 , N/A ,$23.40 , N/A ,$26.00 ,$17.03 , N/A ,$11.28 , N/A , N/A ,$23.40 , N/A ,$16.41 ,$15.60 ,$23.40 , N/A ,$23.40 ,$23.40 , N/A ,$16.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205386,N/A,HC HANDLE LARYNGEAL BLADE,272,1 ,$70.00 ,$45.50 ,$30.38 ,$70.00 ,$52.15 ,$45.85 , N/A ,$36.89 , N/A ,$44.17 ,$44.17 ,$44.17 ,$44.17 ,$63.00 ,$52.50 , N/A ,$61.60 , N/A ,$52.50 ,$52.50 ,$59.50 ,$59.50 , N/A ,$59.50 , N/A ,$55.30 ,$55.30 ,$55.30 ,$63.00 , N/A ,$63.00 , N/A ,$70.00 ,$45.85 , N/A ,$30.38 , N/A , N/A ,$63.00 , N/A ,$44.17 ,$42.00 ,$63.00 , N/A ,$63.00 ,$63.00 , N/A ,$45.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205387,N/A,HC IRRIGATION SOL W/WATER/SODIUM CHLORIDE,272,1 ,$27.09 ,$17.61 ,$11.76 ,$27.09 ,$20.18 ,$17.74 , N/A ,$14.28 , N/A ,$17.09 ,$17.09 ,$17.09 ,$17.09 ,$24.38 ,$20.32 , N/A ,$23.84 , N/A ,$20.32 ,$20.32 ,$23.03 ,$23.03 , N/A ,$23.03 , N/A ,$21.40 ,$21.40 ,$21.40 ,$24.38 , N/A ,$24.38 , N/A ,$27.09 ,$17.74 , N/A ,$11.76 , N/A , N/A ,$24.38 , N/A ,$17.09 ,$16.25 ,$24.38 , N/A ,$24.38 ,$24.38 , N/A ,$17.61 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205389,N/A,HC FORCEPS LIGHTED,272,1 ,$19.00 ,$12.35 ,$8.25 ,$19.00 ,$14.16 ,$12.45 , N/A ,$10.01 , N/A ,$11.99 ,$11.99 ,$11.99 ,$11.99 ,$17.10 ,$14.25 , N/A ,$16.72 , N/A ,$14.25 ,$14.25 ,$16.15 ,$16.15 , N/A ,$16.15 , N/A ,$15.01 ,$15.01 ,$15.01 ,$17.10 , N/A ,$17.10 , N/A ,$19.00 ,$12.45 , N/A ,$8.25 , N/A , N/A ,$17.10 , N/A ,$11.99 ,$11.40 ,$17.10 , N/A ,$17.10 ,$17.10 , N/A ,$12.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205392,N/A,HC FORCEP JAW RADIAL W/NEEDLE,272,1 ,$55.00 ,$35.75 ,$23.87 ,$55.00 ,$40.98 ,$36.03 , N/A ,$28.99 , N/A ,$34.71 ,$34.71 ,$34.71 ,$34.71 ,$49.50 ,$41.25 , N/A ,$48.40 , N/A ,$41.25 ,$41.25 ,$46.75 ,$46.75 , N/A ,$46.75 , N/A ,$43.45 ,$43.45 ,$43.45 ,$49.50 , N/A ,$49.50 , N/A ,$55.00 ,$36.03 , N/A ,$23.87 , N/A , N/A ,$49.50 , N/A ,$34.71 ,$33.00 ,$49.50 , N/A ,$49.50 ,$49.50 , N/A ,$35.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205393,N/A,HC PENCIL ELECTROSURGICAL W/SMOKE EVACUATOR,272,1 ,$75.18 ,$48.87 ,$32.63 ,$75.18 ,$56.01 ,$49.24 , N/A ,$39.62 , N/A ,$47.44 ,$47.44 ,$47.44 ,$47.44 ,$67.66 ,$56.39 , N/A ,$66.16 , N/A ,$56.39 ,$56.39 ,$63.90 ,$63.90 , N/A ,$63.90 , N/A ,$59.39 ,$59.39 ,$59.39 ,$67.66 , N/A ,$67.66 , N/A ,$75.18 ,$49.24 , N/A ,$32.63 , N/A , N/A ,$67.66 , N/A ,$47.44 ,$45.11 ,$67.66 , N/A ,$67.66 ,$67.66 , N/A ,$48.87 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205398,N/A,HC SURGICEL HEMOSTAT 2X3,272,1 ,$90.54 ,$58.85 ,$39.29 ,$90.54 ,$67.45 ,$59.30 , N/A ,$47.71 , N/A ,$57.13 ,$57.13 ,$57.13 ,$57.13 ,$81.49 ,$67.91 , N/A ,$79.68 , N/A ,$67.91 ,$67.91 ,$76.96 ,$76.96 , N/A ,$76.96 , N/A ,$71.53 ,$71.53 ,$71.53 ,$81.49 , N/A ,$81.49 , N/A ,$90.54 ,$59.30 , N/A ,$39.29 , N/A , N/A ,$81.49 , N/A ,$57.13 ,$54.32 ,$81.49 , N/A ,$81.49 ,$81.49 , N/A ,$58.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205407,N/A,HC PRONG NASAL INFANT CPAP,272,1 ,$23.00 ,$14.95 ,$9.98 ,$23.00 ,$17.14 ,$15.07 , N/A ,$12.12 , N/A ,$14.51 ,$14.51 ,$14.51 ,$14.51 ,$20.70 ,$17.25 , N/A ,$20.24 , N/A ,$17.25 ,$17.25 ,$19.55 ,$19.55 , N/A ,$19.55 , N/A ,$18.17 ,$18.17 ,$18.17 ,$20.70 , N/A ,$20.70 , N/A ,$23.00 ,$15.07 , N/A ,$9.98 , N/A , N/A ,$20.70 , N/A ,$14.51 ,$13.80 ,$20.70 , N/A ,$20.70 ,$20.70 , N/A ,$14.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205408,N/A,HC BONNET INFANT CPAP,272,1 ,$33.00 ,$21.45 ,$14.32 ,$33.00 ,$24.59 ,$21.62 , N/A ,$17.39 , N/A ,$20.82 ,$20.82 ,$20.82 ,$20.82 ,$29.70 ,$24.75 , N/A ,$29.04 , N/A ,$24.75 ,$24.75 ,$28.05 ,$28.05 , N/A ,$28.05 , N/A ,$26.07 ,$26.07 ,$26.07 ,$29.70 , N/A ,$29.70 , N/A ,$33.00 ,$21.62 , N/A ,$14.32 , N/A , N/A ,$29.70 , N/A ,$20.82 ,$19.80 ,$29.70 , N/A ,$29.70 ,$29.70 , N/A ,$21.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205417,N/A,HC HEADGEAR INFANT CPAP,272,1 ,$58.81 ,$38.23 ,$25.52 ,$58.81 ,$43.81 ,$38.52 , N/A ,$30.99 , N/A ,$37.11 ,$37.11 ,$37.11 ,$37.11 ,$52.93 ,$44.11 , N/A ,$51.75 , N/A ,$44.11 ,$44.11 ,$49.99 ,$49.99 , N/A ,$49.99 , N/A ,$46.46 ,$46.46 ,$46.46 ,$52.93 , N/A ,$52.93 , N/A ,$58.81 ,$38.52 , N/A ,$25.52 , N/A , N/A ,$52.93 , N/A ,$37.11 ,$35.29 ,$52.93 , N/A ,$52.93 ,$52.93 , N/A ,$38.23 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205423,N/A,HC CANISTER WOUND VAC 150ML,272,1 ,$60.84 ,$39.55 ,$26.40 ,$60.84 ,$45.33 ,$39.85 , N/A ,$32.06 , N/A ,$38.39 ,$38.39 ,$38.39 ,$38.39 ,$54.76 ,$45.63 , N/A ,$53.54 , N/A ,$45.63 ,$45.63 ,$51.71 ,$51.71 , N/A ,$51.71 , N/A ,$48.06 ,$48.06 ,$48.06 ,$54.76 , N/A ,$54.76 , N/A ,$60.84 ,$39.85 , N/A ,$26.40 , N/A , N/A ,$54.76 , N/A ,$38.39 ,$36.50 ,$54.76 , N/A ,$54.76 ,$54.76 , N/A ,$39.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205424,N/A,HC LIGHTED FORGEIN BODY REMOVAL FORCEPS,272,1 ,$30.55 ,$19.86 ,$13.26 ,$30.55 ,$22.76 ,$20.01 , N/A ,$16.10 , N/A ,$19.28 ,$19.28 ,$19.28 ,$19.28 ,$27.50 ,$22.91 , N/A ,$26.88 , N/A ,$22.91 ,$22.91 ,$25.97 ,$25.97 , N/A ,$25.97 , N/A ,$24.13 ,$24.13 ,$24.13 ,$27.50 , N/A ,$27.50 , N/A ,$30.55 ,$20.01 , N/A ,$13.26 , N/A , N/A ,$27.50 , N/A ,$19.28 ,$18.33 ,$27.50 , N/A ,$27.50 ,$27.50 , N/A ,$19.86 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205430,N/A,HC NEO PUFF TUBING,272,1 ,$33.93 ,$22.05 ,$14.73 ,$33.93 ,$25.28 ,$22.22 , N/A ,$17.88 , N/A ,$21.41 ,$21.41 ,$21.41 ,$21.41 ,$30.54 ,$25.45 , N/A ,$29.86 , N/A ,$25.45 ,$25.45 ,$28.84 ,$28.84 , N/A ,$28.84 , N/A ,$26.80 ,$26.80 ,$26.80 ,$30.54 , N/A ,$30.54 , N/A ,$33.93 ,$22.22 , N/A ,$14.73 , N/A , N/A ,$30.54 , N/A ,$21.41 ,$20.36 ,$30.54 , N/A ,$30.54 ,$30.54 , N/A ,$22.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205431,N/A,HC NEO PUFF MASK ERG,272,1 ,$32.91 ,$21.39 ,$14.28 ,$32.91 ,$24.52 ,$21.56 , N/A ,$17.34 , N/A ,$20.77 ,$20.77 ,$20.77 ,$20.77 ,$29.62 ,$24.68 , N/A ,$28.96 , N/A ,$24.68 ,$24.68 ,$27.97 ,$27.97 , N/A ,$27.97 , N/A ,$26.00 ,$26.00 ,$26.00 ,$29.62 , N/A ,$29.62 , N/A ,$32.91 ,$21.56 , N/A ,$14.28 , N/A , N/A ,$29.62 , N/A ,$20.77 ,$19.75 ,$29.62 , N/A ,$29.62 ,$29.62 , N/A ,$21.39 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205432,N/A,HC NEO PUFF MASK DISPOSABLE,272,1 ,$17.00 ,$11.05 ,$7.38 ,$17.00 ,$12.67 ,$11.14 , N/A ,$8.96 , N/A ,$10.73 ,$10.73 ,$10.73 ,$10.73 ,$15.30 ,$12.75 , N/A ,$14.96 , N/A ,$12.75 ,$12.75 ,$14.45 ,$14.45 , N/A ,$14.45 , N/A ,$13.43 ,$13.43 ,$13.43 ,$15.30 , N/A ,$15.30 , N/A ,$17.00 ,$11.14 , N/A ,$7.38 , N/A , N/A ,$15.30 , N/A ,$10.73 ,$10.20 ,$15.30 , N/A ,$15.30 ,$15.30 , N/A ,$11.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205433,N/A,HC CPAP BUBBLE SYSTEM,272,1 ,$226.92 ,$147.50 ,$98.48 ,$226.92 ,$169.06 ,$148.63 , N/A ,$119.59 , N/A ,$143.19 ,$143.19 ,$143.19 ,$143.19 ,$204.23 ,$170.19 , N/A ,$199.69 , N/A ,$170.19 ,$170.19 ,$192.88 ,$192.88 , N/A ,$192.88 , N/A ,$179.27 ,$179.27 ,$179.27 ,$204.23 , N/A ,$204.23 , N/A ,$226.92 ,$148.63 , N/A ,$98.48 , N/A , N/A ,$204.23 , N/A ,$143.19 ,$136.15 ,$204.23 , N/A ,$204.23 ,$204.23 , N/A ,$147.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205436,N/A,HC THERAPY PUTTY,272,1 ,$106.62 ,$69.30 ,$46.27 ,$106.62 ,$79.43 ,$69.84 , N/A ,$56.19 , N/A ,$67.28 ,$67.28 ,$67.28 ,$67.28 ,$95.96 ,$79.97 , N/A ,$93.83 , N/A ,$79.97 ,$79.97 ,$90.63 ,$90.63 , N/A ,$90.63 , N/A ,$84.23 ,$84.23 ,$84.23 ,$95.96 , N/A ,$95.96 , N/A ,$106.62 ,$69.84 , N/A ,$46.27 , N/A , N/A ,$95.96 , N/A ,$67.28 ,$63.97 ,$95.96 , N/A ,$95.96 ,$95.96 , N/A ,$69.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205437,N/A,HC PUMP MODULE ADMIN SET NEEDLESS VALVES,272,1 ,$16.00 ,$10.40 ,$6.94 ,$16.00 ,$11.92 ,$10.48 , N/A ,$8.43 , N/A ,$10.10 ,$10.10 ,$10.10 ,$10.10 ,$14.40 ,$12.00 , N/A ,$14.08 , N/A ,$12.00 ,$12.00 ,$13.60 ,$13.60 , N/A ,$13.60 , N/A ,$12.64 ,$12.64 ,$12.64 ,$14.40 , N/A ,$14.40 , N/A ,$16.00 ,$10.48 , N/A ,$6.94 , N/A , N/A ,$14.40 , N/A ,$10.10 ,$9.60 ,$14.40 , N/A ,$14.40 ,$14.40 , N/A ,$10.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205438,N/A,"HC 2"" TAPE ADHESIVE KINESIO",272,1 ,$24.27 ,$15.78 ,$10.53 ,$24.27 ,$18.08 ,$15.90 , N/A ,$12.79 , N/A ,$15.31 ,$15.31 ,$15.31 ,$15.31 ,$21.84 ,$18.20 , N/A ,$21.36 , N/A ,$18.20 ,$18.20 ,$20.63 ,$20.63 , N/A ,$20.63 , N/A ,$19.17 ,$19.17 ,$19.17 ,$21.84 , N/A ,$21.84 , N/A ,$24.27 ,$15.90 , N/A ,$10.53 , N/A , N/A ,$21.84 , N/A ,$15.31 ,$14.56 ,$21.84 , N/A ,$21.84 ,$21.84 , N/A ,$15.78 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205439,N/A,HC ROSIDAL SOFT FOAM PADDING BANDAGE,272,1 ,$16.59 ,$10.78 ,$7.20 ,$16.59 ,$12.36 ,$10.87 , N/A ,$8.74 , N/A ,$10.47 ,$10.47 ,$10.47 ,$10.47 ,$14.93 ,$12.44 , N/A ,$14.60 , N/A ,$12.44 ,$12.44 ,$14.10 ,$14.10 , N/A ,$14.10 , N/A ,$13.11 ,$13.11 ,$13.11 ,$14.93 , N/A ,$14.93 , N/A ,$16.59 ,$10.87 , N/A ,$7.20 , N/A , N/A ,$14.93 , N/A ,$10.47 ,$9.95 ,$14.93 , N/A ,$14.93 ,$14.93 , N/A ,$10.78 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205443,N/A,HC SENSOR PEDIATRIC ADHESIVE,272,1 ,$21.18 ,$13.77 ,$9.19 ,$21.18 ,$15.78 ,$13.87 , N/A ,$11.16 , N/A ,$13.36 ,$13.36 ,$13.36 ,$13.36 ,$19.06 ,$15.89 , N/A ,$18.64 , N/A ,$15.89 ,$15.89 ,$18.00 ,$18.00 , N/A ,$18.00 , N/A ,$16.73 ,$16.73 ,$16.73 ,$19.06 , N/A ,$19.06 , N/A ,$21.18 ,$13.87 , N/A ,$9.19 , N/A , N/A ,$19.06 , N/A ,$13.36 ,$12.71 ,$19.06 , N/A ,$19.06 ,$19.06 , N/A ,$13.77 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27205445,N/A,HC CLOT BUSTER INSTRUMENT CLEANER,272,1 ,$16.76 ,$10.89 ,$7.27 ,$16.76 ,$12.49 ,$10.98 , N/A ,$8.83 , N/A ,$10.58 ,$10.58 ,$10.58 ,$10.58 ,$15.08 ,$12.57 , N/A ,$14.75 , N/A ,$12.57 ,$12.57 ,$14.25 ,$14.25 , N/A ,$14.25 , N/A ,$13.24 ,$13.24 ,$13.24 ,$15.08 , N/A ,$15.08 , N/A ,$16.76 ,$10.98 , N/A ,$7.27 , N/A , N/A ,$15.08 , N/A ,$10.58 ,$10.06 ,$15.08 , N/A ,$15.08 ,$15.08 , N/A ,$10.89 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27272900,S2900,HC SURGERY ROBOTIC TECHNICAL SYSTEM,272,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27400001,A4378,HC POUCH UROSTOMY,274,1 ,$31.87 ,$20.72 ,$13.83 ,$31.87 ,$23.74 ,$20.87 , N/A ,$16.80 , N/A ,$20.11 ,$20.11 ,$20.11 ,$20.11 ,$28.68 ,$23.90 , N/A ,$28.05 , N/A ,$23.90 ,$23.90 ,$27.09 ,$27.09 , N/A ,$27.09 , N/A ,$25.18 ,$25.18 ,$25.18 ,$28.68 , N/A ,$28.68 , N/A ,$31.87 ,$20.87 , N/A ,$13.83 , N/A , N/A ,$28.68 , N/A ,$20.11 ,$19.12 ,$28.68 , N/A ,$28.68 ,$28.68 , N/A ,$20.72 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27400104,L1830,HC KNEE IMMOBILIZER,274,1 ,$209.03 ,$135.87 ,$90.72 ,$228.94 ,$155.73 ,$136.91 ,$105.64 ,$110.16 ,$105.64 ,$131.90 ,$131.90 ,$131.90 ,$131.90 ,$188.13 ,$156.77 ,$105.64 ,$183.95 ,$105.64 ,$156.77 ,$156.77 ,$177.68 ,$177.68 ,$105.64 ,$177.68 ,$105.64 ,$165.13 ,$165.13 ,$165.13 ,$188.13 ,$209.03 ,$188.13 ,$105.64 ,$209.03 ,$136.91 ,$105.64 ,$90.72 , N/A ,$110.57 ,$188.13 ,$228.94 ,$131.90 ,$125.42 ,$188.13 ,$105.64 ,$188.13 ,$188.13 ,$105.64 ,$135.87 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27400210,L8000,HC PROSTH BREAST BRA W/O FORM COTTON,274,1 ,$46.74 ,$30.38 ,$20.29 ,$100.78 ,$34.82 ,$30.61 ,$46.50 ,$24.63 ,$46.50 ,$29.49 ,$29.49 ,$29.49 ,$29.49 ,$42.07 ,$35.06 ,$46.50 ,$41.13 ,$46.50 ,$35.06 ,$35.06 ,$39.73 ,$39.73 ,$46.50 ,$39.73 ,$46.50 ,$36.92 ,$36.92 ,$36.92 ,$42.07 ,$46.74 ,$42.07 ,$46.50 ,$46.74 ,$30.61 ,$46.50 ,$20.29 , N/A ,$46.74 ,$42.07 ,$100.78 ,$29.49 ,$28.04 ,$42.07 ,$46.50 ,$42.07 ,$42.07 ,$46.50 ,$30.38 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27400211,L8000,HC PROSTH BREAST BRA W/O FORM OTHER,274,1 ,$59.18 ,$38.47 ,$25.68 ,$106.55 ,$44.09 ,$38.76 ,$49.17 ,$31.19 ,$49.17 ,$37.34 ,$37.34 ,$37.34 ,$37.34 ,$53.26 ,$44.39 ,$49.17 ,$52.08 ,$49.17 ,$44.39 ,$44.39 ,$50.30 ,$50.30 ,$49.17 ,$50.30 ,$49.17 ,$46.75 ,$46.75 ,$46.75 ,$53.26 ,$59.18 ,$53.26 ,$49.17 ,$59.18 ,$38.76 ,$49.17 ,$25.68 , N/A ,$51.46 ,$53.26 ,$106.55 ,$37.34 ,$35.51 ,$53.26 ,$49.17 ,$53.26 ,$53.26 ,$49.17 ,$38.47 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27400212,L8015,HC PROSTH BREAST EXTERNAL W/FORM POST MASTECTOMY,274,1 ,$160.96 ,$104.62 ,$69.86 ,$186.66 ,$119.92 ,$105.43 ,$86.13 ,$84.83 ,$86.13 ,$101.57 ,$101.57 ,$101.57 ,$101.57 ,$144.86 ,$120.72 ,$86.13 ,$141.64 ,$86.13 ,$120.72 ,$120.72 ,$136.82 ,$136.82 ,$86.13 ,$136.82 ,$86.13 ,$127.16 ,$127.16 ,$127.16 ,$144.86 ,$160.96 ,$144.86 ,$86.13 ,$160.96 ,$105.43 ,$86.13 ,$69.86 , N/A ,$90.16 ,$144.86 ,$186.66 ,$101.57 ,$96.58 ,$144.86 ,$86.13 ,$144.86 ,$144.86 ,$86.13 ,$104.62 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27400213,L8020,HC PROSTH BREAST MASTECTOMY FORM,274,1 ,$398.95 ,$259.32 ,$173.14 ,$607.43 ,$297.22 ,$261.31 ,$280.29 ,$210.25 ,$280.29 ,$251.74 ,$251.74 ,$251.74 ,$251.74 ,$359.06 ,$299.21 ,$280.29 ,$351.08 ,$280.29 ,$299.21 ,$299.21 ,$339.11 ,$339.11 ,$280.29 ,$339.11 ,$280.29 ,$315.17 ,$315.17 ,$315.17 ,$359.06 ,$398.95 ,$359.06 ,$280.29 ,$398.95 ,$261.31 ,$280.29 ,$173.14 , N/A ,$293.38 ,$359.06 ,$607.43 ,$251.74 ,$239.37 ,$359.06 ,$280.29 ,$359.06 ,$359.06 ,$280.29 ,$259.32 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27400214,L8030,HC PROSTH BREAST W/O INTEGRAL ADHESIVE,274,1 ,$525.78 ,$341.76 ,$228.19 ,$896.83 ,$391.71 ,$344.39 ,$413.83 ,$277.09 ,$413.83 ,$331.77 ,$331.77 ,$331.77 ,$331.77 ,$473.20 ,$394.34 ,$413.83 ,$462.69 ,$413.83 ,$394.34 ,$394.34 ,$446.91 ,$446.91 ,$413.83 ,$446.91 ,$413.83 ,$415.37 ,$415.37 ,$415.37 ,$473.20 ,$525.78 ,$473.20 ,$413.83 ,$525.78 ,$344.39 ,$413.83 ,$228.19 , N/A ,$433.15 ,$473.20 ,$896.83 ,$331.77 ,$315.47 ,$473.20 ,$413.83 ,$473.20 ,$473.20 ,$413.83 ,$341.76 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27400215,L8030,HC PROSTH BREAST W/O INTEGRAL PARTIAL,274,1 ,$290.47 ,$188.81 ,$126.06 ,$787.59 ,$216.40 ,$190.26 ,$290.47 ,$153.08 ,$290.47 ,$183.29 ,$183.29 ,$183.29 ,$183.29 ,$261.42 ,$217.85 ,$290.47 ,$255.61 ,$290.47 ,$217.85 ,$217.85 ,$246.90 ,$246.90 ,$290.47 ,$246.90 ,$290.47 ,$229.47 ,$229.47 ,$229.47 ,$261.42 ,$290.47 ,$261.42 ,$290.47 ,$290.47 ,$190.26 ,$290.47 ,$126.06 , N/A ,$290.47 ,$261.42 ,$787.59 ,$183.29 ,$174.28 ,$261.42 ,$290.47 ,$261.42 ,$261.42 ,$290.47 ,$188.81 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27400216,L8031,HC PROSTH BREAST W/ADHESIVE,274,1 ,$533.91 ,$347.04 ,$231.72 ,$900.60 ,$397.76 ,$349.71 ,$415.57 ,$281.37 ,$415.57 ,$336.90 ,$336.90 ,$336.90 ,$336.90 ,$480.52 ,$400.43 ,$415.57 ,$469.84 ,$415.57 ,$400.43 ,$400.43 ,$453.82 ,$453.82 ,$415.57 ,$453.82 ,$415.57 ,$421.79 ,$421.79 ,$421.79 ,$480.52 ,$533.91 ,$480.52 ,$415.57 ,$533.91 ,$349.71 ,$415.57 ,$231.72 , N/A ,$434.97 ,$480.52 ,$900.60 ,$336.90 ,$320.35 ,$480.52 ,$415.57 ,$480.52 ,$480.52 ,$415.57 ,$347.04 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500049,C1721,HC ICD DEFIB DUAL CHAMBER T7,275,1 ,"$34,500.00 ","$22,425.00 ","$14,973.00 ","$34,500.00 ","$25,702.50 ","$22,597.50 ", N/A ,"$18,181.50 ", N/A ,"$21,769.50 ","$21,769.50 ","$21,769.50 ","$21,769.50 ","$31,050.00 ","$25,875.00 ", N/A ,"$30,360.00 ", N/A ,"$25,875.00 ","$25,875.00 ","$29,325.00 ","$29,325.00 ", N/A ,"$29,325.00 ", N/A ,"$27,255.00 ","$27,255.00 ","$27,255.00 ","$31,050.00 ", N/A ,"$31,050.00 ", N/A ,"$34,500.00 ","$22,597.50 ", N/A ,"$14,973.00 ", N/A , N/A ,"$31,050.00 ", N/A ,"$21,769.50 ","$20,700.00 ","$31,050.00 ", N/A ,"$31,050.00 ","$31,050.00 ", N/A ,"$22,425.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500069,C1722,HC ICD DEFIB SINGLE CHAMBER T5,275,1 ,"$31,500.00 ","$20,475.00 ","$13,671.00 ","$31,500.00 ","$23,467.50 ","$20,632.50 ", N/A ,"$16,600.50 ", N/A ,"$19,876.50 ","$19,876.50 ","$19,876.50 ","$19,876.50 ","$28,350.00 ","$23,625.00 ", N/A ,"$27,720.00 ", N/A ,"$23,625.00 ","$23,625.00 ","$26,775.00 ","$26,775.00 ", N/A ,"$26,775.00 ", N/A ,"$24,885.00 ","$24,885.00 ","$24,885.00 ","$28,350.00 ", N/A ,"$28,350.00 ", N/A ,"$31,500.00 ","$20,632.50 ", N/A ,"$13,671.00 ", N/A , N/A ,"$28,350.00 ", N/A ,"$19,876.50 ","$18,900.00 ","$28,350.00 ", N/A ,"$28,350.00 ","$28,350.00 ", N/A ,"$20,475.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500078,C1722,HC ICD DEFIB SINGLE CHAMBER T14,275,1 ,"$31,500.00 ","$20,475.00 ","$13,671.00 ","$31,500.00 ","$23,467.50 ","$20,632.50 ", N/A ,"$16,600.50 ", N/A ,"$19,876.50 ","$19,876.50 ","$19,876.50 ","$19,876.50 ","$28,350.00 ","$23,625.00 ", N/A ,"$27,720.00 ", N/A ,"$23,625.00 ","$23,625.00 ","$26,775.00 ","$26,775.00 ", N/A ,"$26,775.00 ", N/A ,"$24,885.00 ","$24,885.00 ","$24,885.00 ","$28,350.00 ", N/A ,"$28,350.00 ", N/A ,"$31,500.00 ","$20,632.50 ", N/A ,"$13,671.00 ", N/A , N/A ,"$28,350.00 ", N/A ,"$19,876.50 ","$18,900.00 ","$28,350.00 ", N/A ,"$28,350.00 ","$28,350.00 ", N/A ,"$20,475.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500091,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T5,275,1 ,"$7,500.00 ","$4,875.00 ","$3,255.00 ","$7,500.00 ","$5,587.50 ","$4,912.50 ", N/A ,"$3,952.50 ", N/A ,"$4,732.50 ","$4,732.50 ","$4,732.50 ","$4,732.50 ","$6,750.00 ","$5,625.00 ", N/A ,"$6,600.00 ", N/A ,"$5,625.00 ","$5,625.00 ","$6,375.00 ","$6,375.00 ", N/A ,"$6,375.00 ", N/A ,"$5,925.00 ","$5,925.00 ","$5,925.00 ","$6,750.00 ", N/A ,"$6,750.00 ", N/A ,"$7,500.00 ","$4,912.50 ", N/A ,"$3,255.00 ", N/A , N/A ,"$6,750.00 ", N/A ,"$4,732.50 ","$4,500.00 ","$6,750.00 ", N/A ,"$6,750.00 ","$6,750.00 ", N/A ,"$4,875.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500092,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T6,275,1 ,"$8,100.00 ","$5,265.00 ","$3,515.40 ","$8,100.00 ","$6,034.50 ","$5,305.50 ", N/A ,"$4,268.70 ", N/A ,"$5,111.10 ","$5,111.10 ","$5,111.10 ","$5,111.10 ","$7,290.00 ","$6,075.00 ", N/A ,"$7,128.00 ", N/A ,"$6,075.00 ","$6,075.00 ","$6,885.00 ","$6,885.00 ", N/A ,"$6,885.00 ", N/A ,"$6,399.00 ","$6,399.00 ","$6,399.00 ","$7,290.00 ", N/A ,"$7,290.00 ", N/A ,"$8,100.00 ","$5,305.50 ", N/A ,"$3,515.40 ", N/A , N/A ,"$7,290.00 ", N/A ,"$5,111.10 ","$4,860.00 ","$7,290.00 ", N/A ,"$7,290.00 ","$7,290.00 ", N/A ,"$5,265.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500093,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T7,275,1 ,"$8,700.00 ","$5,655.00 ","$3,775.80 ","$8,700.00 ","$6,481.50 ","$5,698.50 ", N/A ,"$4,584.90 ", N/A ,"$5,489.70 ","$5,489.70 ","$5,489.70 ","$5,489.70 ","$7,830.00 ","$6,525.00 ", N/A ,"$7,656.00 ", N/A ,"$6,525.00 ","$6,525.00 ","$7,395.00 ","$7,395.00 ", N/A ,"$7,395.00 ", N/A ,"$6,873.00 ","$6,873.00 ","$6,873.00 ","$7,830.00 ", N/A ,"$7,830.00 ", N/A ,"$8,700.00 ","$5,698.50 ", N/A ,"$3,775.80 ", N/A , N/A ,"$7,830.00 ", N/A ,"$5,489.70 ","$5,220.00 ","$7,830.00 ", N/A ,"$7,830.00 ","$7,830.00 ", N/A ,"$5,655.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500094,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T8,275,1 ,"$9,300.00 ","$6,045.00 ","$4,036.20 ","$9,300.00 ","$6,928.50 ","$6,091.50 ", N/A ,"$4,901.10 ", N/A ,"$5,868.30 ","$5,868.30 ","$5,868.30 ","$5,868.30 ","$8,370.00 ","$6,975.00 ", N/A ,"$8,184.00 ", N/A ,"$6,975.00 ","$6,975.00 ","$7,905.00 ","$7,905.00 ", N/A ,"$7,905.00 ", N/A ,"$7,347.00 ","$7,347.00 ","$7,347.00 ","$8,370.00 ", N/A ,"$8,370.00 ", N/A ,"$9,300.00 ","$6,091.50 ", N/A ,"$4,036.20 ", N/A , N/A ,"$8,370.00 ", N/A ,"$5,868.30 ","$5,580.00 ","$8,370.00 ", N/A ,"$8,370.00 ","$8,370.00 ", N/A ,"$6,045.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500095,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T9,275,1 ,"$9,900.00 ","$6,435.00 ","$4,296.60 ","$9,900.00 ","$7,375.50 ","$6,484.50 ", N/A ,"$5,217.30 ", N/A ,"$6,246.90 ","$6,246.90 ","$6,246.90 ","$6,246.90 ","$8,910.00 ","$7,425.00 ", N/A ,"$8,712.00 ", N/A ,"$7,425.00 ","$7,425.00 ","$8,415.00 ","$8,415.00 ", N/A ,"$8,415.00 ", N/A ,"$7,821.00 ","$7,821.00 ","$7,821.00 ","$8,910.00 ", N/A ,"$8,910.00 ", N/A ,"$9,900.00 ","$6,484.50 ", N/A ,"$4,296.60 ", N/A , N/A ,"$8,910.00 ", N/A ,"$6,246.90 ","$5,940.00 ","$8,910.00 ", N/A ,"$8,910.00 ","$8,910.00 ", N/A ,"$6,435.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500096,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T10,275,1 ,"$10,500.00 ","$6,825.00 ","$4,557.00 ","$10,500.00 ","$7,822.50 ","$6,877.50 ", N/A ,"$5,533.50 ", N/A ,"$6,625.50 ","$6,625.50 ","$6,625.50 ","$6,625.50 ","$9,450.00 ","$7,875.00 ", N/A ,"$9,240.00 ", N/A ,"$7,875.00 ","$7,875.00 ","$8,925.00 ","$8,925.00 ", N/A ,"$8,925.00 ", N/A ,"$8,295.00 ","$8,295.00 ","$8,295.00 ","$9,450.00 ", N/A ,"$9,450.00 ", N/A ,"$10,500.00 ","$6,877.50 ", N/A ,"$4,557.00 ", N/A , N/A ,"$9,450.00 ", N/A ,"$6,625.50 ","$6,300.00 ","$9,450.00 ", N/A ,"$9,450.00 ","$9,450.00 ", N/A ,"$6,825.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500097,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T11,275,1 ,"$11,100.00 ","$7,215.00 ","$4,817.40 ","$11,100.00 ","$8,269.50 ","$7,270.50 ", N/A ,"$5,849.70 ", N/A ,"$7,004.10 ","$7,004.10 ","$7,004.10 ","$7,004.10 ","$9,990.00 ","$8,325.00 ", N/A ,"$9,768.00 ", N/A ,"$8,325.00 ","$8,325.00 ","$9,435.00 ","$9,435.00 ", N/A ,"$9,435.00 ", N/A ,"$8,769.00 ","$8,769.00 ","$8,769.00 ","$9,990.00 ", N/A ,"$9,990.00 ", N/A ,"$11,100.00 ","$7,270.50 ", N/A ,"$4,817.40 ", N/A , N/A ,"$9,990.00 ", N/A ,"$7,004.10 ","$6,660.00 ","$9,990.00 ", N/A ,"$9,990.00 ","$9,990.00 ", N/A ,"$7,215.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500098,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T12,275,1 ,"$11,700.00 ","$7,605.00 ","$5,077.80 ","$11,700.00 ","$8,716.50 ","$7,663.50 ", N/A ,"$6,165.90 ", N/A ,"$7,382.70 ","$7,382.70 ","$7,382.70 ","$7,382.70 ","$10,530.00 ","$8,775.00 ", N/A ,"$10,296.00 ", N/A ,"$8,775.00 ","$8,775.00 ","$9,945.00 ","$9,945.00 ", N/A ,"$9,945.00 ", N/A ,"$9,243.00 ","$9,243.00 ","$9,243.00 ","$10,530.00 ", N/A ,"$10,530.00 ", N/A ,"$11,700.00 ","$7,663.50 ", N/A ,"$5,077.80 ", N/A , N/A ,"$10,530.00 ", N/A ,"$7,382.70 ","$7,020.00 ","$10,530.00 ", N/A ,"$10,530.00 ","$10,530.00 ", N/A ,"$7,605.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500099,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T13,275,1 ,"$12,300.00 ","$7,995.00 ","$5,338.20 ","$12,300.00 ","$9,163.50 ","$8,056.50 ", N/A ,"$6,482.10 ", N/A ,"$7,761.30 ","$7,761.30 ","$7,761.30 ","$7,761.30 ","$11,070.00 ","$9,225.00 ", N/A ,"$10,824.00 ", N/A ,"$9,225.00 ","$9,225.00 ","$10,455.00 ","$10,455.00 ", N/A ,"$10,455.00 ", N/A ,"$9,717.00 ","$9,717.00 ","$9,717.00 ","$11,070.00 ", N/A ,"$11,070.00 ", N/A ,"$12,300.00 ","$8,056.50 ", N/A ,"$5,338.20 ", N/A , N/A ,"$11,070.00 ", N/A ,"$7,761.30 ","$7,380.00 ","$11,070.00 ", N/A ,"$11,070.00 ","$11,070.00 ", N/A ,"$7,995.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500100,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T14,275,1 ,"$12,900.00 ","$8,385.00 ","$5,598.60 ","$12,900.00 ","$9,610.50 ","$8,449.50 ", N/A ,"$6,798.30 ", N/A ,"$8,139.90 ","$8,139.90 ","$8,139.90 ","$8,139.90 ","$11,610.00 ","$9,675.00 ", N/A ,"$11,352.00 ", N/A ,"$9,675.00 ","$9,675.00 ","$10,965.00 ","$10,965.00 ", N/A ,"$10,965.00 ", N/A ,"$10,191.00 ","$10,191.00 ","$10,191.00 ","$11,610.00 ", N/A ,"$11,610.00 ", N/A ,"$12,900.00 ","$8,449.50 ", N/A ,"$5,598.60 ", N/A , N/A ,"$11,610.00 ", N/A ,"$8,139.90 ","$7,740.00 ","$11,610.00 ", N/A ,"$11,610.00 ","$11,610.00 ", N/A ,"$8,385.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500101,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T15,275,1 ,"$13,500.00 ","$8,775.00 ","$5,859.00 ","$13,500.00 ","$10,057.50 ","$8,842.50 ", N/A ,"$7,114.50 ", N/A ,"$8,518.50 ","$8,518.50 ","$8,518.50 ","$8,518.50 ","$12,150.00 ","$10,125.00 ", N/A ,"$11,880.00 ", N/A ,"$10,125.00 ","$10,125.00 ","$11,475.00 ","$11,475.00 ", N/A ,"$11,475.00 ", N/A ,"$10,665.00 ","$10,665.00 ","$10,665.00 ","$12,150.00 ", N/A ,"$12,150.00 ", N/A ,"$13,500.00 ","$8,842.50 ", N/A ,"$5,859.00 ", N/A , N/A ,"$12,150.00 ", N/A ,"$8,518.50 ","$8,100.00 ","$12,150.00 ", N/A ,"$12,150.00 ","$12,150.00 ", N/A ,"$8,775.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500102,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T16,275,1 ,"$14,100.00 ","$9,165.00 ","$6,119.40 ","$14,100.00 ","$10,504.50 ","$9,235.50 ", N/A ,"$7,430.70 ", N/A ,"$8,897.10 ","$8,897.10 ","$8,897.10 ","$8,897.10 ","$12,690.00 ","$10,575.00 ", N/A ,"$12,408.00 ", N/A ,"$10,575.00 ","$10,575.00 ","$11,985.00 ","$11,985.00 ", N/A ,"$11,985.00 ", N/A ,"$11,139.00 ","$11,139.00 ","$11,139.00 ","$12,690.00 ", N/A ,"$12,690.00 ", N/A ,"$14,100.00 ","$9,235.50 ", N/A ,"$6,119.40 ", N/A , N/A ,"$12,690.00 ", N/A ,"$8,897.10 ","$8,460.00 ","$12,690.00 ", N/A ,"$12,690.00 ","$12,690.00 ", N/A ,"$9,165.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500103,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T17,275,1 ,"$14,700.00 ","$9,555.00 ","$6,379.80 ","$14,700.00 ","$10,951.50 ","$9,628.50 ", N/A ,"$7,746.90 ", N/A ,"$9,275.70 ","$9,275.70 ","$9,275.70 ","$9,275.70 ","$13,230.00 ","$11,025.00 ", N/A ,"$12,936.00 ", N/A ,"$11,025.00 ","$11,025.00 ","$12,495.00 ","$12,495.00 ", N/A ,"$12,495.00 ", N/A ,"$11,613.00 ","$11,613.00 ","$11,613.00 ","$13,230.00 ", N/A ,"$13,230.00 ", N/A ,"$14,700.00 ","$9,628.50 ", N/A ,"$6,379.80 ", N/A , N/A ,"$13,230.00 ", N/A ,"$9,275.70 ","$8,820.00 ","$13,230.00 ", N/A ,"$13,230.00 ","$13,230.00 ", N/A ,"$9,555.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500104,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T18,275,1 ,"$15,300.00 ","$9,945.00 ","$6,640.20 ","$15,300.00 ","$11,398.50 ","$10,021.50 ", N/A ,"$8,063.10 ", N/A ,"$9,654.30 ","$9,654.30 ","$9,654.30 ","$9,654.30 ","$13,770.00 ","$11,475.00 ", N/A ,"$13,464.00 ", N/A ,"$11,475.00 ","$11,475.00 ","$13,005.00 ","$13,005.00 ", N/A ,"$13,005.00 ", N/A ,"$12,087.00 ","$12,087.00 ","$12,087.00 ","$13,770.00 ", N/A ,"$13,770.00 ", N/A ,"$15,300.00 ","$10,021.50 ", N/A ,"$6,640.20 ", N/A , N/A ,"$13,770.00 ", N/A ,"$9,654.30 ","$9,180.00 ","$13,770.00 ", N/A ,"$13,770.00 ","$13,770.00 ", N/A ,"$9,945.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500105,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T19,275,1 ,"$15,900.00 ","$10,335.00 ","$6,900.60 ","$15,900.00 ","$11,845.50 ","$10,414.50 ", N/A ,"$8,379.30 ", N/A ,"$10,032.90 ","$10,032.90 ","$10,032.90 ","$10,032.90 ","$14,310.00 ","$11,925.00 ", N/A ,"$13,992.00 ", N/A ,"$11,925.00 ","$11,925.00 ","$13,515.00 ","$13,515.00 ", N/A ,"$13,515.00 ", N/A ,"$12,561.00 ","$12,561.00 ","$12,561.00 ","$14,310.00 ", N/A ,"$14,310.00 ", N/A ,"$15,900.00 ","$10,414.50 ", N/A ,"$6,900.60 ", N/A , N/A ,"$14,310.00 ", N/A ,"$10,032.90 ","$9,540.00 ","$14,310.00 ", N/A ,"$14,310.00 ","$14,310.00 ", N/A ,"$10,335.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500106,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T20,275,1 ,"$16,500.00 ","$10,725.00 ","$7,161.00 ","$16,500.00 ","$12,292.50 ","$10,807.50 ", N/A ,"$8,695.50 ", N/A ,"$10,411.50 ","$10,411.50 ","$10,411.50 ","$10,411.50 ","$14,850.00 ","$12,375.00 ", N/A ,"$14,520.00 ", N/A ,"$12,375.00 ","$12,375.00 ","$14,025.00 ","$14,025.00 ", N/A ,"$14,025.00 ", N/A ,"$13,035.00 ","$13,035.00 ","$13,035.00 ","$14,850.00 ", N/A ,"$14,850.00 ", N/A ,"$16,500.00 ","$10,807.50 ", N/A ,"$7,161.00 ", N/A , N/A ,"$14,850.00 ", N/A ,"$10,411.50 ","$9,900.00 ","$14,850.00 ", N/A ,"$14,850.00 ","$14,850.00 ", N/A ,"$10,725.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500107,C1785,HC PACEMAKER DUAL CHAMBER RATE-RESP T21,275,1 ,"$17,100.00 ","$11,115.00 ","$7,421.40 ","$17,100.00 ","$12,739.50 ","$11,200.50 ", N/A ,"$9,011.70 ", N/A ,"$10,790.10 ","$10,790.10 ","$10,790.10 ","$10,790.10 ","$15,390.00 ","$12,825.00 ", N/A ,"$15,048.00 ", N/A ,"$12,825.00 ","$12,825.00 ","$14,535.00 ","$14,535.00 ", N/A ,"$14,535.00 ", N/A ,"$13,509.00 ","$13,509.00 ","$13,509.00 ","$15,390.00 ", N/A ,"$15,390.00 ", N/A ,"$17,100.00 ","$11,200.50 ", N/A ,"$7,421.40 ", N/A , N/A ,"$15,390.00 ", N/A ,"$10,790.10 ","$10,260.00 ","$15,390.00 ", N/A ,"$15,390.00 ","$15,390.00 ", N/A ,"$11,115.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500120,C1786,HC PACEMAKER SINGLE CHAMBER RATE-RESP T10,275,1 ,"$7,500.00 ","$4,875.00 ","$3,255.00 ","$7,500.00 ","$5,587.50 ","$4,912.50 ", N/A ,"$3,952.50 ", N/A ,"$4,732.50 ","$4,732.50 ","$4,732.50 ","$4,732.50 ","$6,750.00 ","$5,625.00 ", N/A ,"$6,600.00 ", N/A ,"$5,625.00 ","$5,625.00 ","$6,375.00 ","$6,375.00 ", N/A ,"$6,375.00 ", N/A ,"$5,925.00 ","$5,925.00 ","$5,925.00 ","$6,750.00 ", N/A ,"$6,750.00 ", N/A ,"$7,500.00 ","$4,912.50 ", N/A ,"$3,255.00 ", N/A , N/A ,"$6,750.00 ", N/A ,"$4,732.50 ","$4,500.00 ","$6,750.00 ", N/A ,"$6,750.00 ","$6,750.00 ", N/A ,"$4,875.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500121,C1786,HC PACEMAKER SINGLE CHAMBER RATE-RESP T11,275,1 ,"$8,100.00 ","$5,265.00 ","$3,515.40 ","$8,100.00 ","$6,034.50 ","$5,305.50 ", N/A ,"$4,268.70 ", N/A ,"$5,111.10 ","$5,111.10 ","$5,111.10 ","$5,111.10 ","$7,290.00 ","$6,075.00 ", N/A ,"$7,128.00 ", N/A ,"$6,075.00 ","$6,075.00 ","$6,885.00 ","$6,885.00 ", N/A ,"$6,885.00 ", N/A ,"$6,399.00 ","$6,399.00 ","$6,399.00 ","$7,290.00 ", N/A ,"$7,290.00 ", N/A ,"$8,100.00 ","$5,305.50 ", N/A ,"$3,515.40 ", N/A , N/A ,"$7,290.00 ", N/A ,"$5,111.10 ","$4,860.00 ","$7,290.00 ", N/A ,"$7,290.00 ","$7,290.00 ", N/A ,"$5,265.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500122,C1786,HC PACEMAKER SINGLE CHAMBER RATE-RESP T12,275,1 ,"$8,700.00 ","$5,655.00 ","$3,775.80 ","$8,700.00 ","$6,481.50 ","$5,698.50 ", N/A ,"$4,584.90 ", N/A ,"$5,489.70 ","$5,489.70 ","$5,489.70 ","$5,489.70 ","$7,830.00 ","$6,525.00 ", N/A ,"$7,656.00 ", N/A ,"$6,525.00 ","$6,525.00 ","$7,395.00 ","$7,395.00 ", N/A ,"$7,395.00 ", N/A ,"$6,873.00 ","$6,873.00 ","$6,873.00 ","$7,830.00 ", N/A ,"$7,830.00 ", N/A ,"$8,700.00 ","$5,698.50 ", N/A ,"$3,775.80 ", N/A , N/A ,"$7,830.00 ", N/A ,"$5,489.70 ","$5,220.00 ","$7,830.00 ", N/A ,"$7,830.00 ","$7,830.00 ", N/A ,"$5,655.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500123,C1786,HC PACEMAKER SINGLE CHAMBER RATE-RESP T13,275,1 ,"$9,300.00 ","$6,045.00 ","$4,036.20 ","$9,300.00 ","$6,928.50 ","$6,091.50 ", N/A ,"$4,901.10 ", N/A ,"$5,868.30 ","$5,868.30 ","$5,868.30 ","$5,868.30 ","$8,370.00 ","$6,975.00 ", N/A ,"$8,184.00 ", N/A ,"$6,975.00 ","$6,975.00 ","$7,905.00 ","$7,905.00 ", N/A ,"$7,905.00 ", N/A ,"$7,347.00 ","$7,347.00 ","$7,347.00 ","$8,370.00 ", N/A ,"$8,370.00 ", N/A ,"$9,300.00 ","$6,091.50 ", N/A ,"$4,036.20 ", N/A , N/A ,"$8,370.00 ", N/A ,"$5,868.30 ","$5,580.00 ","$8,370.00 ", N/A ,"$8,370.00 ","$8,370.00 ", N/A ,"$6,045.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500124,C1786,HC PACEMAKER SINGLE CHAMBER RATE-RESP T14,275,1 ,"$9,900.00 ","$6,435.00 ","$4,296.60 ","$9,900.00 ","$7,375.50 ","$6,484.50 ", N/A ,"$5,217.30 ", N/A ,"$6,246.90 ","$6,246.90 ","$6,246.90 ","$6,246.90 ","$8,910.00 ","$7,425.00 ", N/A ,"$8,712.00 ", N/A ,"$7,425.00 ","$7,425.00 ","$8,415.00 ","$8,415.00 ", N/A ,"$8,415.00 ", N/A ,"$7,821.00 ","$7,821.00 ","$7,821.00 ","$8,910.00 ", N/A ,"$8,910.00 ", N/A ,"$9,900.00 ","$6,484.50 ", N/A ,"$4,296.60 ", N/A , N/A ,"$8,910.00 ", N/A ,"$6,246.90 ","$5,940.00 ","$8,910.00 ", N/A ,"$8,910.00 ","$8,910.00 ", N/A ,"$6,435.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500125,C1786,HC PACEMAKER SINGLE CHAMBER RATE-RESP T15,275,1 ,"$10,500.00 ","$6,825.00 ","$4,557.00 ","$10,500.00 ","$7,822.50 ","$6,877.50 ", N/A ,"$5,533.50 ", N/A ,"$6,625.50 ","$6,625.50 ","$6,625.50 ","$6,625.50 ","$9,450.00 ","$7,875.00 ", N/A ,"$9,240.00 ", N/A ,"$7,875.00 ","$7,875.00 ","$8,925.00 ","$8,925.00 ", N/A ,"$8,925.00 ", N/A ,"$8,295.00 ","$8,295.00 ","$8,295.00 ","$9,450.00 ", N/A ,"$9,450.00 ", N/A ,"$10,500.00 ","$6,877.50 ", N/A ,"$4,557.00 ", N/A , N/A ,"$9,450.00 ", N/A ,"$6,625.50 ","$6,300.00 ","$9,450.00 ", N/A ,"$9,450.00 ","$9,450.00 ", N/A ,"$6,825.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27500189,C2621,HC PACEMAKER OTHER THAN SINGLE/DUAL T19,275,1 ,"$16,500.00 ","$10,725.00 ","$7,161.00 ","$16,500.00 ","$12,292.50 ","$10,807.50 ", N/A ,"$8,695.50 ", N/A ,"$10,411.50 ","$10,411.50 ","$10,411.50 ","$10,411.50 ","$14,850.00 ","$12,375.00 ", N/A ,"$14,520.00 ", N/A ,"$12,375.00 ","$12,375.00 ","$14,025.00 ","$14,025.00 ", N/A ,"$14,025.00 ", N/A ,"$13,035.00 ","$13,035.00 ","$13,035.00 ","$14,850.00 ", N/A ,"$14,850.00 ", N/A ,"$16,500.00 ","$10,807.50 ", N/A ,"$7,161.00 ", N/A , N/A ,"$14,850.00 ", N/A ,"$10,411.50 ","$9,900.00 ","$14,850.00 ", N/A ,"$14,850.00 ","$14,850.00 ", N/A ,"$10,725.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27800553,A4648,HC TISSUE MARKER IMPLANTABLE,278,1 ,$92.99 ,$60.44 ,$40.36 ,$92.99 ,$69.28 ,$60.91 , N/A ,$49.01 , N/A ,$58.68 ,$58.68 ,$58.68 ,$58.68 ,$83.69 ,$69.74 , N/A ,$81.83 , N/A ,$69.74 ,$69.74 ,$79.04 ,$79.04 , N/A ,$79.04 , N/A ,$73.46 ,$73.46 ,$73.46 ,$83.69 , N/A ,$83.69 , N/A ,$92.99 ,$60.91 , N/A ,$40.36 , N/A , N/A ,$83.69 , N/A ,$58.68 ,$55.79 ,$83.69 , N/A ,$83.69 ,$83.69 , N/A ,$60.44 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801484,C1894,HC INTRODUCER MICROPUNCTURE SET,278,1 ,$99.24 ,$64.51 ,$43.07 ,$99.24 ,$73.93 ,$65.00 , N/A ,$52.30 , N/A ,$62.62 ,$62.62 ,$62.62 ,$62.62 ,$89.32 ,$74.43 , N/A ,$87.33 , N/A ,$74.43 ,$74.43 ,$84.35 ,$84.35 , N/A ,$84.35 , N/A ,$78.40 ,$78.40 ,$78.40 ,$89.32 , N/A ,$89.32 , N/A ,$99.24 ,$65.00 , N/A ,$43.07 , N/A , N/A ,$89.32 , N/A ,$62.62 ,$59.54 ,$89.32 , N/A ,$89.32 ,$89.32 , N/A ,$64.51 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801599,C1764,HC RECORDER CARDIAC EVENT IMPLANT T17,278,1 ,"$10,912.00 ","$7,092.80 ","$4,735.81 ","$10,912.00 ","$8,129.44 ","$7,147.36 ", N/A ,"$5,750.62 ", N/A ,"$6,885.47 ","$6,885.47 ","$6,885.47 ","$6,885.47 ","$9,820.80 ","$8,184.00 ", N/A ,"$9,602.56 ", N/A ,"$8,184.00 ","$8,184.00 ","$9,275.20 ","$9,275.20 ", N/A ,"$9,275.20 ", N/A ,"$8,620.48 ","$8,620.48 ","$8,620.48 ","$9,820.80 ", N/A ,"$9,820.80 ", N/A ,"$10,912.00 ","$7,147.36 ", N/A ,"$4,735.81 ", N/A , N/A ,"$9,820.80 ", N/A ,"$6,885.47 ","$6,547.20 ","$9,820.80 ", N/A ,"$9,820.80 ","$9,820.80 ", N/A ,"$7,092.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801671,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T7,278,1 ,"$3,300.00 ","$2,145.00 ","$1,432.20 ","$3,300.00 ","$2,458.50 ","$2,161.50 ", N/A ,"$1,739.10 ", N/A ,"$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,970.00 ","$2,475.00 ", N/A ,"$2,904.00 ", N/A ,"$2,475.00 ","$2,475.00 ","$2,805.00 ","$2,805.00 ", N/A ,"$2,805.00 ", N/A ,"$2,607.00 ","$2,607.00 ","$2,607.00 ","$2,970.00 ", N/A ,"$2,970.00 ", N/A ,"$3,300.00 ","$2,161.50 ", N/A ,"$1,432.20 ", N/A , N/A ,"$2,970.00 ", N/A ,"$2,082.30 ","$1,980.00 ","$2,970.00 ", N/A ,"$2,970.00 ","$2,970.00 ", N/A ,"$2,145.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801672,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T8,278,1 ,"$3,900.00 ","$2,535.00 ","$1,692.60 ","$3,900.00 ","$2,905.50 ","$2,554.50 ", N/A ,"$2,055.30 ", N/A ,"$2,460.90 ","$2,460.90 ","$2,460.90 ","$2,460.90 ","$3,510.00 ","$2,925.00 ", N/A ,"$3,432.00 ", N/A ,"$2,925.00 ","$2,925.00 ","$3,315.00 ","$3,315.00 ", N/A ,"$3,315.00 ", N/A ,"$3,081.00 ","$3,081.00 ","$3,081.00 ","$3,510.00 ", N/A ,"$3,510.00 ", N/A ,"$3,900.00 ","$2,554.50 ", N/A ,"$1,692.60 ", N/A , N/A ,"$3,510.00 ", N/A ,"$2,460.90 ","$2,340.00 ","$3,510.00 ", N/A ,"$3,510.00 ","$3,510.00 ", N/A ,"$2,535.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801673,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T9,278,1 ,"$4,500.00 ","$2,925.00 ","$1,953.00 ","$4,500.00 ","$3,352.50 ","$2,947.50 ", N/A ,"$2,371.50 ", N/A ,"$2,839.50 ","$2,839.50 ","$2,839.50 ","$2,839.50 ","$4,050.00 ","$3,375.00 ", N/A ,"$3,960.00 ", N/A ,"$3,375.00 ","$3,375.00 ","$3,825.00 ","$3,825.00 ", N/A ,"$3,825.00 ", N/A ,"$3,555.00 ","$3,555.00 ","$3,555.00 ","$4,050.00 ", N/A ,"$4,050.00 ", N/A ,"$4,500.00 ","$2,947.50 ", N/A ,"$1,953.00 ", N/A , N/A ,"$4,050.00 ", N/A ,"$2,839.50 ","$2,700.00 ","$4,050.00 ", N/A ,"$4,050.00 ","$4,050.00 ", N/A ,"$2,925.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801674,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T10,278,1 ,"$5,100.00 ","$3,315.00 ","$2,213.40 ","$5,100.00 ","$3,799.50 ","$3,340.50 ", N/A ,"$2,687.70 ", N/A ,"$3,218.10 ","$3,218.10 ","$3,218.10 ","$3,218.10 ","$4,590.00 ","$3,825.00 ", N/A ,"$4,488.00 ", N/A ,"$3,825.00 ","$3,825.00 ","$4,335.00 ","$4,335.00 ", N/A ,"$4,335.00 ", N/A ,"$4,029.00 ","$4,029.00 ","$4,029.00 ","$4,590.00 ", N/A ,"$4,590.00 ", N/A ,"$5,100.00 ","$3,340.50 ", N/A ,"$2,213.40 ", N/A , N/A ,"$4,590.00 ", N/A ,"$3,218.10 ","$3,060.00 ","$4,590.00 ", N/A ,"$4,590.00 ","$4,590.00 ", N/A ,"$3,315.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801675,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T11,278,1 ,"$5,700.00 ","$3,705.00 ","$2,473.80 ","$5,700.00 ","$4,246.50 ","$3,733.50 ", N/A ,"$3,003.90 ", N/A ,"$3,596.70 ","$3,596.70 ","$3,596.70 ","$3,596.70 ","$5,130.00 ","$4,275.00 ", N/A ,"$5,016.00 ", N/A ,"$4,275.00 ","$4,275.00 ","$4,845.00 ","$4,845.00 ", N/A ,"$4,845.00 ", N/A ,"$4,503.00 ","$4,503.00 ","$4,503.00 ","$5,130.00 ", N/A ,"$5,130.00 ", N/A ,"$5,700.00 ","$3,733.50 ", N/A ,"$2,473.80 ", N/A , N/A ,"$5,130.00 ", N/A ,"$3,596.70 ","$3,420.00 ","$5,130.00 ", N/A ,"$5,130.00 ","$5,130.00 ", N/A ,"$3,705.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801676,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T12,278,1 ,"$6,300.00 ","$4,095.00 ","$2,734.20 ","$6,300.00 ","$4,693.50 ","$4,126.50 ", N/A ,"$3,320.10 ", N/A ,"$3,975.30 ","$3,975.30 ","$3,975.30 ","$3,975.30 ","$5,670.00 ","$4,725.00 ", N/A ,"$5,544.00 ", N/A ,"$4,725.00 ","$4,725.00 ","$5,355.00 ","$5,355.00 ", N/A ,"$5,355.00 ", N/A ,"$4,977.00 ","$4,977.00 ","$4,977.00 ","$5,670.00 ", N/A ,"$5,670.00 ", N/A ,"$6,300.00 ","$4,126.50 ", N/A ,"$2,734.20 ", N/A , N/A ,"$5,670.00 ", N/A ,"$3,975.30 ","$3,780.00 ","$5,670.00 ", N/A ,"$5,670.00 ","$5,670.00 ", N/A ,"$4,095.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801677,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T13,278,1 ,"$6,900.00 ","$4,485.00 ","$2,994.60 ","$6,900.00 ","$5,140.50 ","$4,519.50 ", N/A ,"$3,636.30 ", N/A ,"$4,353.90 ","$4,353.90 ","$4,353.90 ","$4,353.90 ","$6,210.00 ","$5,175.00 ", N/A ,"$6,072.00 ", N/A ,"$5,175.00 ","$5,175.00 ","$5,865.00 ","$5,865.00 ", N/A ,"$5,865.00 ", N/A ,"$5,451.00 ","$5,451.00 ","$5,451.00 ","$6,210.00 ", N/A ,"$6,210.00 ", N/A ,"$6,900.00 ","$4,519.50 ", N/A ,"$2,994.60 ", N/A , N/A ,"$6,210.00 ", N/A ,"$4,353.90 ","$4,140.00 ","$6,210.00 ", N/A ,"$6,210.00 ","$6,210.00 ", N/A ,"$4,485.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801678,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T14,278,1 ,"$7,500.00 ","$4,875.00 ","$3,255.00 ","$7,500.00 ","$5,587.50 ","$4,912.50 ", N/A ,"$3,952.50 ", N/A ,"$4,732.50 ","$4,732.50 ","$4,732.50 ","$4,732.50 ","$6,750.00 ","$5,625.00 ", N/A ,"$6,600.00 ", N/A ,"$5,625.00 ","$5,625.00 ","$6,375.00 ","$6,375.00 ", N/A ,"$6,375.00 ", N/A ,"$5,925.00 ","$5,925.00 ","$5,925.00 ","$6,750.00 ", N/A ,"$6,750.00 ", N/A ,"$7,500.00 ","$4,912.50 ", N/A ,"$3,255.00 ", N/A , N/A ,"$6,750.00 ", N/A ,"$4,732.50 ","$4,500.00 ","$6,750.00 ", N/A ,"$6,750.00 ","$6,750.00 ", N/A ,"$4,875.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801679,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T15,278,1 ,"$8,100.00 ","$5,265.00 ","$3,515.40 ","$8,100.00 ","$6,034.50 ","$5,305.50 ", N/A ,"$4,268.70 ", N/A ,"$5,111.10 ","$5,111.10 ","$5,111.10 ","$5,111.10 ","$7,290.00 ","$6,075.00 ", N/A ,"$7,128.00 ", N/A ,"$6,075.00 ","$6,075.00 ","$6,885.00 ","$6,885.00 ", N/A ,"$6,885.00 ", N/A ,"$6,399.00 ","$6,399.00 ","$6,399.00 ","$7,290.00 ", N/A ,"$7,290.00 ", N/A ,"$8,100.00 ","$5,305.50 ", N/A ,"$3,515.40 ", N/A , N/A ,"$7,290.00 ", N/A ,"$5,111.10 ","$4,860.00 ","$7,290.00 ", N/A ,"$7,290.00 ","$7,290.00 ", N/A ,"$5,265.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801680,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T16,278,1 ,"$8,700.00 ","$5,655.00 ","$3,775.80 ","$8,700.00 ","$6,481.50 ","$5,698.50 ", N/A ,"$4,584.90 ", N/A ,"$5,489.70 ","$5,489.70 ","$5,489.70 ","$5,489.70 ","$7,830.00 ","$6,525.00 ", N/A ,"$7,656.00 ", N/A ,"$6,525.00 ","$6,525.00 ","$7,395.00 ","$7,395.00 ", N/A ,"$7,395.00 ", N/A ,"$6,873.00 ","$6,873.00 ","$6,873.00 ","$7,830.00 ", N/A ,"$7,830.00 ", N/A ,"$8,700.00 ","$5,698.50 ", N/A ,"$3,775.80 ", N/A , N/A ,"$7,830.00 ", N/A ,"$5,489.70 ","$5,220.00 ","$7,830.00 ", N/A ,"$7,830.00 ","$7,830.00 ", N/A ,"$5,655.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801681,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T17,278,1 ,"$9,300.00 ","$6,045.00 ","$4,036.20 ","$9,300.00 ","$6,928.50 ","$6,091.50 ", N/A ,"$4,901.10 ", N/A ,"$5,868.30 ","$5,868.30 ","$5,868.30 ","$5,868.30 ","$8,370.00 ","$6,975.00 ", N/A ,"$8,184.00 ", N/A ,"$6,975.00 ","$6,975.00 ","$7,905.00 ","$7,905.00 ", N/A ,"$7,905.00 ", N/A ,"$7,347.00 ","$7,347.00 ","$7,347.00 ","$8,370.00 ", N/A ,"$8,370.00 ", N/A ,"$9,300.00 ","$6,091.50 ", N/A ,"$4,036.20 ", N/A , N/A ,"$8,370.00 ", N/A ,"$5,868.30 ","$5,580.00 ","$8,370.00 ", N/A ,"$8,370.00 ","$8,370.00 ", N/A ,"$6,045.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801682,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T18,278,1 ,"$9,900.00 ","$6,435.00 ","$4,296.60 ","$9,900.00 ","$7,375.50 ","$6,484.50 ", N/A ,"$5,217.30 ", N/A ,"$6,246.90 ","$6,246.90 ","$6,246.90 ","$6,246.90 ","$8,910.00 ","$7,425.00 ", N/A ,"$8,712.00 ", N/A ,"$7,425.00 ","$7,425.00 ","$8,415.00 ","$8,415.00 ", N/A ,"$8,415.00 ", N/A ,"$7,821.00 ","$7,821.00 ","$7,821.00 ","$8,910.00 ", N/A ,"$8,910.00 ", N/A ,"$9,900.00 ","$6,484.50 ", N/A ,"$4,296.60 ", N/A , N/A ,"$8,910.00 ", N/A ,"$6,246.90 ","$5,940.00 ","$8,910.00 ", N/A ,"$8,910.00 ","$8,910.00 ", N/A ,"$6,435.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801683,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T19,278,1 ,"$10,500.00 ","$6,825.00 ","$4,557.00 ","$10,500.00 ","$7,822.50 ","$6,877.50 ", N/A ,"$5,533.50 ", N/A ,"$6,625.50 ","$6,625.50 ","$6,625.50 ","$6,625.50 ","$9,450.00 ","$7,875.00 ", N/A ,"$9,240.00 ", N/A ,"$7,875.00 ","$7,875.00 ","$8,925.00 ","$8,925.00 ", N/A ,"$8,925.00 ", N/A ,"$8,295.00 ","$8,295.00 ","$8,295.00 ","$9,450.00 ", N/A ,"$9,450.00 ", N/A ,"$10,500.00 ","$6,877.50 ", N/A ,"$4,557.00 ", N/A , N/A ,"$9,450.00 ", N/A ,"$6,625.50 ","$6,300.00 ","$9,450.00 ", N/A ,"$9,450.00 ","$9,450.00 ", N/A ,"$6,825.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801684,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T20,278,1 ,"$11,100.00 ","$7,215.00 ","$4,817.40 ","$11,100.00 ","$8,269.50 ","$7,270.50 ", N/A ,"$5,849.70 ", N/A ,"$7,004.10 ","$7,004.10 ","$7,004.10 ","$7,004.10 ","$9,990.00 ","$8,325.00 ", N/A ,"$9,768.00 ", N/A ,"$8,325.00 ","$8,325.00 ","$9,435.00 ","$9,435.00 ", N/A ,"$9,435.00 ", N/A ,"$8,769.00 ","$8,769.00 ","$8,769.00 ","$9,990.00 ", N/A ,"$9,990.00 ", N/A ,"$11,100.00 ","$7,270.50 ", N/A ,"$4,817.40 ", N/A , N/A ,"$9,990.00 ", N/A ,"$7,004.10 ","$6,660.00 ","$9,990.00 ", N/A ,"$9,990.00 ","$9,990.00 ", N/A ,"$7,215.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801685,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T21,278,1 ,"$11,700.00 ","$7,605.00 ","$5,077.80 ","$11,700.00 ","$8,716.50 ","$7,663.50 ", N/A ,"$6,165.90 ", N/A ,"$7,382.70 ","$7,382.70 ","$7,382.70 ","$7,382.70 ","$10,530.00 ","$8,775.00 ", N/A ,"$10,296.00 ", N/A ,"$8,775.00 ","$8,775.00 ","$9,945.00 ","$9,945.00 ", N/A ,"$9,945.00 ", N/A ,"$9,243.00 ","$9,243.00 ","$9,243.00 ","$10,530.00 ", N/A ,"$10,530.00 ", N/A ,"$11,700.00 ","$7,663.50 ", N/A ,"$5,077.80 ", N/A , N/A ,"$10,530.00 ", N/A ,"$7,382.70 ","$7,020.00 ","$10,530.00 ", N/A ,"$10,530.00 ","$10,530.00 ", N/A ,"$7,605.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801686,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T22,278,1 ,"$12,300.00 ","$7,995.00 ","$5,338.20 ","$12,300.00 ","$9,163.50 ","$8,056.50 ", N/A ,"$6,482.10 ", N/A ,"$7,761.30 ","$7,761.30 ","$7,761.30 ","$7,761.30 ","$11,070.00 ","$9,225.00 ", N/A ,"$10,824.00 ", N/A ,"$9,225.00 ","$9,225.00 ","$10,455.00 ","$10,455.00 ", N/A ,"$10,455.00 ", N/A ,"$9,717.00 ","$9,717.00 ","$9,717.00 ","$11,070.00 ", N/A ,"$11,070.00 ", N/A ,"$12,300.00 ","$8,056.50 ", N/A ,"$5,338.20 ", N/A , N/A ,"$11,070.00 ", N/A ,"$7,761.30 ","$7,380.00 ","$11,070.00 ", N/A ,"$11,070.00 ","$11,070.00 ", N/A ,"$7,995.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801687,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T23,278,1 ,"$12,900.00 ","$8,385.00 ","$5,598.60 ","$12,900.00 ","$9,610.50 ","$8,449.50 ", N/A ,"$6,798.30 ", N/A ,"$8,139.90 ","$8,139.90 ","$8,139.90 ","$8,139.90 ","$11,610.00 ","$9,675.00 ", N/A ,"$11,352.00 ", N/A ,"$9,675.00 ","$9,675.00 ","$10,965.00 ","$10,965.00 ", N/A ,"$10,965.00 ", N/A ,"$10,191.00 ","$10,191.00 ","$10,191.00 ","$11,610.00 ", N/A ,"$11,610.00 ", N/A ,"$12,900.00 ","$8,449.50 ", N/A ,"$5,598.60 ", N/A , N/A ,"$11,610.00 ", N/A ,"$8,139.90 ","$7,740.00 ","$11,610.00 ", N/A ,"$11,610.00 ","$11,610.00 ", N/A ,"$8,385.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801688,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T24,278,1 ,"$13,500.00 ","$8,775.00 ","$5,859.00 ","$13,500.00 ","$10,057.50 ","$8,842.50 ", N/A ,"$7,114.50 ", N/A ,"$8,518.50 ","$8,518.50 ","$8,518.50 ","$8,518.50 ","$12,150.00 ","$10,125.00 ", N/A ,"$11,880.00 ", N/A ,"$10,125.00 ","$10,125.00 ","$11,475.00 ","$11,475.00 ", N/A ,"$11,475.00 ", N/A ,"$10,665.00 ","$10,665.00 ","$10,665.00 ","$12,150.00 ", N/A ,"$12,150.00 ", N/A ,"$13,500.00 ","$8,842.50 ", N/A ,"$5,859.00 ", N/A , N/A ,"$12,150.00 ", N/A ,"$8,518.50 ","$8,100.00 ","$12,150.00 ", N/A ,"$12,150.00 ","$12,150.00 ", N/A ,"$8,775.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801689,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T25,278,1 ,"$14,100.00 ","$9,165.00 ","$6,119.40 ","$14,100.00 ","$10,504.50 ","$9,235.50 ", N/A ,"$7,430.70 ", N/A ,"$8,897.10 ","$8,897.10 ","$8,897.10 ","$8,897.10 ","$12,690.00 ","$10,575.00 ", N/A ,"$12,408.00 ", N/A ,"$10,575.00 ","$10,575.00 ","$11,985.00 ","$11,985.00 ", N/A ,"$11,985.00 ", N/A ,"$11,139.00 ","$11,139.00 ","$11,139.00 ","$12,690.00 ", N/A ,"$12,690.00 ", N/A ,"$14,100.00 ","$9,235.50 ", N/A ,"$6,119.40 ", N/A , N/A ,"$12,690.00 ", N/A ,"$8,897.10 ","$8,460.00 ","$12,690.00 ", N/A ,"$12,690.00 ","$12,690.00 ", N/A ,"$9,165.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801690,C1874,HC STENT COATED/COVERED W/DEL SYSTEM T26,278,1 ,"$14,700.00 ","$9,555.00 ","$6,379.80 ","$14,700.00 ","$10,951.50 ","$9,628.50 ", N/A ,"$7,746.90 ", N/A ,"$9,275.70 ","$9,275.70 ","$9,275.70 ","$9,275.70 ","$13,230.00 ","$11,025.00 ", N/A ,"$12,936.00 ", N/A ,"$11,025.00 ","$11,025.00 ","$12,495.00 ","$12,495.00 ", N/A ,"$12,495.00 ", N/A ,"$11,613.00 ","$11,613.00 ","$11,613.00 ","$13,230.00 ", N/A ,"$13,230.00 ", N/A ,"$14,700.00 ","$9,628.50 ", N/A ,"$6,379.80 ", N/A , N/A ,"$13,230.00 ", N/A ,"$9,275.70 ","$8,820.00 ","$13,230.00 ", N/A ,"$13,230.00 ","$13,230.00 ", N/A ,"$9,555.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801709,C1876,HC STENT NON-COATED/NON-COVERED W/DEL SYSTEM T6,278,1 ,"$5,100.00 ","$3,315.00 ","$2,213.40 ","$5,100.00 ","$3,799.50 ","$3,340.50 ", N/A ,"$2,687.70 ", N/A ,"$3,218.10 ","$3,218.10 ","$3,218.10 ","$3,218.10 ","$4,590.00 ","$3,825.00 ", N/A ,"$4,488.00 ", N/A ,"$3,825.00 ","$3,825.00 ","$4,335.00 ","$4,335.00 ", N/A ,"$4,335.00 ", N/A ,"$4,029.00 ","$4,029.00 ","$4,029.00 ","$4,590.00 ", N/A ,"$4,590.00 ", N/A ,"$5,100.00 ","$3,340.50 ", N/A ,"$2,213.40 ", N/A , N/A ,"$4,590.00 ", N/A ,"$3,218.10 ","$3,060.00 ","$4,590.00 ", N/A ,"$4,590.00 ","$4,590.00 ", N/A ,"$3,315.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801713,C1876,HC STENT NON-COATED/NON-COVERED W/DEL SYSTEM T10,278,1 ,$525.00 ,$341.25 ,$227.85 ,$525.00 ,$391.13 ,$343.88 , N/A ,$276.68 , N/A ,$331.28 ,$331.28 ,$331.28 ,$331.28 ,$472.50 ,$393.75 , N/A ,$462.00 , N/A ,$393.75 ,$393.75 ,$446.25 ,$446.25 , N/A ,$446.25 , N/A ,$414.75 ,$414.75 ,$414.75 ,$472.50 , N/A ,$472.50 , N/A ,$525.00 ,$343.88 , N/A ,$227.85 , N/A , N/A ,$472.50 , N/A ,$331.28 ,$315.00 ,$472.50 , N/A ,$472.50 ,$472.50 , N/A ,$341.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801714,C1876,HC STENT NON-COATED/NON-COVERED W/DEL SYSTEM T11,278,1 ,$600.00 ,$390.00 ,$260.40 ,$600.00 ,$447.00 ,$393.00 , N/A ,$316.20 , N/A ,$378.60 ,$378.60 ,$378.60 ,$378.60 ,$540.00 ,$450.00 , N/A ,$528.00 , N/A ,$450.00 ,$450.00 ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$474.00 ,$474.00 ,$474.00 ,$540.00 , N/A ,$540.00 , N/A ,$600.00 ,$393.00 , N/A ,$260.40 , N/A , N/A ,$540.00 , N/A ,$378.60 ,$360.00 ,$540.00 , N/A ,$540.00 ,$540.00 , N/A ,$390.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801715,C1876,HC STENT NON-COATED/NON-COVERED W/DEL SYSTEM T12,278,1 ,$750.00 ,$487.50 ,$325.50 ,$750.00 ,$558.75 ,$491.25 , N/A ,$395.25 , N/A ,$473.25 ,$473.25 ,$473.25 ,$473.25 ,$675.00 ,$562.50 , N/A ,$660.00 , N/A ,$562.50 ,$562.50 ,$637.50 ,$637.50 , N/A ,$637.50 , N/A ,$592.50 ,$592.50 ,$592.50 ,$675.00 , N/A ,$675.00 , N/A ,$750.00 ,$491.25 , N/A ,$325.50 , N/A , N/A ,$675.00 , N/A ,$473.25 ,$450.00 ,$675.00 , N/A ,$675.00 ,$675.00 , N/A ,$487.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801716,C1876,HC STENT NON-COATED/NON-COVERED W/DEL SYSTEM T13,278,1 ,$900.00 ,$585.00 ,$390.60 ,$900.00 ,$670.50 ,$589.50 , N/A ,$474.30 , N/A ,$567.90 ,$567.90 ,$567.90 ,$567.90 ,$810.00 ,$675.00 , N/A ,$792.00 , N/A ,$675.00 ,$675.00 ,$765.00 ,$765.00 , N/A ,$765.00 , N/A ,$711.00 ,$711.00 ,$711.00 ,$810.00 , N/A ,$810.00 , N/A ,$900.00 ,$589.50 , N/A ,$390.60 , N/A , N/A ,$810.00 , N/A ,$567.90 ,$540.00 ,$810.00 , N/A ,$810.00 ,$810.00 , N/A ,$585.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801717,C1876,HC STENT NON-COATED/NON-COVERED W/DEL SYSTEM T14,278,1 ,"$1,050.00 ",$682.50 ,$455.70 ,"$1,050.00 ",$782.25 ,$687.75 , N/A ,$553.35 , N/A ,$662.55 ,$662.55 ,$662.55 ,$662.55 ,$945.00 ,$787.50 , N/A ,$924.00 , N/A ,$787.50 ,$787.50 ,$892.50 ,$892.50 , N/A ,$892.50 , N/A ,$829.50 ,$829.50 ,$829.50 ,$945.00 , N/A ,$945.00 , N/A ,"$1,050.00 ",$687.75 , N/A ,$455.70 , N/A , N/A ,$945.00 , N/A ,$662.55 ,$630.00 ,$945.00 , N/A ,$945.00 ,$945.00 , N/A ,$682.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801718,C1876,HC STENT NON-COATED/NON-COVERED W/DEL SYSTEM T15,278,1 ,"$1,200.00 ",$780.00 ,$520.80 ,"$1,200.00 ",$894.00 ,$786.00 , N/A ,$632.40 , N/A ,$757.20 ,$757.20 ,$757.20 ,$757.20 ,"$1,080.00 ",$900.00 , N/A ,"$1,056.00 ", N/A ,$900.00 ,$900.00 ,"$1,020.00 ","$1,020.00 ", N/A ,"$1,020.00 ", N/A ,$948.00 ,$948.00 ,$948.00 ,"$1,080.00 ", N/A ,"$1,080.00 ", N/A ,"$1,200.00 ",$786.00 , N/A ,$520.80 , N/A , N/A ,"$1,080.00 ", N/A ,$757.20 ,$720.00 ,"$1,080.00 ", N/A ,"$1,080.00 ","$1,080.00 ", N/A ,$780.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801719,C1876,HC STENT NON-COATED/NON-COVERED W/DEL SYSTEM T16,278,1 ,"$1,350.00 ",$877.50 ,$585.90 ,"$1,350.00 ","$1,005.75 ",$884.25 , N/A ,$711.45 , N/A ,$851.85 ,$851.85 ,$851.85 ,$851.85 ,"$1,215.00 ","$1,012.50 ", N/A ,"$1,188.00 ", N/A ,"$1,012.50 ","$1,012.50 ","$1,147.50 ","$1,147.50 ", N/A ,"$1,147.50 ", N/A ,"$1,066.50 ","$1,066.50 ","$1,066.50 ","$1,215.00 ", N/A ,"$1,215.00 ", N/A ,"$1,350.00 ",$884.25 , N/A ,$585.90 , N/A , N/A ,"$1,215.00 ", N/A ,$851.85 ,$810.00 ,"$1,215.00 ", N/A ,"$1,215.00 ","$1,215.00 ", N/A ,$877.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801720,C1876,HC STENT NON-COATED/NON-COVERED W/DEL SYSTEM T17,278,1 ,"$1,500.00 ",$975.00 ,$651.00 ,"$1,500.00 ","$1,117.50 ",$982.50 , N/A ,$790.50 , N/A ,$946.50 ,$946.50 ,$946.50 ,$946.50 ,"$1,350.00 ","$1,125.00 ", N/A ,"$1,320.00 ", N/A ,"$1,125.00 ","$1,125.00 ","$1,275.00 ","$1,275.00 ", N/A ,"$1,275.00 ", N/A ,"$1,185.00 ","$1,185.00 ","$1,185.00 ","$1,350.00 ", N/A ,"$1,350.00 ", N/A ,"$1,500.00 ",$982.50 , N/A ,$651.00 , N/A , N/A ,"$1,350.00 ", N/A ,$946.50 ,$900.00 ,"$1,350.00 ", N/A ,"$1,350.00 ","$1,350.00 ", N/A ,$975.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801721,C1876,HC STENT NON-COATED/NON-COVERED W/DEL SYSTEM T18,278,1 ,"$2,100.00 ","$1,365.00 ",$911.40 ,"$2,100.00 ","$1,564.50 ","$1,375.50 ", N/A ,"$1,106.70 ", N/A ,"$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,890.00 ","$1,575.00 ", N/A ,"$1,848.00 ", N/A ,"$1,575.00 ","$1,575.00 ","$1,785.00 ","$1,785.00 ", N/A ,"$1,785.00 ", N/A ,"$1,659.00 ","$1,659.00 ","$1,659.00 ","$1,890.00 ", N/A ,"$1,890.00 ", N/A ,"$2,100.00 ","$1,375.50 ", N/A ,$911.40 , N/A , N/A ,"$1,890.00 ", N/A ,"$1,325.10 ","$1,260.00 ","$1,890.00 ", N/A ,"$1,890.00 ","$1,890.00 ", N/A ,"$1,365.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801722,C1876,HC STENT NON-COATED/NON-COVERED W/DEL SYSTEM T19,278,1 ,"$2,700.00 ","$1,755.00 ","$1,171.80 ","$2,700.00 ","$2,011.50 ","$1,768.50 ", N/A ,"$1,422.90 ", N/A ,"$1,703.70 ","$1,703.70 ","$1,703.70 ","$1,703.70 ","$2,430.00 ","$2,025.00 ", N/A ,"$2,376.00 ", N/A ,"$2,025.00 ","$2,025.00 ","$2,295.00 ","$2,295.00 ", N/A ,"$2,295.00 ", N/A ,"$2,133.00 ","$2,133.00 ","$2,133.00 ","$2,430.00 ", N/A ,"$2,430.00 ", N/A ,"$2,700.00 ","$1,768.50 ", N/A ,"$1,171.80 ", N/A , N/A ,"$2,430.00 ", N/A ,"$1,703.70 ","$1,620.00 ","$2,430.00 ", N/A ,"$2,430.00 ","$2,430.00 ", N/A ,"$1,755.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801723,C1876,HC STENT NON-COATED/NON-COVERED W/DEL SYSTEM T20,278,1 ,"$3,300.00 ","$2,145.00 ","$1,432.20 ","$3,300.00 ","$2,458.50 ","$2,161.50 ", N/A ,"$1,739.10 ", N/A ,"$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,970.00 ","$2,475.00 ", N/A ,"$2,904.00 ", N/A ,"$2,475.00 ","$2,475.00 ","$2,805.00 ","$2,805.00 ", N/A ,"$2,805.00 ", N/A ,"$2,607.00 ","$2,607.00 ","$2,607.00 ","$2,970.00 ", N/A ,"$2,970.00 ", N/A ,"$3,300.00 ","$2,161.50 ", N/A ,"$1,432.20 ", N/A , N/A ,"$2,970.00 ", N/A ,"$2,082.30 ","$1,980.00 ","$2,970.00 ", N/A ,"$2,970.00 ","$2,970.00 ", N/A ,"$2,145.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801724,C1876,HC STENT NON-COATED/NON-COVERED W/DEL SYSTEM T21,278,1 ,"$3,900.00 ","$2,535.00 ","$1,692.60 ","$3,900.00 ","$2,905.50 ","$2,554.50 ", N/A ,"$2,055.30 ", N/A ,"$2,460.90 ","$2,460.90 ","$2,460.90 ","$2,460.90 ","$3,510.00 ","$2,925.00 ", N/A ,"$3,432.00 ", N/A ,"$2,925.00 ","$2,925.00 ","$3,315.00 ","$3,315.00 ", N/A ,"$3,315.00 ", N/A ,"$3,081.00 ","$3,081.00 ","$3,081.00 ","$3,510.00 ", N/A ,"$3,510.00 ", N/A ,"$3,900.00 ","$2,554.50 ", N/A ,"$1,692.60 ", N/A , N/A ,"$3,510.00 ", N/A ,"$2,460.90 ","$2,340.00 ","$3,510.00 ", N/A ,"$3,510.00 ","$3,510.00 ", N/A ,"$2,535.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801725,C1876,HC STENT NON-COATED/NON-COVERED W/DEL SYSTEM T22,278,1 ,"$4,500.00 ","$2,925.00 ","$1,953.00 ","$4,500.00 ","$3,352.50 ","$2,947.50 ", N/A ,"$2,371.50 ", N/A ,"$2,839.50 ","$2,839.50 ","$2,839.50 ","$2,839.50 ","$4,050.00 ","$3,375.00 ", N/A ,"$3,960.00 ", N/A ,"$3,375.00 ","$3,375.00 ","$3,825.00 ","$3,825.00 ", N/A ,"$3,825.00 ", N/A ,"$3,555.00 ","$3,555.00 ","$3,555.00 ","$4,050.00 ", N/A ,"$4,050.00 ", N/A ,"$4,500.00 ","$2,947.50 ", N/A ,"$1,953.00 ", N/A , N/A ,"$4,050.00 ", N/A ,"$2,839.50 ","$2,700.00 ","$4,050.00 ", N/A ,"$4,050.00 ","$4,050.00 ", N/A ,"$2,925.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801730,C1876,HC STENT NON-COATED/NON-COVERED W/DEL SYSTEM T27,278,1 ,"$7,500.00 ","$4,875.00 ","$3,255.00 ","$7,500.00 ","$5,587.50 ","$4,912.50 ", N/A ,"$3,952.50 ", N/A ,"$4,732.50 ","$4,732.50 ","$4,732.50 ","$4,732.50 ","$6,750.00 ","$5,625.00 ", N/A ,"$6,600.00 ", N/A ,"$5,625.00 ","$5,625.00 ","$6,375.00 ","$6,375.00 ", N/A ,"$6,375.00 ", N/A ,"$5,925.00 ","$5,925.00 ","$5,925.00 ","$6,750.00 ", N/A ,"$6,750.00 ", N/A ,"$7,500.00 ","$4,912.50 ", N/A ,"$3,255.00 ", N/A , N/A ,"$6,750.00 ", N/A ,"$4,732.50 ","$4,500.00 ","$6,750.00 ", N/A ,"$6,750.00 ","$6,750.00 ", N/A ,"$4,875.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801732,C1876,HC STENT NON-COATED/NON-COVERED W/DEL SYSTEM T29,278,1 ,"$8,700.00 ","$5,655.00 ","$3,775.80 ","$8,700.00 ","$6,481.50 ","$5,698.50 ", N/A ,"$4,584.90 ", N/A ,"$5,489.70 ","$5,489.70 ","$5,489.70 ","$5,489.70 ","$7,830.00 ","$6,525.00 ", N/A ,"$7,656.00 ", N/A ,"$6,525.00 ","$6,525.00 ","$7,395.00 ","$7,395.00 ", N/A ,"$7,395.00 ", N/A ,"$6,873.00 ","$6,873.00 ","$6,873.00 ","$7,830.00 ", N/A ,"$7,830.00 ", N/A ,"$8,700.00 ","$5,698.50 ", N/A ,"$3,775.80 ", N/A , N/A ,"$7,830.00 ", N/A ,"$5,489.70 ","$5,220.00 ","$7,830.00 ", N/A ,"$7,830.00 ","$7,830.00 ", N/A ,"$5,655.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801769,C1880,HC FILTER VENA CAVA T7,278,1 ,"$3,300.00 ","$2,145.00 ","$1,432.20 ","$3,300.00 ","$2,458.50 ","$2,161.50 ", N/A ,"$1,739.10 ", N/A ,"$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,970.00 ","$2,475.00 ", N/A ,"$2,904.00 ", N/A ,"$2,475.00 ","$2,475.00 ","$2,805.00 ","$2,805.00 ", N/A ,"$2,805.00 ", N/A ,"$2,607.00 ","$2,607.00 ","$2,607.00 ","$2,970.00 ", N/A ,"$2,970.00 ", N/A ,"$3,300.00 ","$2,161.50 ", N/A ,"$1,432.20 ", N/A , N/A ,"$2,970.00 ", N/A ,"$2,082.30 ","$1,980.00 ","$2,970.00 ", N/A ,"$2,970.00 ","$2,970.00 ", N/A ,"$2,145.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801770,C1880,HC FILTER VENA CAVA T8,278,1 ,"$3,900.00 ","$2,535.00 ","$1,692.60 ","$3,900.00 ","$2,905.50 ","$2,554.50 ", N/A ,"$2,055.30 ", N/A ,"$2,460.90 ","$2,460.90 ","$2,460.90 ","$2,460.90 ","$3,510.00 ","$2,925.00 ", N/A ,"$3,432.00 ", N/A ,"$2,925.00 ","$2,925.00 ","$3,315.00 ","$3,315.00 ", N/A ,"$3,315.00 ", N/A ,"$3,081.00 ","$3,081.00 ","$3,081.00 ","$3,510.00 ", N/A ,"$3,510.00 ", N/A ,"$3,900.00 ","$2,554.50 ", N/A ,"$1,692.60 ", N/A , N/A ,"$3,510.00 ", N/A ,"$2,460.90 ","$2,340.00 ","$3,510.00 ", N/A ,"$3,510.00 ","$3,510.00 ", N/A ,"$2,535.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801816,C1895,HC LEAD ICD ENDOCARDIAL DUAL COIL T4,278,1 ,"$7,000.00 ","$4,550.00 ","$3,038.00 ","$7,000.00 ","$5,215.00 ","$4,585.00 ", N/A ,"$3,689.00 ", N/A ,"$4,417.00 ","$4,417.00 ","$4,417.00 ","$4,417.00 ","$6,300.00 ","$5,250.00 ", N/A ,"$6,160.00 ", N/A ,"$5,250.00 ","$5,250.00 ","$5,950.00 ","$5,950.00 ", N/A ,"$5,950.00 ", N/A ,"$5,530.00 ","$5,530.00 ","$5,530.00 ","$6,300.00 ", N/A ,"$6,300.00 ", N/A ,"$7,000.00 ","$4,585.00 ", N/A ,"$3,038.00 ", N/A , N/A ,"$6,300.00 ", N/A ,"$4,417.00 ","$4,200.00 ","$6,300.00 ", N/A ,"$6,300.00 ","$6,300.00 ", N/A ,"$4,550.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801972,C1898,HC LEAD PACEMAKER NON TRANSVENOUS SINGLE PASS T6,278,1 ,"$1,200.00 ",$780.00 ,$520.80 ,"$1,200.00 ",$894.00 ,$786.00 , N/A ,$632.40 , N/A ,$757.20 ,$757.20 ,$757.20 ,$757.20 ,"$1,080.00 ",$900.00 , N/A ,"$1,056.00 ", N/A ,$900.00 ,$900.00 ,"$1,020.00 ","$1,020.00 ", N/A ,"$1,020.00 ", N/A ,$948.00 ,$948.00 ,$948.00 ,"$1,080.00 ", N/A ,"$1,080.00 ", N/A ,"$1,200.00 ",$786.00 , N/A ,$520.80 , N/A , N/A ,"$1,080.00 ", N/A ,$757.20 ,$720.00 ,"$1,080.00 ", N/A ,"$1,080.00 ","$1,080.00 ", N/A ,$780.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801973,C1898,HC LEAD PACEMAKER NON TRANSVENOUS SINGLE PASS T7,278,1 ,"$1,350.00 ",$877.50 ,$585.90 ,"$1,350.00 ","$1,005.75 ",$884.25 , N/A ,$711.45 , N/A ,$851.85 ,$851.85 ,$851.85 ,$851.85 ,"$1,215.00 ","$1,012.50 ", N/A ,"$1,188.00 ", N/A ,"$1,012.50 ","$1,012.50 ","$1,147.50 ","$1,147.50 ", N/A ,"$1,147.50 ", N/A ,"$1,066.50 ","$1,066.50 ","$1,066.50 ","$1,215.00 ", N/A ,"$1,215.00 ", N/A ,"$1,350.00 ",$884.25 , N/A ,$585.90 , N/A , N/A ,"$1,215.00 ", N/A ,$851.85 ,$810.00 ,"$1,215.00 ", N/A ,"$1,215.00 ","$1,215.00 ", N/A ,$877.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801974,C1898,HC LEAD PACEMAKER NON TRANSVENOUS SINGLE PASS T8,278,1 ,"$1,500.00 ",$975.00 ,$651.00 ,"$1,500.00 ","$1,117.50 ",$982.50 , N/A ,$790.50 , N/A ,$946.50 ,$946.50 ,$946.50 ,$946.50 ,"$1,350.00 ","$1,125.00 ", N/A ,"$1,320.00 ", N/A ,"$1,125.00 ","$1,125.00 ","$1,275.00 ","$1,275.00 ", N/A ,"$1,275.00 ", N/A ,"$1,185.00 ","$1,185.00 ","$1,185.00 ","$1,350.00 ", N/A ,"$1,350.00 ", N/A ,"$1,500.00 ",$982.50 , N/A ,$651.00 , N/A , N/A ,"$1,350.00 ", N/A ,$946.50 ,$900.00 ,"$1,350.00 ", N/A ,"$1,350.00 ","$1,350.00 ", N/A ,$975.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801975,C1898,HC LEAD PACEMAKER NON TRANSVENOUS SINGLE PASS T9,278,1 ,"$2,100.00 ","$1,365.00 ",$911.40 ,"$2,100.00 ","$1,564.50 ","$1,375.50 ", N/A ,"$1,106.70 ", N/A ,"$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,890.00 ","$1,575.00 ", N/A ,"$1,848.00 ", N/A ,"$1,575.00 ","$1,575.00 ","$1,785.00 ","$1,785.00 ", N/A ,"$1,785.00 ", N/A ,"$1,659.00 ","$1,659.00 ","$1,659.00 ","$1,890.00 ", N/A ,"$1,890.00 ", N/A ,"$2,100.00 ","$1,375.50 ", N/A ,$911.40 , N/A , N/A ,"$1,890.00 ", N/A ,"$1,325.10 ","$1,260.00 ","$1,890.00 ", N/A ,"$1,890.00 ","$1,890.00 ", N/A ,"$1,365.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801976,C1898,HC LEAD PACEMAKER NON TRANSVENOUS SINGLE PASS T10,278,1 ,"$2,700.00 ","$1,755.00 ","$1,171.80 ","$2,700.00 ","$2,011.50 ","$1,768.50 ", N/A ,"$1,422.90 ", N/A ,"$1,703.70 ","$1,703.70 ","$1,703.70 ","$1,703.70 ","$2,430.00 ","$2,025.00 ", N/A ,"$2,376.00 ", N/A ,"$2,025.00 ","$2,025.00 ","$2,295.00 ","$2,295.00 ", N/A ,"$2,295.00 ", N/A ,"$2,133.00 ","$2,133.00 ","$2,133.00 ","$2,430.00 ", N/A ,"$2,430.00 ", N/A ,"$2,700.00 ","$1,768.50 ", N/A ,"$1,171.80 ", N/A , N/A ,"$2,430.00 ", N/A ,"$1,703.70 ","$1,620.00 ","$2,430.00 ", N/A ,"$2,430.00 ","$2,430.00 ", N/A ,"$1,755.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27801987,C1900,HC LEAD VENTRICULAR CORONARY VENOUS T1,278,1 ,"$1,350.00 ",$877.50 ,$585.90 ,"$1,350.00 ","$1,005.75 ",$884.25 , N/A ,$711.45 , N/A ,$851.85 ,$851.85 ,$851.85 ,$851.85 ,"$1,215.00 ","$1,012.50 ", N/A ,"$1,188.00 ", N/A ,"$1,012.50 ","$1,012.50 ","$1,147.50 ","$1,147.50 ", N/A ,"$1,147.50 ", N/A ,"$1,066.50 ","$1,066.50 ","$1,066.50 ","$1,215.00 ", N/A ,"$1,215.00 ", N/A ,"$1,350.00 ",$884.25 , N/A ,$585.90 , N/A , N/A ,"$1,215.00 ", N/A ,$851.85 ,$810.00 ,"$1,215.00 ", N/A ,"$1,215.00 ","$1,215.00 ", N/A ,$877.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802016,N/A,HC IMPLANT SURGICAL T1,278,1 ,$10.00 ,$6.50 ,$4.34 ,$10.00 ,$7.45 ,$6.55 , N/A ,$5.27 , N/A ,$6.31 ,$6.31 ,$6.31 ,$6.31 ,$9.00 ,$7.50 , N/A ,$8.80 , N/A ,$7.50 ,$7.50 ,$8.50 ,$8.50 , N/A ,$8.50 , N/A ,$7.90 ,$7.90 ,$7.90 ,$9.00 , N/A ,$9.00 , N/A ,$10.00 ,$6.55 , N/A ,$4.34 , N/A , N/A ,$9.00 , N/A ,$6.31 ,$6.00 ,$9.00 , N/A ,$9.00 ,$9.00 , N/A ,$6.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802017,N/A,HC IMPLANT SURGICAL T2,278,1 ,$20.00 ,$13.00 ,$8.68 ,$20.00 ,$14.90 ,$13.10 , N/A ,$10.54 , N/A ,$12.62 ,$12.62 ,$12.62 ,$12.62 ,$18.00 ,$15.00 , N/A ,$17.60 , N/A ,$15.00 ,$15.00 ,$17.00 ,$17.00 , N/A ,$17.00 , N/A ,$15.80 ,$15.80 ,$15.80 ,$18.00 , N/A ,$18.00 , N/A ,$20.00 ,$13.10 , N/A ,$8.68 , N/A , N/A ,$18.00 , N/A ,$12.62 ,$12.00 ,$18.00 , N/A ,$18.00 ,$18.00 , N/A ,$13.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802018,N/A,HC IMPLANT SURGICAL T3,278,1 ,$30.00 ,$19.50 ,$13.02 ,$30.00 ,$22.35 ,$19.65 , N/A ,$15.81 , N/A ,$18.93 ,$18.93 ,$18.93 ,$18.93 ,$27.00 ,$22.50 , N/A ,$26.40 , N/A ,$22.50 ,$22.50 ,$25.50 ,$25.50 , N/A ,$25.50 , N/A ,$23.70 ,$23.70 ,$23.70 ,$27.00 , N/A ,$27.00 , N/A ,$30.00 ,$19.65 , N/A ,$13.02 , N/A , N/A ,$27.00 , N/A ,$18.93 ,$18.00 ,$27.00 , N/A ,$27.00 ,$27.00 , N/A ,$19.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802019,N/A,HC IMPLANT SURGICAL T4,278,1 ,$75.00 ,$48.75 ,$32.55 ,$75.00 ,$55.88 ,$49.13 , N/A ,$39.53 , N/A ,$47.33 ,$47.33 ,$47.33 ,$47.33 ,$67.50 ,$56.25 , N/A ,$66.00 , N/A ,$56.25 ,$56.25 ,$63.75 ,$63.75 , N/A ,$63.75 , N/A ,$59.25 ,$59.25 ,$59.25 ,$67.50 , N/A ,$67.50 , N/A ,$75.00 ,$49.13 , N/A ,$32.55 , N/A , N/A ,$67.50 , N/A ,$47.33 ,$45.00 ,$67.50 , N/A ,$67.50 ,$67.50 , N/A ,$48.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802020,N/A,HC IMPLANT SURGICAL T5,278,1 ,$150.00 ,$97.50 ,$65.10 ,$150.00 ,$111.75 ,$98.25 , N/A ,$79.05 , N/A ,$94.65 ,$94.65 ,$94.65 ,$94.65 ,$135.00 ,$112.50 , N/A ,$132.00 , N/A ,$112.50 ,$112.50 ,$127.50 ,$127.50 , N/A ,$127.50 , N/A ,$118.50 ,$118.50 ,$118.50 ,$135.00 , N/A ,$135.00 , N/A ,$150.00 ,$98.25 , N/A ,$65.10 , N/A , N/A ,$135.00 , N/A ,$94.65 ,$90.00 ,$135.00 , N/A ,$135.00 ,$135.00 , N/A ,$97.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802021,N/A,HC IMPLANT SURGICAL T6,278,1 ,$225.00 ,$146.25 ,$97.65 ,$225.00 ,$167.63 ,$147.38 , N/A ,$118.58 , N/A ,$141.98 ,$141.98 ,$141.98 ,$141.98 ,$202.50 ,$168.75 , N/A ,$198.00 , N/A ,$168.75 ,$168.75 ,$191.25 ,$191.25 , N/A ,$191.25 , N/A ,$177.75 ,$177.75 ,$177.75 ,$202.50 , N/A ,$202.50 , N/A ,$225.00 ,$147.38 , N/A ,$97.65 , N/A , N/A ,$202.50 , N/A ,$141.98 ,$135.00 ,$202.50 , N/A ,$202.50 ,$202.50 , N/A ,$146.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802022,N/A,HC IMPLANT SURGICAL T7,278,1 ,$300.00 ,$195.00 ,$130.20 ,$300.00 ,$223.50 ,$196.50 , N/A ,$158.10 , N/A ,$189.30 ,$189.30 ,$189.30 ,$189.30 ,$270.00 ,$225.00 , N/A ,$264.00 , N/A ,$225.00 ,$225.00 ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$237.00 ,$237.00 ,$237.00 ,$270.00 , N/A ,$270.00 , N/A ,$300.00 ,$196.50 , N/A ,$130.20 , N/A , N/A ,$270.00 , N/A ,$189.30 ,$180.00 ,$270.00 , N/A ,$270.00 ,$270.00 , N/A ,$195.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802023,N/A,HC IMPLANT SURGICAL T8,278,1 ,$375.00 ,$243.75 ,$162.75 ,$375.00 ,$279.38 ,$245.63 , N/A ,$197.63 , N/A ,$236.63 ,$236.63 ,$236.63 ,$236.63 ,$337.50 ,$281.25 , N/A ,$330.00 , N/A ,$281.25 ,$281.25 ,$318.75 ,$318.75 , N/A ,$318.75 , N/A ,$296.25 ,$296.25 ,$296.25 ,$337.50 , N/A ,$337.50 , N/A ,$375.00 ,$245.63 , N/A ,$162.75 , N/A , N/A ,$337.50 , N/A ,$236.63 ,$225.00 ,$337.50 , N/A ,$337.50 ,$337.50 , N/A ,$243.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802024,N/A,HC IMPLANT SURGICAL T9,278,1 ,$450.00 ,$292.50 ,$195.30 ,$450.00 ,$335.25 ,$294.75 , N/A ,$237.15 , N/A ,$283.95 ,$283.95 ,$283.95 ,$283.95 ,$405.00 ,$337.50 , N/A ,$396.00 , N/A ,$337.50 ,$337.50 ,$382.50 ,$382.50 , N/A ,$382.50 , N/A ,$355.50 ,$355.50 ,$355.50 ,$405.00 , N/A ,$405.00 , N/A ,$450.00 ,$294.75 , N/A ,$195.30 , N/A , N/A ,$405.00 , N/A ,$283.95 ,$270.00 ,$405.00 , N/A ,$405.00 ,$405.00 , N/A ,$292.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802025,N/A,HC IMPLANT SURGICAL T10,278,1 ,$525.00 ,$341.25 ,$227.85 ,$525.00 ,$391.13 ,$343.88 , N/A ,$276.68 , N/A ,$331.28 ,$331.28 ,$331.28 ,$331.28 ,$472.50 ,$393.75 , N/A ,$462.00 , N/A ,$393.75 ,$393.75 ,$446.25 ,$446.25 , N/A ,$446.25 , N/A ,$414.75 ,$414.75 ,$414.75 ,$472.50 , N/A ,$472.50 , N/A ,$525.00 ,$343.88 , N/A ,$227.85 , N/A , N/A ,$472.50 , N/A ,$331.28 ,$315.00 ,$472.50 , N/A ,$472.50 ,$472.50 , N/A ,$341.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802026,N/A,HC IMPLANT SURGICAL T11,278,1 ,$600.00 ,$390.00 ,$260.40 ,$600.00 ,$447.00 ,$393.00 , N/A ,$316.20 , N/A ,$378.60 ,$378.60 ,$378.60 ,$378.60 ,$540.00 ,$450.00 , N/A ,$528.00 , N/A ,$450.00 ,$450.00 ,$510.00 ,$510.00 , N/A ,$510.00 , N/A ,$474.00 ,$474.00 ,$474.00 ,$540.00 , N/A ,$540.00 , N/A ,$600.00 ,$393.00 , N/A ,$260.40 , N/A , N/A ,$540.00 , N/A ,$378.60 ,$360.00 ,$540.00 , N/A ,$540.00 ,$540.00 , N/A ,$390.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802027,N/A,HC IMPLANT SURGICAL T12,278,1 ,$750.00 ,$487.50 ,$325.50 ,$750.00 ,$558.75 ,$491.25 , N/A ,$395.25 , N/A ,$473.25 ,$473.25 ,$473.25 ,$473.25 ,$675.00 ,$562.50 , N/A ,$660.00 , N/A ,$562.50 ,$562.50 ,$637.50 ,$637.50 , N/A ,$637.50 , N/A ,$592.50 ,$592.50 ,$592.50 ,$675.00 , N/A ,$675.00 , N/A ,$750.00 ,$491.25 , N/A ,$325.50 , N/A , N/A ,$675.00 , N/A ,$473.25 ,$450.00 ,$675.00 , N/A ,$675.00 ,$675.00 , N/A ,$487.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802028,N/A,HC IMPLANT SURGICAL T13,278,1 ,$900.00 ,$585.00 ,$390.60 ,$900.00 ,$670.50 ,$589.50 , N/A ,$474.30 , N/A ,$567.90 ,$567.90 ,$567.90 ,$567.90 ,$810.00 ,$675.00 , N/A ,$792.00 , N/A ,$675.00 ,$675.00 ,$765.00 ,$765.00 , N/A ,$765.00 , N/A ,$711.00 ,$711.00 ,$711.00 ,$810.00 , N/A ,$810.00 , N/A ,$900.00 ,$589.50 , N/A ,$390.60 , N/A , N/A ,$810.00 , N/A ,$567.90 ,$540.00 ,$810.00 , N/A ,$810.00 ,$810.00 , N/A ,$585.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802029,N/A,HC IMPLANT SURGICAL T14,278,1 ,"$1,050.00 ",$682.50 ,$455.70 ,"$1,050.00 ",$782.25 ,$687.75 , N/A ,$553.35 , N/A ,$662.55 ,$662.55 ,$662.55 ,$662.55 ,$945.00 ,$787.50 , N/A ,$924.00 , N/A ,$787.50 ,$787.50 ,$892.50 ,$892.50 , N/A ,$892.50 , N/A ,$829.50 ,$829.50 ,$829.50 ,$945.00 , N/A ,$945.00 , N/A ,"$1,050.00 ",$687.75 , N/A ,$455.70 , N/A , N/A ,$945.00 , N/A ,$662.55 ,$630.00 ,$945.00 , N/A ,$945.00 ,$945.00 , N/A ,$682.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802030,N/A,HC IMPLANT SURGICAL T15,278,1 ,"$1,200.00 ",$780.00 ,$520.80 ,"$1,200.00 ",$894.00 ,$786.00 , N/A ,$632.40 , N/A ,$757.20 ,$757.20 ,$757.20 ,$757.20 ,"$1,080.00 ",$900.00 , N/A ,"$1,056.00 ", N/A ,$900.00 ,$900.00 ,"$1,020.00 ","$1,020.00 ", N/A ,"$1,020.00 ", N/A ,$948.00 ,$948.00 ,$948.00 ,"$1,080.00 ", N/A ,"$1,080.00 ", N/A ,"$1,200.00 ",$786.00 , N/A ,$520.80 , N/A , N/A ,"$1,080.00 ", N/A ,$757.20 ,$720.00 ,"$1,080.00 ", N/A ,"$1,080.00 ","$1,080.00 ", N/A ,$780.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802031,N/A,HC IMPLANT SURGICAL T16,278,1 ,"$1,350.00 ",$877.50 ,$585.90 ,"$1,350.00 ","$1,005.75 ",$884.25 , N/A ,$711.45 , N/A ,$851.85 ,$851.85 ,$851.85 ,$851.85 ,"$1,215.00 ","$1,012.50 ", N/A ,"$1,188.00 ", N/A ,"$1,012.50 ","$1,012.50 ","$1,147.50 ","$1,147.50 ", N/A ,"$1,147.50 ", N/A ,"$1,066.50 ","$1,066.50 ","$1,066.50 ","$1,215.00 ", N/A ,"$1,215.00 ", N/A ,"$1,350.00 ",$884.25 , N/A ,$585.90 , N/A , N/A ,"$1,215.00 ", N/A ,$851.85 ,$810.00 ,"$1,215.00 ", N/A ,"$1,215.00 ","$1,215.00 ", N/A ,$877.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802032,N/A,HC IMPLANT SURGICAL T17,278,1 ,"$1,500.00 ",$975.00 ,$651.00 ,"$1,500.00 ","$1,117.50 ",$982.50 , N/A ,$790.50 , N/A ,$946.50 ,$946.50 ,$946.50 ,$946.50 ,"$1,350.00 ","$1,125.00 ", N/A ,"$1,320.00 ", N/A ,"$1,125.00 ","$1,125.00 ","$1,275.00 ","$1,275.00 ", N/A ,"$1,275.00 ", N/A ,"$1,185.00 ","$1,185.00 ","$1,185.00 ","$1,350.00 ", N/A ,"$1,350.00 ", N/A ,"$1,500.00 ",$982.50 , N/A ,$651.00 , N/A , N/A ,"$1,350.00 ", N/A ,$946.50 ,$900.00 ,"$1,350.00 ", N/A ,"$1,350.00 ","$1,350.00 ", N/A ,$975.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802033,N/A,HC IMPLANT SURGICAL T18,278,1 ,"$2,100.00 ","$1,365.00 ",$911.40 ,"$2,100.00 ","$1,564.50 ","$1,375.50 ", N/A ,"$1,106.70 ", N/A ,"$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,325.10 ","$1,890.00 ","$1,575.00 ", N/A ,"$1,848.00 ", N/A ,"$1,575.00 ","$1,575.00 ","$1,785.00 ","$1,785.00 ", N/A ,"$1,785.00 ", N/A ,"$1,659.00 ","$1,659.00 ","$1,659.00 ","$1,890.00 ", N/A ,"$1,890.00 ", N/A ,"$2,100.00 ","$1,375.50 ", N/A ,$911.40 , N/A , N/A ,"$1,890.00 ", N/A ,"$1,325.10 ","$1,260.00 ","$1,890.00 ", N/A ,"$1,890.00 ","$1,890.00 ", N/A ,"$1,365.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802034,N/A,HC IMPLANT SURGICAL T19,278,1 ,"$2,700.00 ","$1,755.00 ","$1,171.80 ","$2,700.00 ","$2,011.50 ","$1,768.50 ", N/A ,"$1,422.90 ", N/A ,"$1,703.70 ","$1,703.70 ","$1,703.70 ","$1,703.70 ","$2,430.00 ","$2,025.00 ", N/A ,"$2,376.00 ", N/A ,"$2,025.00 ","$2,025.00 ","$2,295.00 ","$2,295.00 ", N/A ,"$2,295.00 ", N/A ,"$2,133.00 ","$2,133.00 ","$2,133.00 ","$2,430.00 ", N/A ,"$2,430.00 ", N/A ,"$2,700.00 ","$1,768.50 ", N/A ,"$1,171.80 ", N/A , N/A ,"$2,430.00 ", N/A ,"$1,703.70 ","$1,620.00 ","$2,430.00 ", N/A ,"$2,430.00 ","$2,430.00 ", N/A ,"$1,755.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802035,N/A,HC IMPLANT SURGICAL T20,278,1 ,"$3,300.00 ","$2,145.00 ","$1,432.20 ","$3,300.00 ","$2,458.50 ","$2,161.50 ", N/A ,"$1,739.10 ", N/A ,"$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,082.30 ","$2,970.00 ","$2,475.00 ", N/A ,"$2,904.00 ", N/A ,"$2,475.00 ","$2,475.00 ","$2,805.00 ","$2,805.00 ", N/A ,"$2,805.00 ", N/A ,"$2,607.00 ","$2,607.00 ","$2,607.00 ","$2,970.00 ", N/A ,"$2,970.00 ", N/A ,"$3,300.00 ","$2,161.50 ", N/A ,"$1,432.20 ", N/A , N/A ,"$2,970.00 ", N/A ,"$2,082.30 ","$1,980.00 ","$2,970.00 ", N/A ,"$2,970.00 ","$2,970.00 ", N/A ,"$2,145.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802104,C2623,HC CATHETER TRANS ANGIO DRUG COATED NON-LASER T1,278,1 ,"$5,100.00 ","$3,315.00 ","$2,213.40 ","$5,100.00 ","$3,799.50 ","$3,340.50 ", N/A ,"$2,687.70 ", N/A ,"$3,218.10 ","$3,218.10 ","$3,218.10 ","$3,218.10 ","$4,590.00 ","$3,825.00 ", N/A ,"$4,488.00 ", N/A ,"$3,825.00 ","$3,825.00 ","$4,335.00 ","$4,335.00 ", N/A ,"$4,335.00 ", N/A ,"$4,029.00 ","$4,029.00 ","$4,029.00 ","$4,590.00 ", N/A ,"$4,590.00 ", N/A ,"$5,100.00 ","$3,340.50 ", N/A ,"$2,213.40 ", N/A , N/A ,"$4,590.00 ", N/A ,"$3,218.10 ","$3,060.00 ","$4,590.00 ", N/A ,"$4,590.00 ","$4,590.00 ", N/A ,"$3,315.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802105,C2623,HC CATHETER TRANS ANGIO DRUG COATED NON-LASER T2,278,1 ,"$5,700.00 ","$3,705.00 ","$2,473.80 ","$5,700.00 ","$4,246.50 ","$3,733.50 ", N/A ,"$3,003.90 ", N/A ,"$3,596.70 ","$3,596.70 ","$3,596.70 ","$3,596.70 ","$5,130.00 ","$4,275.00 ", N/A ,"$5,016.00 ", N/A ,"$4,275.00 ","$4,275.00 ","$4,845.00 ","$4,845.00 ", N/A ,"$4,845.00 ", N/A ,"$4,503.00 ","$4,503.00 ","$4,503.00 ","$5,130.00 ", N/A ,"$5,130.00 ", N/A ,"$5,700.00 ","$3,733.50 ", N/A ,"$2,473.80 ", N/A , N/A ,"$5,130.00 ", N/A ,"$3,596.70 ","$3,420.00 ","$5,130.00 ", N/A ,"$5,130.00 ","$5,130.00 ", N/A ,"$3,705.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802106,C2623,HC CATHETER TRANS ANGIO DRUG COATED NON-LASER T3,278,1 ,"$6,300.00 ","$4,095.00 ","$2,734.20 ","$6,300.00 ","$4,693.50 ","$4,126.50 ", N/A ,"$3,320.10 ", N/A ,"$3,975.30 ","$3,975.30 ","$3,975.30 ","$3,975.30 ","$5,670.00 ","$4,725.00 ", N/A ,"$5,544.00 ", N/A ,"$4,725.00 ","$4,725.00 ","$5,355.00 ","$5,355.00 ", N/A ,"$5,355.00 ", N/A ,"$4,977.00 ","$4,977.00 ","$4,977.00 ","$5,670.00 ", N/A ,"$5,670.00 ", N/A ,"$6,300.00 ","$4,126.50 ", N/A ,"$2,734.20 ", N/A , N/A ,"$5,670.00 ", N/A ,"$3,975.30 ","$3,780.00 ","$5,670.00 ", N/A ,"$5,670.00 ","$5,670.00 ", N/A ,"$4,095.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802124,C1788,HC PORT VASCULAR ACCESS,278,1 ,"$1,500.00 ",$975.00 ,$651.00 ,"$1,500.00 ","$1,117.50 ",$982.50 , N/A ,$790.50 , N/A ,$946.50 ,$946.50 ,$946.50 ,$946.50 ,"$1,350.00 ","$1,125.00 ", N/A ,"$1,320.00 ", N/A ,"$1,125.00 ","$1,125.00 ","$1,275.00 ","$1,275.00 ", N/A ,"$1,275.00 ", N/A ,"$1,185.00 ","$1,185.00 ","$1,185.00 ","$1,350.00 ", N/A ,"$1,350.00 ", N/A ,"$1,500.00 ",$982.50 , N/A ,$651.00 , N/A , N/A ,"$1,350.00 ", N/A ,$946.50 ,$900.00 ,"$1,350.00 ", N/A ,"$1,350.00 ","$1,350.00 ", N/A ,$975.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802153,C2617,HC STENT NONCORONARY TEMPORARY W/O DELIVERY SYSTEM T1,278,1 ,$375.00 ,$243.75 ,$162.75 ,$375.00 ,$279.38 ,$245.63 , N/A ,$197.63 , N/A ,$236.63 ,$236.63 ,$236.63 ,$236.63 ,$337.50 ,$281.25 , N/A ,$330.00 , N/A ,$281.25 ,$281.25 ,$318.75 ,$318.75 , N/A ,$318.75 , N/A ,$296.25 ,$296.25 ,$296.25 ,$337.50 , N/A ,$337.50 , N/A ,$375.00 ,$245.63 , N/A ,$162.75 , N/A , N/A ,$337.50 , N/A ,$236.63 ,$225.00 ,$337.50 , N/A ,$337.50 ,$337.50 , N/A ,$243.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802157,C2617,HC STENT NONCORONARY TEMPORARY W/O DELIVERY SYSTEM T2,278,1 ,$450.00 ,$292.50 ,$195.30 ,$450.00 ,$335.25 ,$294.75 , N/A ,$237.15 , N/A ,$283.95 ,$283.95 ,$283.95 ,$283.95 ,$405.00 ,$337.50 , N/A ,$396.00 , N/A ,$337.50 ,$337.50 ,$382.50 ,$382.50 , N/A ,$382.50 , N/A ,$355.50 ,$355.50 ,$355.50 ,$405.00 , N/A ,$405.00 , N/A ,$450.00 ,$294.75 , N/A ,$195.30 , N/A , N/A ,$405.00 , N/A ,$283.95 ,$270.00 ,$405.00 , N/A ,$405.00 ,$405.00 , N/A ,$292.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27802158,C2617,HC STENT NONCORONARY TEMPORARY W/O DELIVERY SYSTEM T3,278,1 ,$525.00 ,$341.25 ,$227.85 ,$525.00 ,$391.13 ,$343.88 , N/A ,$276.68 , N/A ,$331.28 ,$331.28 ,$331.28 ,$331.28 ,$472.50 ,$393.75 , N/A ,$462.00 , N/A ,$393.75 ,$393.75 ,$446.25 ,$446.25 , N/A ,$446.25 , N/A ,$414.75 ,$414.75 ,$414.75 ,$472.50 , N/A ,$472.50 , N/A ,$525.00 ,$343.88 , N/A ,$227.85 , N/A , N/A ,$472.50 , N/A ,$331.28 ,$315.00 ,$472.50 , N/A ,$472.50 ,$472.50 , N/A ,$341.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27864122,Q4122,HC DERMACELL PER SQ CM,278,1 ,"$14,700.00 ","$9,555.00 ","$6,379.80 ","$14,700.00 ","$10,951.50 ","$9,628.50 ", N/A ,"$7,746.90 ", N/A ,"$9,275.70 ","$9,275.70 ","$9,275.70 ","$9,275.70 ","$13,230.00 ","$11,025.00 ", N/A ,"$12,936.00 ", N/A ,"$11,025.00 ","$11,025.00 ","$12,495.00 ","$12,495.00 ", N/A ,"$12,495.00 ", N/A ,"$11,613.00 ","$11,613.00 ","$11,613.00 ","$13,230.00 ", N/A ,"$13,230.00 ", N/A ,"$14,700.00 ","$9,628.50 ", N/A ,"$6,379.80 ", N/A , N/A ,"$13,230.00 ", N/A ,"$9,275.70 ","$8,820.00 ","$13,230.00 ", N/A ,"$13,230.00 ","$13,230.00 ", N/A ,"$9,555.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27871767,C1767,"HC GENERATOR, NEUROSTIMULATOR (IMPLANTABLE), NON-RECHARGEABLE",278,1 ,"$32,250.00 ","$20,962.50 ","$13,996.50 ","$32,250.00 ","$24,026.25 ","$21,123.75 ", N/A ,"$16,995.75 ", N/A ,"$20,349.75 ","$20,349.75 ","$20,349.75 ","$20,349.75 ","$29,025.00 ","$24,187.50 ", N/A ,"$28,380.00 ", N/A ,"$24,187.50 ","$24,187.50 ","$27,412.50 ","$27,412.50 ", N/A ,"$27,412.50 ", N/A ,"$25,477.50 ","$25,477.50 ","$25,477.50 ","$29,025.00 ", N/A ,"$29,025.00 ", N/A ,"$32,250.00 ","$21,123.75 ", N/A ,"$13,996.50 ", N/A , N/A ,"$29,025.00 ", N/A ,"$20,349.75 ","$19,350.00 ","$29,025.00 ", N/A ,"$29,025.00 ","$29,025.00 ", N/A ,"$20,962.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27871778,C1778,HC LEAD NEUROSTIMULATOR (IMPLANTABLE),278,1 ,"$3,506.25 ","$2,279.06 ","$1,521.71 ","$3,506.25 ","$2,612.16 ","$2,296.59 ", N/A ,"$1,847.79 ", N/A ,"$2,212.44 ","$2,212.44 ","$2,212.44 ","$2,212.44 ","$3,155.63 ","$2,629.69 ", N/A ,"$3,085.50 ", N/A ,"$2,629.69 ","$2,629.69 ","$2,980.31 ","$2,980.31 ", N/A ,"$2,980.31 ", N/A ,"$2,769.94 ","$2,769.94 ","$2,769.94 ","$3,155.63 ", N/A ,"$3,155.63 ", N/A ,"$3,506.25 ","$2,296.59 ", N/A ,"$1,521.71 ", N/A , N/A ,"$3,155.63 ", N/A ,"$2,212.44 ","$2,103.75 ","$3,155.63 ", N/A ,"$3,155.63 ","$3,155.63 ", N/A ,"$2,279.06 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),27871787,C1787,HC PATIENT PROGRAMMER NEUROSTIMULATOR,278,1 ,"$2,700.00 ","$1,755.00 ","$1,171.80 ","$2,700.00 ","$2,011.50 ","$1,768.50 ", N/A ,"$1,422.90 ", N/A ,"$1,703.70 ","$1,703.70 ","$1,703.70 ","$1,703.70 ","$2,430.00 ","$2,025.00 ", N/A ,"$2,376.00 ", N/A ,"$2,025.00 ","$2,025.00 ","$2,295.00 ","$2,295.00 ", N/A ,"$2,295.00 ", N/A ,"$2,133.00 ","$2,133.00 ","$2,133.00 ","$2,430.00 ", N/A ,"$2,430.00 ", N/A ,"$2,700.00 ","$1,768.50 ", N/A ,"$1,171.80 ", N/A , N/A ,"$2,430.00 ", N/A ,"$1,703.70 ","$1,620.00 ","$2,430.00 ", N/A ,"$2,430.00 ","$2,430.00 ", N/A ,"$1,755.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30000009,36416,HC CAPILLARY COLLECTION,300,1 ,$7.00 ,$4.55 ,$3.04 ,$7.00 ,$5.22 ,$4.59 , N/A ,$3.69 , N/A ,$4.42 ,$4.42 ,$4.42 ,$4.42 ,$6.30 ,$5.25 , N/A ,$6.16 , N/A ,$5.25 ,$5.25 ,$5.95 ,$5.95 , N/A ,$5.95 , N/A ,$5.53 ,$5.53 ,$5.53 ,$6.30 , N/A ,$6.30 , N/A ,$7.00 ,$4.59 , N/A ,$3.04 , N/A , N/A ,$6.30 , N/A ,$4.42 ,$4.20 ,$6.30 , N/A ,$6.30 ,$6.30 , N/A ,$4.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30000010,36415,HC VENIPUNCTURE,300,1 ,$27.00 ,$17.55 ,$3.00 ,$27.00 ,$20.12 ,$17.69 ,$3.00 ,$14.23 ,$3.00 ,$17.04 ,$17.04 ,$17.04 ,$17.04 ,$24.30 ,$20.25 ,$3.00 ,$23.76 ,$3.00 ,$20.25 , N/A , N/A , N/A ,$3.00 , N/A ,$3.00 ,$21.33 ,$21.33 ,$21.33 ,$24.30 ,$7.50 ,$24.30 ,$3.00 ,$3.00 ,$17.69 ,$3.00 ,$11.72 , N/A ,$3.15 ,$24.30 ,$6.75 ,$17.04 ,$16.20 ,$24.30 ,$3.00 ,$24.30 ,$24.30 ,$3.00 ,$17.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30000016,36592,HC COLLECT BLD CENTRL/PERPH CATH,300,1 ,$140.00 ,$91.00 ,$60.76 ,$239.09 ,$104.30 ,$91.70 ,$106.26 ,$73.78 ,$106.26 ,$88.34 ,$88.34 ,$88.34 ,$88.34 ,$126.00 ,$105.00 ,$106.26 ,$123.20 ,$106.26 ,$105.00 ,$105.00 ,$119.00 ,$119.00 ,$106.26 ,$119.00 ,$106.26 ,$110.60 ,$110.60 ,$110.60 ,$126.00 ,$140.00 ,$126.00 ,$106.26 ,$140.00 ,$91.70 ,$106.26 ,$60.76 , N/A ,$111.57 ,$126.00 ,$239.09 ,$88.34 ,$84.00 ,$126.00 ,$106.26 ,$126.00 ,$126.00 ,$106.26 ,$91.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30000213,36591,HC COLLECT BLOOD PORT/ACCESS DVC,300,1 ,$205.00 ,$133.25 ,$88.97 ,$239.09 ,$152.73 ,$134.28 ,$106.26 ,$108.04 ,$106.26 ,$129.36 ,$129.36 ,$129.36 ,$129.36 ,$184.50 ,$153.75 ,$106.26 ,$180.40 ,$106.26 ,$153.75 ,$153.75 ,$174.25 ,$174.25 ,$106.26 ,$174.25 ,$106.26 ,$161.95 ,$161.95 ,$161.95 ,$184.50 ,$205.00 ,$184.50 ,$106.26 ,$205.00 ,$134.28 ,$106.26 ,$88.97 , N/A ,$111.57 ,$184.50 ,$239.09 ,$129.36 ,$123.00 ,$184.50 ,$106.26 ,$184.50 ,$184.50 ,$106.26 ,$133.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30000218,86927,HC FFP THAWING EACH UNIT,300,1 ,$50.00 ,$32.50 ,$21.70 ,$318.55 ,$37.25 ,$32.75 ,$50.00 ,$26.35 ,$50.00 ,$31.55 ,$31.55 ,$31.55 ,$31.55 ,$45.00 ,$37.50 ,$50.00 ,$44.00 ,$50.00 ,$37.50 ,$37.50 ,$42.50 ,$42.50 ,$50.00 ,$42.50 ,$50.00 ,$39.50 ,$39.50 ,$39.50 ,$45.00 ,$50.00 ,$45.00 ,$50.00 ,$50.00 ,$32.75 ,$50.00 ,$21.70 , N/A ,$50.00 ,$45.00 ,$318.55 ,$31.55 ,$30.00 ,$45.00 ,$50.00 ,$45.00 ,$45.00 ,$50.00 ,$32.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30000223,89051,HC CELL CT BODY FLUID W/DIFF,300,1 ,$165.00 ,$107.25 ,$5.60 ,$165.00 ,$122.93 ,$108.08 ,$5.60 ,$86.96 ,$5.60 ,$104.12 ,$104.12 ,$104.12 ,$104.12 ,$148.50 ,$123.75 ,$5.60 ,$145.20 ,$5.60 ,$123.75 ,$123.75 ,$140.25 ,$140.25 ,$5.60 ,$140.25 ,$5.60 ,$130.35 ,$130.35 ,$130.35 ,$148.50 ,$14.00 ,$148.50 ,$5.60 ,$165.00 ,$108.08 ,$5.60 ,$71.61 , N/A ,$5.88 ,$148.50 ,$12.60 ,$104.12 ,$99.00 ,$148.50 ,$5.60 ,$148.50 ,$148.50 ,$5.60 ,$107.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30000225,89190,HC SMEAR NASAL EOSINOPHILS,300,1 ,$69.00 ,$44.85 ,$5.79 ,$69.00 ,$51.41 ,$45.20 ,$5.79 ,$36.36 ,$5.79 ,$43.54 ,$43.54 ,$43.54 ,$43.54 ,$62.10 ,$51.75 ,$5.79 ,$60.72 ,$5.79 ,$51.75 ,$51.75 ,$58.65 ,$58.65 ,$5.79 ,$58.65 ,$5.79 ,$54.51 ,$54.51 ,$54.51 ,$62.10 ,$14.48 ,$62.10 ,$5.79 ,$69.00 ,$45.20 ,$5.79 ,$29.95 , N/A ,$6.08 ,$62.10 ,$13.03 ,$43.54 ,$41.40 ,$62.10 ,$5.79 ,$62.10 ,$62.10 ,$5.79 ,$44.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30000245,89055,HC LEUKO ASSESS STOOL QN/SEMI,300,1 ,$79.00 ,$51.35 ,$4.27 ,$79.00 ,$58.86 ,$51.75 ,$4.27 ,$41.63 ,$4.27 ,$49.85 ,$49.85 ,$49.85 ,$49.85 ,$71.10 ,$59.25 ,$4.27 ,$69.52 ,$4.27 ,$59.25 ,$59.25 ,$67.15 ,$67.15 ,$4.27 ,$67.15 ,$4.27 ,$62.41 ,$62.41 ,$62.41 ,$71.10 ,$10.68 ,$71.10 ,$4.27 ,$79.00 ,$51.75 ,$4.27 ,$34.29 , N/A ,$4.48 ,$71.10 ,$9.61 ,$49.85 ,$47.40 ,$71.10 ,$4.27 ,$71.10 ,$71.10 ,$4.27 ,$51.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30000246,89060,HC CRYSTAL ID LIGHT MICRO,300,1 ,$126.00 ,$81.90 ,$7.33 ,$126.00 ,$93.87 ,$82.53 ,$7.33 ,$66.40 ,$7.33 ,$79.51 ,$79.51 ,$79.51 ,$79.51 ,$113.40 ,$94.50 ,$7.33 ,$110.88 ,$7.33 ,$94.50 ,$94.50 ,$107.10 ,$107.10 ,$7.33 ,$107.10 ,$7.33 ,$99.54 ,$99.54 ,$99.54 ,$113.40 ,$18.33 ,$113.40 ,$7.33 ,$126.00 ,$82.53 ,$7.33 ,$54.68 , N/A ,$7.70 ,$113.40 ,$16.49 ,$79.51 ,$75.60 ,$113.40 ,$7.33 ,$113.40 ,$113.40 ,$7.33 ,$81.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30000249,89320,HC SEMEN ANALYSIS COMPLETE,300,1 ,$536.00 ,$348.40 ,$12.31 ,$536.00 ,$399.32 ,$351.08 ,$12.31 ,$282.47 ,$12.31 ,$338.22 ,$338.22 ,$338.22 ,$338.22 ,$482.40 ,$402.00 ,$12.31 ,$471.68 ,$12.31 ,$402.00 ,$402.00 ,$455.60 ,$455.60 ,$12.31 ,$455.60 ,$12.31 ,$423.44 ,$423.44 ,$423.44 ,$482.40 ,$30.78 ,$482.40 ,$12.31 ,$536.00 ,$351.08 ,$12.31 ,$232.62 , N/A ,$12.93 ,$482.40 ,$27.70 ,$338.22 ,$321.60 ,$482.40 ,$12.31 ,$482.40 ,$482.40 ,$12.31 ,$348.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30000250,89321,HC SEMEN PRESENCE/MOTILITY,300,1 ,$113.00 ,$73.45 ,$12.05 ,$113.00 ,$84.19 ,$74.02 ,$12.05 ,$59.55 ,$12.05 ,$71.30 ,$71.30 ,$71.30 ,$71.30 ,$101.70 ,$84.75 ,$12.05 ,$99.44 ,$12.05 ,$84.75 ,$84.75 ,$96.05 ,$96.05 ,$12.05 ,$96.05 ,$12.05 ,$89.27 ,$89.27 ,$89.27 ,$101.70 ,$30.13 ,$101.70 ,$12.05 ,$113.00 ,$74.02 ,$12.05 ,$49.04 , N/A ,$12.65 ,$101.70 ,$27.11 ,$71.30 ,$67.80 ,$101.70 ,$12.05 ,$101.70 ,$101.70 ,$12.05 ,$73.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30000260,36600,HC ARTERIAL PUNCTURE,300,1 ,$29.00 ,$18.85 ,$12.59 ,$239.09 ,$21.61 ,$19.00 ,$29.00 ,$15.28 ,$29.00 ,$18.30 ,$18.30 ,$18.30 ,$18.30 ,$26.10 ,$21.75 ,$29.00 ,$25.52 ,$29.00 ,$21.75 ,$21.75 ,$24.65 ,$24.65 ,$29.00 ,$24.65 ,$29.00 ,$22.91 ,$22.91 ,$22.91 ,$26.10 ,$29.00 ,$26.10 ,$29.00 ,$29.00 ,$19.00 ,$29.00 ,$12.59 , N/A ,$29.00 ,$26.10 ,$239.09 ,$18.30 ,$17.40 ,$26.10 ,$29.00 ,$26.10 ,$26.10 ,$29.00 ,$18.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30000261,N/A,HC LAB HANDLING AND TRANSPORT,300,1 ,$15.00 ,$9.75 ,$6.51 ,$15.00 ,$11.18 ,$9.83 , N/A ,$7.91 , N/A ,$9.47 ,$9.47 ,$9.47 ,$9.47 ,$13.50 ,$11.25 , N/A ,$13.20 , N/A ,$11.25 ,$11.25 ,$12.75 ,$12.75 , N/A ,$12.75 , N/A ,$11.85 ,$11.85 ,$11.85 ,$13.50 , N/A ,$13.50 , N/A ,$15.00 ,$9.83 , N/A ,$6.51 , N/A , N/A ,$13.50 , N/A ,$9.47 ,$9.00 ,$13.50 , N/A ,$13.50 ,$13.50 , N/A ,$9.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30002018,89060,HC CRYSTAL ID LIGHT MICRO,300,1 ,$34.00 ,$22.10 ,$7.33 ,$34.00 ,$25.33 ,$22.27 ,$7.33 ,$17.92 ,$7.33 ,$21.45 ,$21.45 ,$21.45 ,$21.45 ,$30.60 ,$25.50 ,$7.33 ,$29.92 ,$7.33 ,$25.50 ,$25.50 ,$28.90 ,$28.90 ,$7.33 ,$28.90 ,$7.33 ,$26.86 ,$26.86 ,$26.86 ,$30.60 ,$18.33 ,$30.60 ,$7.33 ,$34.00 ,$22.27 ,$7.33 ,$14.76 , N/A ,$7.70 ,$30.60 ,$16.49 ,$21.45 ,$20.40 ,$30.60 ,$7.33 ,$30.60 ,$30.60 ,$7.33 ,$22.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30002020,89291,HC BX OOCYTE POLAR/EMBRYO>5 EMB -90,300,1 ,$184.00 ,$119.60 ,$79.86 ,$318.55 ,$137.08 ,$120.52 ,$141.58 ,$96.97 ,$141.58 ,$116.10 ,$116.10 ,$116.10 ,$116.10 ,$165.60 ,$138.00 ,$141.58 ,$161.92 ,$141.58 ,$138.00 ,$138.00 ,$156.40 ,$156.40 ,$141.58 ,$156.40 ,$141.58 ,$145.36 ,$145.36 ,$145.36 ,$165.60 ,$184.00 ,$165.60 ,$141.58 ,$184.00 ,$120.52 ,$141.58 ,$79.86 , N/A ,$148.66 ,$165.60 ,$318.55 ,$116.10 ,$110.40 ,$165.60 ,$141.58 ,$165.60 ,$165.60 ,$141.58 ,$119.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30002021,89310,HC SPERM COUNT,300,1 ,$204.00 ,$132.60 ,$8.61 ,$204.00 ,$151.98 ,$133.62 ,$8.61 ,$107.51 ,$8.61 ,$128.72 ,$128.72 ,$128.72 ,$128.72 ,$183.60 ,$153.00 ,$8.61 ,$179.52 ,$8.61 ,$153.00 ,$153.00 ,$173.40 ,$173.40 ,$8.61 ,$173.40 ,$8.61 ,$161.16 ,$161.16 ,$161.16 ,$183.60 ,$21.53 ,$183.60 ,$8.61 ,$204.00 ,$133.62 ,$8.61 ,$88.54 , N/A ,$9.04 ,$183.60 ,$19.37 ,$128.72 ,$122.40 ,$183.60 ,$8.61 ,$183.60 ,$183.60 ,$8.61 ,$132.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30002026,G0483,HC UA DRUG COLLECTION FEE,300,1 ,$63.00 ,$40.95 ,$27.34 ,$141.75 ,$46.94 ,$41.27 ,$63.00 ,$33.20 ,$63.00 ,$39.75 ,$39.75 ,$39.75 ,$39.75 ,$56.70 ,$47.25 ,$63.00 ,$55.44 ,$63.00 ,$47.25 ,$47.25 ,$53.55 ,$53.55 ,$63.00 ,$53.55 ,$63.00 ,$49.77 ,$49.77 ,$49.77 ,$56.70 ,$63.00 ,$56.70 ,$63.00 ,$63.00 ,$41.27 ,$63.00 ,$27.34 , N/A ,$63.00 ,$56.70 ,$141.75 ,$39.75 ,$37.80 ,$56.70 ,$63.00 ,$56.70 ,$56.70 ,$63.00 ,$40.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30002028,N/A,HC HEALTH PROFILE PACKAGE CLIENT ONLY,300,1 ,$26.00 ,$16.90 ,$11.28 ,$26.00 ,$19.37 ,$17.03 , N/A ,$13.70 , N/A ,$16.41 ,$16.41 ,$16.41 ,$16.41 ,$23.40 ,$19.50 , N/A ,$22.88 , N/A ,$19.50 ,$19.50 ,$22.10 ,$22.10 , N/A ,$22.10 , N/A ,$20.54 ,$20.54 ,$20.54 ,$23.40 , N/A ,$23.40 , N/A ,$26.00 ,$17.03 , N/A ,$11.28 , N/A , N/A ,$23.40 , N/A ,$16.41 ,$15.60 ,$23.40 , N/A ,$23.40 ,$23.40 , N/A ,$16.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30040115,99001,HC SPECIMEN HAND/CONVEY OTHER,300,1 ,$50.00 ,$32.50 ,$21.70 ,$50.00 ,$37.25 ,$32.75 , N/A ,$26.35 , N/A ,$31.55 ,$31.55 ,$31.55 ,$31.55 ,$45.00 ,$37.50 , N/A ,$44.00 , N/A ,$37.50 ,$37.50 ,$42.50 ,$42.50 , N/A ,$42.50 , N/A ,$39.50 ,$39.50 ,$39.50 ,$45.00 , N/A ,$45.00 , N/A ,$50.00 ,$32.75 , N/A ,$21.70 , N/A , N/A ,$45.00 , N/A ,$31.55 ,$30.00 ,$45.00 , N/A ,$45.00 ,$45.00 , N/A ,$32.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100101,80048,HC BASIC METABOLIC PANEL,301,1 ,$97.00 ,$63.05 ,$8.46 ,$97.00 ,$72.27 ,$63.54 ,$8.46 ,$51.12 ,$8.46 ,$61.21 ,$61.21 ,$61.21 ,$61.21 ,$87.30 ,$72.75 ,$8.46 ,$85.36 ,$8.46 ,$72.75 ,$72.75 ,$82.45 ,$82.45 ,$8.46 ,$82.45 ,$8.46 ,$76.63 ,$76.63 ,$76.63 ,$87.30 ,$21.15 ,$87.30 ,$8.46 ,$8.46 ,$63.54 ,$8.46 ,$42.10 , N/A ,$8.88 ,$87.30 ,$19.04 ,$61.21 ,$58.20 ,$87.30 ,$8.46 ,$87.30 ,$87.30 ,$8.46 ,$63.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100103,80051,HC ELECTROLYTE PANEL,301,1 ,$140.00 ,$91.00 ,$7.01 ,$140.00 ,$104.30 ,$91.70 ,$7.01 ,$73.78 ,$7.01 ,$88.34 ,$88.34 ,$88.34 ,$88.34 ,$126.00 ,$105.00 ,$7.01 ,$123.20 ,$7.01 ,$105.00 ,$105.00 ,$119.00 ,$119.00 ,$7.01 ,$119.00 ,$7.01 ,$110.60 ,$110.60 ,$110.60 ,$126.00 ,$17.53 ,$126.00 ,$7.01 ,$140.00 ,$91.70 ,$7.01 ,$60.76 , N/A ,$7.36 ,$126.00 ,$15.77 ,$88.34 ,$84.00 ,$126.00 ,$7.01 ,$126.00 ,$126.00 ,$7.01 ,$91.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100104,80053,HC COMPREHENSIVE METABOL PANEL,301,1 ,$104.00 ,$67.60 ,$10.56 ,$104.00 ,$77.48 ,$68.12 ,$10.56 ,$54.81 ,$10.56 ,$65.62 ,$65.62 ,$65.62 ,$65.62 ,$93.60 ,$78.00 ,$10.56 ,$91.52 ,$10.56 ,$78.00 ,$78.00 ,$88.40 ,$88.40 ,$10.56 ,$88.40 ,$10.56 ,$82.16 ,$82.16 ,$82.16 ,$93.60 ,$26.40 ,$93.60 ,$10.56 ,$10.56 ,$68.12 ,$10.56 ,$45.14 , N/A ,$11.09 ,$93.60 ,$23.76 ,$65.62 ,$62.40 ,$93.60 ,$10.56 ,$93.60 ,$93.60 ,$10.56 ,$67.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100106,80055,HC PRENATAL PANEL,301,1 ,$430.00 ,$279.50 ,$47.81 ,$430.00 ,$320.35 ,$281.65 ,$47.81 ,$226.61 ,$47.81 ,$271.33 ,$271.33 ,$271.33 ,$271.33 ,$387.00 ,$322.50 ,$47.81 ,$378.40 ,$47.81 ,$322.50 ,$322.50 ,$365.50 ,$365.50 ,$47.81 ,$365.50 ,$47.81 ,$339.70 ,$339.70 ,$339.70 ,$387.00 ,$119.53 ,$387.00 ,$47.81 ,$430.00 ,$281.65 ,$47.81 ,$186.62 , N/A ,$50.20 ,$387.00 ,$107.57 ,$271.33 ,$258.00 ,$387.00 ,$47.81 ,$387.00 ,$387.00 ,$47.81 ,$279.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100107,80061,HC LIPID PANEL,301,1 ,$154.00 ,$100.10 ,$13.39 ,$154.00 ,$114.73 ,$100.87 ,$13.39 ,$81.16 ,$13.39 ,$97.17 ,$97.17 ,$97.17 ,$97.17 ,$138.60 ,$115.50 ,$13.39 ,$135.52 ,$13.39 ,$115.50 ,$115.50 ,$130.90 ,$130.90 ,$13.39 ,$130.90 ,$13.39 ,$121.66 ,$121.66 ,$121.66 ,$138.60 ,$33.48 ,$138.60 ,$13.39 ,$154.00 ,$100.87 ,$13.39 ,$66.84 , N/A ,$14.06 ,$138.60 ,$30.13 ,$97.17 ,$92.40 ,$138.60 ,$13.39 ,$138.60 ,$138.60 ,$13.39 ,$100.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100108,80069,HC RENAL PANEL,301,1 ,$198.00 ,$128.70 ,$8.68 ,$198.00 ,$147.51 ,$129.69 ,$8.68 ,$104.35 ,$8.68 ,$124.94 ,$124.94 ,$124.94 ,$124.94 ,$178.20 ,$148.50 ,$8.68 ,$174.24 ,$8.68 ,$148.50 ,$148.50 ,$168.30 ,$168.30 ,$8.68 ,$168.30 ,$8.68 ,$156.42 ,$156.42 ,$156.42 ,$178.20 ,$21.70 ,$178.20 ,$8.68 ,$198.00 ,$129.69 ,$8.68 ,$85.93 , N/A ,$9.11 ,$178.20 ,$19.53 ,$124.94 ,$118.80 ,$178.20 ,$8.68 ,$178.20 ,$178.20 ,$8.68 ,$128.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100109,80074,HC HEPATITIS PANEL ACUTE,301,1 ,$416.00 ,$270.40 ,$47.63 ,$416.00 ,$309.92 ,$272.48 ,$47.63 ,$219.23 ,$47.63 ,$262.50 ,$262.50 ,$262.50 ,$262.50 ,$374.40 ,$312.00 ,$47.63 ,$366.08 ,$47.63 ,$312.00 ,$312.00 ,$353.60 ,$353.60 ,$47.63 ,$353.60 ,$47.63 ,$328.64 ,$328.64 ,$328.64 ,$374.40 ,$119.08 ,$374.40 ,$47.63 ,$416.00 ,$272.48 ,$47.63 ,$180.54 , N/A ,$50.01 ,$374.40 ,$107.17 ,$262.50 ,$249.60 ,$374.40 ,$47.63 ,$374.40 ,$374.40 ,$47.63 ,$270.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100110,80076,HC LIVER (HEPATIC) PANEL,301,1 ,$151.00 ,$98.15 ,$8.17 ,$151.00 ,$112.50 ,$98.91 ,$8.17 ,$79.58 ,$8.17 ,$95.28 ,$95.28 ,$95.28 ,$95.28 ,$135.90 ,$113.25 ,$8.17 ,$132.88 ,$8.17 ,$113.25 ,$113.25 ,$128.35 ,$128.35 ,$8.17 ,$128.35 ,$8.17 ,$119.29 ,$119.29 ,$119.29 ,$135.90 ,$20.43 ,$135.90 ,$8.17 ,$151.00 ,$98.91 ,$8.17 ,$65.53 , N/A ,$8.58 ,$135.90 ,$18.38 ,$95.28 ,$90.60 ,$135.90 ,$8.17 ,$135.90 ,$135.90 ,$8.17 ,$98.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100116,80156,HC CARBAMAZEPINE TOTAL,301,1 ,$146.00 ,$94.90 ,$14.57 ,$146.00 ,$108.77 ,$95.63 ,$14.57 ,$76.94 ,$14.57 ,$92.13 ,$92.13 ,$92.13 ,$92.13 ,$131.40 ,$109.50 ,$14.57 ,$128.48 ,$14.57 ,$109.50 ,$109.50 ,$124.10 ,$124.10 ,$14.57 ,$124.10 ,$14.57 ,$115.34 ,$115.34 ,$115.34 ,$131.40 ,$36.43 ,$131.40 ,$14.57 ,$146.00 ,$95.63 ,$14.57 ,$63.36 , N/A ,$15.30 ,$131.40 ,$32.78 ,$92.13 ,$87.60 ,$131.40 ,$14.57 ,$131.40 ,$131.40 ,$14.57 ,$94.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100120,80162,HC DIGOXIN LEVELS,301,1 ,$134.00 ,$87.10 ,$13.28 ,$134.00 ,$99.83 ,$87.77 ,$13.28 ,$70.62 ,$13.28 ,$84.55 ,$84.55 ,$84.55 ,$84.55 ,$120.60 ,$100.50 ,$13.28 ,$117.92 ,$13.28 ,$100.50 ,$100.50 ,$113.90 ,$113.90 ,$13.28 ,$113.90 ,$13.28 ,$105.86 ,$105.86 ,$105.86 ,$120.60 ,$33.20 ,$120.60 ,$13.28 ,$134.00 ,$87.77 ,$13.28 ,$58.16 , N/A ,$13.94 ,$120.60 ,$29.88 ,$84.55 ,$80.40 ,$120.60 ,$13.28 ,$120.60 ,$120.60 ,$13.28 ,$87.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100121,80164,HC VALPROIC ACID,301,1 ,$139.00 ,$90.35 ,$13.54 ,$139.00 ,$103.56 ,$91.05 ,$13.54 ,$73.25 ,$13.54 ,$87.71 ,$87.71 ,$87.71 ,$87.71 ,$125.10 ,$104.25 ,$13.54 ,$122.32 ,$13.54 ,$104.25 ,$104.25 ,$118.15 ,$118.15 ,$13.54 ,$118.15 ,$13.54 ,$109.81 ,$109.81 ,$109.81 ,$125.10 ,$33.85 ,$125.10 ,$13.54 ,$139.00 ,$91.05 ,$13.54 ,$60.33 , N/A ,$14.22 ,$125.10 ,$30.47 ,$87.71 ,$83.40 ,$125.10 ,$13.54 ,$125.10 ,$125.10 ,$13.54 ,$90.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100124,80170,HC GENTAMICIN,301,1 ,$189.00 ,$122.85 ,$16.38 ,$189.00 ,$140.81 ,$123.80 ,$16.38 ,$99.60 ,$16.38 ,$119.26 ,$119.26 ,$119.26 ,$119.26 ,$170.10 ,$141.75 ,$16.38 ,$166.32 ,$16.38 ,$141.75 ,$141.75 ,$160.65 ,$160.65 ,$16.38 ,$160.65 ,$16.38 ,$149.31 ,$149.31 ,$149.31 ,$170.10 ,$40.95 ,$170.10 ,$16.38 ,$189.00 ,$123.80 ,$16.38 ,$82.03 , N/A ,$17.20 ,$170.10 ,$36.86 ,$119.26 ,$113.40 ,$170.10 ,$16.38 ,$170.10 ,$170.10 ,$16.38 ,$122.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100127,80178,HC LITHIUM,301,1 ,$78.00 ,$50.70 ,$6.61 ,$78.00 ,$58.11 ,$51.09 ,$6.61 ,$41.11 ,$6.61 ,$49.22 ,$49.22 ,$49.22 ,$49.22 ,$70.20 ,$58.50 ,$6.61 ,$68.64 ,$6.61 ,$58.50 ,$58.50 ,$66.30 ,$66.30 ,$6.61 ,$66.30 ,$6.61 ,$61.62 ,$61.62 ,$61.62 ,$70.20 ,$16.53 ,$70.20 ,$6.61 ,$78.00 ,$51.09 ,$6.61 ,$33.85 , N/A ,$6.94 ,$70.20 ,$14.87 ,$49.22 ,$46.80 ,$70.20 ,$6.61 ,$70.20 ,$70.20 ,$6.61 ,$50.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100129,80184,HC PHENOBARBITAL,301,1 ,$133.00 ,$86.45 ,$15.30 ,$133.00 ,$99.09 ,$87.12 ,$15.30 ,$70.09 ,$15.30 ,$83.92 ,$83.92 ,$83.92 ,$83.92 ,$119.70 ,$99.75 ,$15.30 ,$117.04 ,$15.30 ,$99.75 ,$99.75 ,$113.05 ,$113.05 ,$15.30 ,$113.05 ,$15.30 ,$105.07 ,$105.07 ,$105.07 ,$119.70 ,$38.25 ,$119.70 ,$15.30 ,$133.00 ,$87.12 ,$15.30 ,$57.72 , N/A ,$16.07 ,$119.70 ,$34.43 ,$83.92 ,$79.80 ,$119.70 ,$15.30 ,$119.70 ,$119.70 ,$15.30 ,$86.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100130,80185,HC PHENYTOIN TOTAL,301,1 ,$139.00 ,$90.35 ,$13.25 ,$139.00 ,$103.56 ,$91.05 ,$13.25 ,$73.25 ,$13.25 ,$87.71 ,$87.71 ,$87.71 ,$87.71 ,$125.10 ,$104.25 ,$13.25 ,$122.32 ,$13.25 ,$104.25 ,$104.25 ,$118.15 ,$118.15 ,$13.25 ,$118.15 ,$13.25 ,$109.81 ,$109.81 ,$109.81 ,$125.10 ,$33.13 ,$125.10 ,$13.25 ,$139.00 ,$91.05 ,$13.25 ,$60.33 , N/A ,$13.91 ,$125.10 ,$29.81 ,$87.71 ,$83.40 ,$125.10 ,$13.25 ,$125.10 ,$125.10 ,$13.25 ,$90.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100138,80198,HC THEOPHYLLINE,301,1 ,$138.00 ,$89.70 ,$14.14 ,$138.00 ,$102.81 ,$90.39 ,$14.14 ,$72.73 ,$14.14 ,$87.08 ,$87.08 ,$87.08 ,$87.08 ,$124.20 ,$103.50 ,$14.14 ,$121.44 ,$14.14 ,$103.50 ,$103.50 ,$117.30 ,$117.30 ,$14.14 ,$117.30 ,$14.14 ,$109.02 ,$109.02 ,$109.02 ,$124.20 ,$35.35 ,$124.20 ,$14.14 ,$138.00 ,$90.39 ,$14.14 ,$59.89 , N/A ,$14.85 ,$124.20 ,$31.82 ,$87.08 ,$82.80 ,$124.20 ,$14.14 ,$124.20 ,$124.20 ,$14.14 ,$89.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100139,80200,HC TOBRAMYCIN,301,1 ,$151.00 ,$98.15 ,$16.13 ,$151.00 ,$112.50 ,$98.91 ,$16.13 ,$79.58 ,$16.13 ,$95.28 ,$95.28 ,$95.28 ,$95.28 ,$135.90 ,$113.25 ,$16.13 ,$132.88 ,$16.13 ,$113.25 ,$113.25 ,$128.35 ,$128.35 ,$16.13 ,$128.35 ,$16.13 ,$119.29 ,$119.29 ,$119.29 ,$135.90 ,$40.33 ,$135.90 ,$16.13 ,$151.00 ,$98.91 ,$16.13 ,$65.53 , N/A ,$16.94 ,$135.90 ,$36.29 ,$95.28 ,$90.60 ,$135.90 ,$16.13 ,$135.90 ,$135.90 ,$16.13 ,$98.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100141,80202,HC VANCOMYCIN,301,1 ,$196.00 ,$127.40 ,$13.54 ,$196.00 ,$146.02 ,$128.38 ,$13.54 ,$103.29 ,$13.54 ,$123.68 ,$123.68 ,$123.68 ,$123.68 ,$176.40 ,$147.00 ,$13.54 ,$172.48 ,$13.54 ,$147.00 ,$147.00 ,$166.60 ,$166.60 ,$13.54 ,$166.60 ,$13.54 ,$154.84 ,$154.84 ,$154.84 ,$176.40 ,$33.85 ,$176.40 ,$13.54 ,$196.00 ,$128.38 ,$13.54 ,$85.06 , N/A ,$14.22 ,$176.40 ,$30.47 ,$123.68 ,$117.60 ,$176.40 ,$13.54 ,$176.40 ,$176.40 ,$13.54 ,$127.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100157,82009,HC ACETONE SERUM,301,1 ,$60.00 ,$39.00 ,$4.52 ,$60.00 ,$44.70 ,$39.30 ,$4.52 ,$31.62 ,$4.52 ,$37.86 ,$37.86 ,$37.86 ,$37.86 ,$54.00 ,$45.00 ,$4.52 ,$52.80 ,$4.52 ,$45.00 ,$45.00 ,$51.00 ,$51.00 ,$4.52 ,$51.00 ,$4.52 ,$47.40 ,$47.40 ,$47.40 ,$54.00 ,$11.30 ,$54.00 ,$4.52 ,$60.00 ,$39.30 ,$4.52 ,$26.04 , N/A ,$4.75 ,$54.00 ,$10.17 ,$37.86 ,$36.00 ,$54.00 ,$4.52 ,$54.00 ,$54.00 ,$4.52 ,$39.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100165,82040,HC ALBUMIN SERUM,301,1 ,$55.00 ,$35.75 ,$4.95 ,$55.00 ,$40.98 ,$36.03 ,$4.95 ,$28.99 ,$4.95 ,$34.71 ,$34.71 ,$34.71 ,$34.71 ,$49.50 ,$41.25 ,$4.95 ,$48.40 ,$4.95 ,$41.25 ,$41.25 ,$46.75 ,$46.75 ,$4.95 ,$46.75 ,$4.95 ,$43.45 ,$43.45 ,$43.45 ,$49.50 ,$12.38 ,$49.50 ,$4.95 ,$55.00 ,$36.03 ,$4.95 ,$23.87 , N/A ,$5.20 ,$49.50 ,$11.14 ,$34.71 ,$33.00 ,$49.50 ,$4.95 ,$49.50 ,$49.50 ,$4.95 ,$35.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100168,82043,HC MICROALBUMIN URINE QN,301,1 ,$127.00 ,$82.55 ,$5.78 ,$127.00 ,$94.62 ,$83.19 ,$5.78 ,$66.93 ,$5.78 ,$80.14 ,$80.14 ,$80.14 ,$80.14 ,$114.30 ,$95.25 ,$5.78 ,$111.76 ,$5.78 ,$95.25 ,$95.25 ,$107.95 ,$107.95 ,$5.78 ,$107.95 ,$5.78 ,$100.33 ,$100.33 ,$100.33 ,$114.30 ,$14.45 ,$114.30 ,$5.78 ,$127.00 ,$83.19 ,$5.78 ,$55.12 , N/A ,$6.07 ,$114.30 ,$13.01 ,$80.14 ,$76.20 ,$114.30 ,$5.78 ,$114.30 ,$114.30 ,$5.78 ,$82.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100186,82140,HC AMMONIA,301,1 ,$159.00 ,$103.35 ,$14.57 ,$159.00 ,$118.46 ,$104.15 ,$14.57 ,$83.79 ,$14.57 ,$100.33 ,$100.33 ,$100.33 ,$100.33 ,$143.10 ,$119.25 ,$14.57 ,$139.92 ,$14.57 ,$119.25 ,$119.25 ,$135.15 ,$135.15 ,$14.57 ,$135.15 ,$14.57 ,$125.61 ,$125.61 ,$125.61 ,$143.10 ,$36.43 ,$143.10 ,$14.57 ,$159.00 ,$104.15 ,$14.57 ,$69.01 , N/A ,$15.30 ,$143.10 ,$32.78 ,$100.33 ,$95.40 ,$143.10 ,$14.57 ,$143.10 ,$143.10 ,$14.57 ,$103.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100188,82150,HC AMYLASE,301,1 ,$84.00 ,$54.60 ,$6.48 ,$84.00 ,$62.58 ,$55.02 ,$6.48 ,$44.27 ,$6.48 ,$53.00 ,$53.00 ,$53.00 ,$53.00 ,$75.60 ,$63.00 ,$6.48 ,$73.92 ,$6.48 ,$63.00 ,$63.00 ,$71.40 ,$71.40 ,$6.48 ,$71.40 ,$6.48 ,$66.36 ,$66.36 ,$66.36 ,$75.60 ,$16.20 ,$75.60 ,$6.48 ,$84.00 ,$55.02 ,$6.48 ,$36.46 , N/A ,$6.80 ,$75.60 ,$14.58 ,$53.00 ,$50.40 ,$75.60 ,$6.48 ,$75.60 ,$75.60 ,$6.48 ,$54.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100202,82247,HC BILIRUBIN TOTAL,301,1 ,$93.00 ,$60.45 ,$5.02 ,$93.00 ,$69.29 ,$60.92 ,$5.02 ,$49.01 ,$5.02 ,$58.68 ,$58.68 ,$58.68 ,$58.68 ,$83.70 ,$69.75 ,$5.02 ,$81.84 ,$5.02 ,$69.75 ,$69.75 ,$79.05 ,$79.05 ,$5.02 ,$79.05 ,$5.02 ,$73.47 ,$73.47 ,$73.47 ,$83.70 ,$12.55 ,$83.70 ,$5.02 ,$93.00 ,$60.92 ,$5.02 ,$40.36 , N/A ,$5.27 ,$83.70 ,$11.30 ,$58.68 ,$55.80 ,$83.70 ,$5.02 ,$83.70 ,$83.70 ,$5.02 ,$60.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100203,82248,HC BILIRUBIN DIRECT,301,1 ,$80.00 ,$52.00 ,$5.02 ,$80.00 ,$59.60 ,$52.40 ,$5.02 ,$42.16 ,$5.02 ,$50.48 ,$50.48 ,$50.48 ,$50.48 ,$72.00 ,$60.00 ,$5.02 ,$70.40 ,$5.02 ,$60.00 ,$60.00 ,$68.00 ,$68.00 ,$5.02 ,$68.00 ,$5.02 ,$63.20 ,$63.20 ,$63.20 ,$72.00 ,$12.55 ,$72.00 ,$5.02 ,$80.00 ,$52.40 ,$5.02 ,$34.72 , N/A ,$5.27 ,$72.00 ,$11.30 ,$50.48 ,$48.00 ,$72.00 ,$5.02 ,$72.00 ,$72.00 ,$5.02 ,$52.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100212,82306,HC VITAMIN D 25 OH,301,1 ,$97.00 ,$63.05 ,$29.60 ,$97.00 ,$72.27 ,$63.54 ,$29.60 ,$51.12 ,$29.60 ,$61.21 ,$61.21 ,$61.21 ,$61.21 ,$87.30 ,$72.75 ,$29.60 ,$85.36 ,$29.60 ,$72.75 ,$72.75 ,$82.45 ,$82.45 ,$29.60 ,$82.45 ,$29.60 ,$76.63 ,$76.63 ,$76.63 ,$87.30 ,$74.00 ,$87.30 ,$29.60 ,$97.00 ,$63.54 ,$29.60 ,$42.10 , N/A ,$31.08 ,$87.30 ,$66.60 ,$61.21 ,$58.20 ,$87.30 ,$29.60 ,$87.30 ,$87.30 ,$29.60 ,$63.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100214,82310,HC CALCIUM,301,1 ,$60.00 ,$39.00 ,$5.16 ,$60.00 ,$44.70 ,$39.30 ,$5.16 ,$31.62 ,$5.16 ,$37.86 ,$37.86 ,$37.86 ,$37.86 ,$54.00 ,$45.00 ,$5.16 ,$52.80 ,$5.16 ,$45.00 ,$45.00 ,$51.00 ,$51.00 ,$5.16 ,$51.00 ,$5.16 ,$47.40 ,$47.40 ,$47.40 ,$54.00 ,$12.90 ,$54.00 ,$5.16 ,$60.00 ,$39.30 ,$5.16 ,$26.04 , N/A ,$5.42 ,$54.00 ,$11.61 ,$37.86 ,$36.00 ,$54.00 ,$5.16 ,$54.00 ,$54.00 ,$5.16 ,$39.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100215,82330,HC CALCIUM IONIZED,301,1 ,$154.00 ,$100.10 ,$13.68 ,$154.00 ,$114.73 ,$100.87 ,$13.68 ,$81.16 ,$13.68 ,$97.17 ,$97.17 ,$97.17 ,$97.17 ,$138.60 ,$115.50 ,$13.68 ,$135.52 ,$13.68 ,$115.50 ,$115.50 ,$130.90 ,$130.90 ,$13.68 ,$130.90 ,$13.68 ,$121.66 ,$121.66 ,$121.66 ,$138.60 ,$34.20 ,$138.60 ,$13.68 ,$154.00 ,$100.87 ,$13.68 ,$66.84 , N/A ,$14.36 ,$138.60 ,$30.78 ,$97.17 ,$92.40 ,$138.60 ,$13.68 ,$138.60 ,$138.60 ,$13.68 ,$100.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100216,82340,HC CALCIUM URINE QN TIMED,301,1 ,$129.00 ,$83.85 ,$6.03 ,$129.00 ,$96.11 ,$84.50 ,$6.03 ,$67.98 ,$6.03 ,$81.40 ,$81.40 ,$81.40 ,$81.40 ,$116.10 ,$96.75 ,$6.03 ,$113.52 ,$6.03 ,$96.75 ,$96.75 ,$109.65 ,$109.65 ,$6.03 ,$109.65 ,$6.03 ,$101.91 ,$101.91 ,$101.91 ,$116.10 ,$15.08 ,$116.10 ,$6.03 ,$129.00 ,$84.50 ,$6.03 ,$55.99 , N/A ,$6.33 ,$116.10 ,$13.57 ,$81.40 ,$77.40 ,$116.10 ,$6.03 ,$116.10 ,$116.10 ,$6.03 ,$83.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100222,82374,HC BICARBONATE,301,1 ,$39.00 ,$25.35 ,$4.88 ,$39.00 ,$29.06 ,$25.55 ,$4.88 ,$20.55 ,$4.88 ,$24.61 ,$24.61 ,$24.61 ,$24.61 ,$35.10 ,$29.25 ,$4.88 ,$34.32 ,$4.88 ,$29.25 ,$29.25 ,$33.15 ,$33.15 ,$4.88 ,$33.15 ,$4.88 ,$30.81 ,$30.81 ,$30.81 ,$35.10 ,$12.20 ,$35.10 ,$4.88 ,$39.00 ,$25.55 ,$4.88 ,$16.93 , N/A ,$5.12 ,$35.10 ,$10.98 ,$24.61 ,$23.40 ,$35.10 ,$4.88 ,$35.10 ,$35.10 ,$4.88 ,$25.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100226,82378,HC CARBINOEMBRYONIC AG (CEA),301,1 ,$180.00 ,$117.00 ,$18.96 ,$180.00 ,$134.10 ,$117.90 ,$18.96 ,$94.86 ,$18.96 ,$113.58 ,$113.58 ,$113.58 ,$113.58 ,$162.00 ,$135.00 ,$18.96 ,$158.40 ,$18.96 ,$135.00 ,$135.00 ,$153.00 ,$153.00 ,$18.96 ,$153.00 ,$18.96 ,$142.20 ,$142.20 ,$142.20 ,$162.00 ,$47.40 ,$162.00 ,$18.96 ,$180.00 ,$117.90 ,$18.96 ,$78.12 , N/A ,$19.91 ,$162.00 ,$42.66 ,$113.58 ,$108.00 ,$162.00 ,$18.96 ,$162.00 ,$162.00 ,$18.96 ,$117.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100237,82435,HC CHLORIDE,301,1 ,$55.00 ,$35.75 ,$4.60 ,$55.00 ,$40.98 ,$36.03 ,$4.60 ,$28.99 ,$4.60 ,$34.71 ,$34.71 ,$34.71 ,$34.71 ,$49.50 ,$41.25 ,$4.60 ,$48.40 ,$4.60 ,$41.25 ,$41.25 ,$46.75 ,$46.75 ,$4.60 ,$46.75 ,$4.60 ,$43.45 ,$43.45 ,$43.45 ,$49.50 ,$11.50 ,$49.50 ,$4.60 ,$55.00 ,$36.03 ,$4.60 ,$23.87 , N/A ,$4.83 ,$49.50 ,$10.35 ,$34.71 ,$33.00 ,$49.50 ,$4.60 ,$49.50 ,$49.50 ,$4.60 ,$35.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100238,82436,HC CHLORIDE URINE,301,1 ,$56.00 ,$36.40 ,$5.75 ,$56.00 ,$41.72 ,$36.68 ,$5.75 ,$29.51 ,$5.75 ,$35.34 ,$35.34 ,$35.34 ,$35.34 ,$50.40 ,$42.00 ,$5.75 ,$49.28 ,$5.75 ,$42.00 ,$42.00 ,$47.60 ,$47.60 ,$5.75 ,$47.60 ,$5.75 ,$44.24 ,$44.24 ,$44.24 ,$50.40 ,$14.38 ,$50.40 ,$5.75 ,$56.00 ,$36.68 ,$5.75 ,$24.30 , N/A ,$6.04 ,$50.40 ,$12.94 ,$35.34 ,$33.60 ,$50.40 ,$5.75 ,$50.40 ,$50.40 ,$5.75 ,$36.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100240,82438,HC CHLORIDE OTHER SOURCE,301,1 ,$33.00 ,$21.45 ,$5.00 ,$33.00 ,$24.59 ,$21.62 ,$5.00 ,$17.39 ,$5.00 ,$20.82 ,$20.82 ,$20.82 ,$20.82 ,$29.70 ,$24.75 ,$5.00 ,$29.04 ,$5.00 ,$24.75 ,$24.75 ,$28.05 ,$28.05 ,$5.00 ,$28.05 ,$5.00 ,$26.07 ,$26.07 ,$26.07 ,$29.70 ,$12.50 ,$29.70 ,$5.00 ,$33.00 ,$21.62 ,$5.00 ,$14.32 , N/A ,$5.25 ,$29.70 ,$11.25 ,$20.82 ,$19.80 ,$29.70 ,$5.00 ,$29.70 ,$29.70 ,$5.00 ,$21.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100241,82465,HC CHOLESTEROL,301,1 ,$55.00 ,$35.75 ,$4.35 ,$55.00 ,$40.98 ,$36.03 ,$4.35 ,$28.99 ,$4.35 ,$34.71 ,$34.71 ,$34.71 ,$34.71 ,$49.50 ,$41.25 ,$4.35 ,$48.40 ,$4.35 ,$41.25 ,$41.25 ,$46.75 ,$46.75 ,$4.35 ,$46.75 ,$4.35 ,$43.45 ,$43.45 ,$43.45 ,$49.50 ,$10.88 ,$49.50 ,$4.35 ,$55.00 ,$36.03 ,$4.35 ,$23.87 , N/A ,$4.57 ,$49.50 ,$9.79 ,$34.71 ,$33.00 ,$49.50 ,$4.35 ,$49.50 ,$49.50 ,$4.35 ,$35.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100254,82533,HC CORTISOL TOTAL,301,1 ,$200.00 ,$130.00 ,$16.30 ,$200.00 ,$149.00 ,$131.00 ,$16.30 ,$105.40 ,$16.30 ,$126.20 ,$126.20 ,$126.20 ,$126.20 ,$180.00 ,$150.00 ,$16.30 ,$176.00 ,$16.30 ,$150.00 ,$150.00 ,$170.00 ,$170.00 ,$16.30 ,$170.00 ,$16.30 ,$158.00 ,$158.00 ,$158.00 ,$180.00 ,$40.75 ,$180.00 ,$16.30 ,$200.00 ,$131.00 ,$16.30 ,$86.80 , N/A ,$17.12 ,$180.00 ,$36.68 ,$126.20 ,$120.00 ,$180.00 ,$16.30 ,$180.00 ,$180.00 ,$16.30 ,$130.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100259,82550,HC CREATINE KINASE (CPK) TOTAL,301,1 ,$85.00 ,$55.25 ,$6.51 ,$85.00 ,$63.33 ,$55.68 ,$6.51 ,$44.80 ,$6.51 ,$53.64 ,$53.64 ,$53.64 ,$53.64 ,$76.50 ,$63.75 ,$6.51 ,$74.80 ,$6.51 ,$63.75 ,$63.75 ,$72.25 ,$72.25 ,$6.51 ,$72.25 ,$6.51 ,$67.15 ,$67.15 ,$67.15 ,$76.50 ,$16.28 ,$76.50 ,$6.51 ,$85.00 ,$55.68 ,$6.51 ,$36.89 , N/A ,$6.84 ,$76.50 ,$14.65 ,$53.64 ,$51.00 ,$76.50 ,$6.51 ,$76.50 ,$76.50 ,$6.51 ,$55.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100261,82553,HC CREATINE KINASE MB FRAC,301,1 ,$197.00 ,$128.05 ,$11.55 ,$197.00 ,$146.77 ,$129.04 ,$11.55 ,$103.82 ,$11.55 ,$124.31 ,$124.31 ,$124.31 ,$124.31 ,$177.30 ,$147.75 ,$11.55 ,$173.36 ,$11.55 ,$147.75 ,$147.75 ,$167.45 ,$167.45 ,$11.55 ,$167.45 ,$11.55 ,$155.63 ,$155.63 ,$155.63 ,$177.30 ,$28.88 ,$177.30 ,$11.55 ,$197.00 ,$129.04 ,$11.55 ,$85.50 , N/A ,$12.13 ,$177.30 ,$25.99 ,$124.31 ,$118.20 ,$177.30 ,$11.55 ,$177.30 ,$177.30 ,$11.55 ,$128.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100262,82565,HC CREATININE,301,1 ,$55.00 ,$35.75 ,$5.12 ,$55.00 ,$40.98 ,$36.03 ,$5.12 ,$28.99 ,$5.12 ,$34.71 ,$34.71 ,$34.71 ,$34.71 ,$49.50 ,$41.25 ,$5.12 ,$48.40 ,$5.12 ,$41.25 ,$41.25 ,$46.75 ,$46.75 ,$5.12 ,$46.75 ,$5.12 ,$43.45 ,$43.45 ,$43.45 ,$49.50 ,$12.80 ,$49.50 ,$5.12 ,$5.12 ,$36.03 ,$5.12 ,$23.87 , N/A ,$5.38 ,$49.50 ,$11.52 ,$34.71 ,$33.00 ,$49.50 ,$5.12 ,$49.50 ,$49.50 ,$5.12 ,$35.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100264,82570,HC CREATININE OTH SOURCE,301,1 ,$113.00 ,$73.45 ,$5.18 ,$113.00 ,$84.19 ,$74.02 ,$5.18 ,$59.55 ,$5.18 ,$71.30 ,$71.30 ,$71.30 ,$71.30 ,$101.70 ,$84.75 ,$5.18 ,$99.44 ,$5.18 ,$84.75 ,$84.75 ,$96.05 ,$96.05 ,$5.18 ,$96.05 ,$5.18 ,$89.27 ,$89.27 ,$89.27 ,$101.70 ,$12.95 ,$101.70 ,$5.18 ,$113.00 ,$74.02 ,$5.18 ,$49.04 , N/A ,$5.44 ,$101.70 ,$11.66 ,$71.30 ,$67.80 ,$101.70 ,$5.18 ,$101.70 ,$101.70 ,$5.18 ,$73.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100266,82575,HC CREATININE CLEARANCE,301,1 ,$164.00 ,$106.60 ,$9.46 ,$164.00 ,$122.18 ,$107.42 ,$9.46 ,$86.43 ,$9.46 ,$103.48 ,$103.48 ,$103.48 ,$103.48 ,$147.60 ,$123.00 ,$9.46 ,$144.32 ,$9.46 ,$123.00 ,$123.00 ,$139.40 ,$139.40 ,$9.46 ,$139.40 ,$9.46 ,$129.56 ,$129.56 ,$129.56 ,$147.60 ,$23.65 ,$147.60 ,$9.46 ,$164.00 ,$107.42 ,$9.46 ,$71.18 , N/A ,$9.93 ,$147.60 ,$21.29 ,$103.48 ,$98.40 ,$147.60 ,$9.46 ,$147.60 ,$147.60 ,$9.46 ,$106.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100269,82607,HC VITAMIN B12,301,1 ,$75.00 ,$48.75 ,$15.08 ,$75.00 ,$55.88 ,$49.13 ,$15.08 ,$39.53 ,$15.08 ,$47.33 ,$47.33 ,$47.33 ,$47.33 ,$67.50 ,$56.25 ,$15.08 ,$66.00 ,$15.08 ,$56.25 ,$56.25 ,$63.75 ,$63.75 ,$15.08 ,$63.75 ,$15.08 ,$59.25 ,$59.25 ,$59.25 ,$67.50 ,$37.70 ,$67.50 ,$15.08 ,$75.00 ,$49.13 ,$15.08 ,$32.55 , N/A ,$15.83 ,$67.50 ,$33.93 ,$47.33 ,$45.00 ,$67.50 ,$15.08 ,$67.50 ,$67.50 ,$15.08 ,$48.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100276,82670,HC ESTRADIOL,301,1 ,$256.00 ,$166.40 ,$27.94 ,$256.00 ,$190.72 ,$167.68 ,$27.94 ,$134.91 ,$27.94 ,$161.54 ,$161.54 ,$161.54 ,$161.54 ,$230.40 ,$192.00 ,$27.94 ,$225.28 ,$27.94 ,$192.00 ,$192.00 ,$217.60 ,$217.60 ,$27.94 ,$217.60 ,$27.94 ,$202.24 ,$202.24 ,$202.24 ,$230.40 ,$69.85 ,$230.40 ,$27.94 ,$256.00 ,$167.68 ,$27.94 ,$111.10 , N/A ,$29.34 ,$230.40 ,$62.87 ,$161.54 ,$153.60 ,$230.40 ,$27.94 ,$230.40 ,$230.40 ,$27.94 ,$166.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100290,82728,HC FERRITIN,301,1 ,$178.00 ,$115.70 ,$13.63 ,$178.00 ,$132.61 ,$116.59 ,$13.63 ,$93.81 ,$13.63 ,$112.32 ,$112.32 ,$112.32 ,$112.32 ,$160.20 ,$133.50 ,$13.63 ,$156.64 ,$13.63 ,$133.50 ,$133.50 ,$151.30 ,$151.30 ,$13.63 ,$151.30 ,$13.63 ,$140.62 ,$140.62 ,$140.62 ,$160.20 ,$34.08 ,$160.20 ,$13.63 ,$178.00 ,$116.59 ,$13.63 ,$77.25 , N/A ,$14.31 ,$160.20 ,$30.67 ,$112.32 ,$106.80 ,$160.20 ,$13.63 ,$160.20 ,$160.20 ,$13.63 ,$115.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100291,82731,HC FETAL FIBRONECTIN,301,1 ,$493.00 ,$320.45 ,$64.41 ,$493.00 ,$367.29 ,$322.92 ,$64.41 ,$259.81 ,$64.41 ,$311.08 ,$311.08 ,$311.08 ,$311.08 ,$443.70 ,$369.75 ,$64.41 ,$433.84 ,$64.41 ,$369.75 ,$369.75 ,$419.05 ,$419.05 ,$64.41 ,$419.05 ,$64.41 ,$389.47 ,$389.47 ,$389.47 ,$443.70 ,$161.03 ,$443.70 ,$64.41 ,$493.00 ,$322.92 ,$64.41 ,$213.96 , N/A ,$67.63 ,$443.70 ,$144.92 ,$311.08 ,$295.80 ,$443.70 ,$64.41 ,$443.70 ,$443.70 ,$64.41 ,$320.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100292,82746,HC FOLIC ACID SERUM,301,1 ,$136.00 ,$88.40 ,$14.70 ,$136.00 ,$101.32 ,$89.08 ,$14.70 ,$71.67 ,$14.70 ,$85.82 ,$85.82 ,$85.82 ,$85.82 ,$122.40 ,$102.00 ,$14.70 ,$119.68 ,$14.70 ,$102.00 ,$102.00 ,$115.60 ,$115.60 ,$14.70 ,$115.60 ,$14.70 ,$107.44 ,$107.44 ,$107.44 ,$122.40 ,$36.75 ,$122.40 ,$14.70 ,$136.00 ,$89.08 ,$14.70 ,$59.02 , N/A ,$15.44 ,$122.40 ,$33.08 ,$85.82 ,$81.60 ,$122.40 ,$14.70 ,$122.40 ,$122.40 ,$14.70 ,$88.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100295,82784,HC GAMMAGLOBULIN,301,1 ,$125.00 ,$81.25 ,$9.30 ,$125.00 ,$93.13 ,$81.88 ,$9.30 ,$65.88 ,$9.30 ,$78.88 ,$78.88 ,$78.88 ,$78.88 ,$112.50 ,$93.75 ,$9.30 ,$110.00 ,$9.30 ,$93.75 ,$93.75 ,$106.25 ,$106.25 ,$9.30 ,$106.25 ,$9.30 ,$98.75 ,$98.75 ,$98.75 ,$112.50 ,$23.25 ,$112.50 ,$9.30 ,$125.00 ,$81.88 ,$9.30 ,$54.25 , N/A ,$9.77 ,$112.50 ,$20.93 ,$78.88 ,$75.00 ,$112.50 ,$9.30 ,$112.50 ,$112.50 ,$9.30 ,$81.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100308,82810,HC BLOOD GAS O2 SAT ONLY,301,1 ,$359.00 ,$233.35 ,$9.77 ,$359.00 ,$267.46 ,$235.15 ,$9.77 ,$189.19 ,$9.77 ,$226.53 ,$226.53 ,$226.53 ,$226.53 ,$323.10 ,$269.25 ,$9.77 ,$315.92 ,$9.77 ,$269.25 ,$269.25 ,$305.15 ,$305.15 ,$9.77 ,$305.15 ,$9.77 ,$283.61 ,$283.61 ,$283.61 ,$323.10 ,$24.43 ,$323.10 ,$9.77 ,$359.00 ,$235.15 ,$9.77 ,$155.81 , N/A ,$10.26 ,$323.10 ,$21.98 ,$226.53 ,$215.40 ,$323.10 ,$9.77 ,$323.10 ,$323.10 ,$9.77 ,$233.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100311,82945,HC GLUCOSE BODY FLUID,301,1 ,$116.00 ,$75.40 ,$3.93 ,$116.00 ,$86.42 ,$75.98 ,$3.93 ,$61.13 ,$3.93 ,$73.20 ,$73.20 ,$73.20 ,$73.20 ,$104.40 ,$87.00 ,$3.93 ,$102.08 ,$3.93 ,$87.00 ,$87.00 ,$98.60 ,$98.60 ,$3.93 ,$98.60 ,$3.93 ,$91.64 ,$91.64 ,$91.64 ,$104.40 ,$9.83 ,$104.40 ,$3.93 ,$116.00 ,$75.98 ,$3.93 ,$50.34 , N/A ,$4.13 ,$104.40 ,$8.84 ,$73.20 ,$69.60 ,$104.40 ,$3.93 ,$104.40 ,$104.40 ,$3.93 ,$75.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100312,82947,HC GLUCOSE,301,1 ,$68.00 ,$44.20 ,$3.93 ,$68.00 ,$50.66 ,$44.54 ,$3.93 ,$35.84 ,$3.93 ,$42.91 ,$42.91 ,$42.91 ,$42.91 ,$61.20 ,$51.00 ,$3.93 ,$59.84 ,$3.93 ,$51.00 ,$51.00 ,$57.80 ,$57.80 ,$3.93 ,$57.80 ,$3.93 ,$53.72 ,$53.72 ,$53.72 ,$61.20 ,$9.83 ,$61.20 ,$3.93 ,$68.00 ,$44.54 ,$3.93 ,$29.51 , N/A ,$4.13 ,$61.20 ,$8.84 ,$42.91 ,$40.80 ,$61.20 ,$3.93 ,$61.20 ,$61.20 ,$3.93 ,$44.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100313,82950,HC GLUCOSE SCREEN,301,1 ,$91.00 ,$59.15 ,$4.75 ,$91.00 ,$67.80 ,$59.61 ,$4.75 ,$47.96 ,$4.75 ,$57.42 ,$57.42 ,$57.42 ,$57.42 ,$81.90 ,$68.25 ,$4.75 ,$80.08 ,$4.75 ,$68.25 ,$68.25 ,$77.35 ,$77.35 ,$4.75 ,$77.35 ,$4.75 ,$71.89 ,$71.89 ,$71.89 ,$81.90 ,$11.88 ,$81.90 ,$4.75 ,$91.00 ,$59.61 ,$4.75 ,$39.49 , N/A ,$4.99 ,$81.90 ,$10.69 ,$57.42 ,$54.60 ,$81.90 ,$4.75 ,$81.90 ,$81.90 ,$4.75 ,$59.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100314,82951,HC GLUCOSE TOLERANCE,301,1 ,$184.00 ,$119.60 ,$12.87 ,$184.00 ,$137.08 ,$120.52 ,$12.87 ,$96.97 ,$12.87 ,$116.10 ,$116.10 ,$116.10 ,$116.10 ,$165.60 ,$138.00 ,$12.87 ,$161.92 ,$12.87 ,$138.00 ,$138.00 ,$156.40 ,$156.40 ,$12.87 ,$156.40 ,$12.87 ,$145.36 ,$145.36 ,$145.36 ,$165.60 ,$32.18 ,$165.60 ,$12.87 ,$184.00 ,$120.52 ,$12.87 ,$79.86 , N/A ,$13.51 ,$165.60 ,$28.96 ,$116.10 ,$110.40 ,$165.60 ,$12.87 ,$165.60 ,$165.60 ,$12.87 ,$119.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100315,82952,HC GLUCOSE TOLERANCE ADDL SPEC,301,1 ,$45.00 ,$29.25 ,$3.92 ,$45.00 ,$33.53 ,$29.48 ,$3.92 ,$23.72 ,$3.92 ,$28.40 ,$28.40 ,$28.40 ,$28.40 ,$40.50 ,$33.75 ,$3.92 ,$39.60 ,$3.92 ,$33.75 ,$33.75 ,$38.25 ,$38.25 ,$3.92 ,$38.25 ,$3.92 ,$35.55 ,$35.55 ,$35.55 ,$40.50 ,$9.80 ,$40.50 ,$3.92 ,$45.00 ,$29.48 ,$3.92 ,$19.53 , N/A ,$4.12 ,$40.50 ,$8.82 ,$28.40 ,$27.00 ,$40.50 ,$3.92 ,$40.50 ,$40.50 ,$3.92 ,$29.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100318,82962,HC GLUCOSE BY DEVICE,301,1 ,$17.00 ,$11.05 ,$3.28 ,$17.00 ,$12.67 ,$11.14 ,$3.28 ,$8.96 ,$3.28 ,$10.73 ,$10.73 ,$10.73 ,$10.73 ,$15.30 ,$12.75 ,$3.28 ,$14.96 ,$3.28 ,$12.75 ,$12.75 ,$14.45 ,$14.45 ,$3.28 ,$14.45 ,$3.28 ,$13.43 ,$13.43 ,$13.43 ,$15.30 ,$8.20 ,$15.30 ,$3.28 ,$17.00 ,$11.14 ,$3.28 ,$7.38 , N/A ,$3.44 ,$15.30 ,$7.38 ,$10.73 ,$10.20 ,$15.30 ,$3.28 ,$15.30 ,$15.30 ,$3.28 ,$11.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100319,82977,HC GGT/GGTP,301,1 ,$73.00 ,$47.45 ,$7.20 ,$73.00 ,$54.39 ,$47.82 ,$7.20 ,$38.47 ,$7.20 ,$46.06 ,$46.06 ,$46.06 ,$46.06 ,$65.70 ,$54.75 ,$7.20 ,$64.24 ,$7.20 ,$54.75 ,$54.75 ,$62.05 ,$62.05 ,$7.20 ,$62.05 ,$7.20 ,$57.67 ,$57.67 ,$57.67 ,$65.70 ,$18.00 ,$65.70 ,$7.20 ,$73.00 ,$47.82 ,$7.20 ,$31.68 , N/A ,$7.56 ,$65.70 ,$16.20 ,$46.06 ,$43.80 ,$65.70 ,$7.20 ,$65.70 ,$65.70 ,$7.20 ,$47.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100322,83001,HC FSH,301,1 ,$156.00 ,$101.40 ,$18.58 ,$156.00 ,$116.22 ,$102.18 ,$18.58 ,$82.21 ,$18.58 ,$98.44 ,$98.44 ,$98.44 ,$98.44 ,$140.40 ,$117.00 ,$18.58 ,$137.28 ,$18.58 ,$117.00 ,$117.00 ,$132.60 ,$132.60 ,$18.58 ,$132.60 ,$18.58 ,$123.24 ,$123.24 ,$123.24 ,$140.40 ,$46.45 ,$140.40 ,$18.58 ,$156.00 ,$102.18 ,$18.58 ,$67.70 , N/A ,$19.51 ,$140.40 ,$41.81 ,$98.44 ,$93.60 ,$140.40 ,$18.58 ,$140.40 ,$140.40 ,$18.58 ,$101.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100325,83002,HC LUTEINIZING HORMONE (LH),301,1 ,$154.00 ,$100.10 ,$18.52 ,$154.00 ,$114.73 ,$100.87 ,$18.52 ,$81.16 ,$18.52 ,$97.17 ,$97.17 ,$97.17 ,$97.17 ,$138.60 ,$115.50 ,$18.52 ,$135.52 ,$18.52 ,$115.50 ,$115.50 ,$130.90 ,$130.90 ,$18.52 ,$130.90 ,$18.52 ,$121.66 ,$121.66 ,$121.66 ,$138.60 ,$46.30 ,$138.60 ,$18.52 ,$154.00 ,$100.87 ,$18.52 ,$66.84 , N/A ,$19.45 ,$138.60 ,$41.67 ,$97.17 ,$92.40 ,$138.60 ,$18.52 ,$138.60 ,$138.60 ,$18.52 ,$100.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100327,83010,HC HAPTOGLOBIN,301,1 ,$156.00 ,$101.40 ,$12.58 ,$156.00 ,$116.22 ,$102.18 ,$12.58 ,$82.21 ,$12.58 ,$98.44 ,$98.44 ,$98.44 ,$98.44 ,$140.40 ,$117.00 ,$12.58 ,$137.28 ,$12.58 ,$117.00 ,$117.00 ,$132.60 ,$132.60 ,$12.58 ,$132.60 ,$12.58 ,$123.24 ,$123.24 ,$123.24 ,$140.40 ,$31.45 ,$140.40 ,$12.58 ,$156.00 ,$102.18 ,$12.58 ,$67.70 , N/A ,$13.21 ,$140.40 ,$28.31 ,$98.44 ,$93.60 ,$140.40 ,$12.58 ,$140.40 ,$140.40 ,$12.58 ,$101.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100337,83036,HC GLYCOSYLATED HGB,301,1 ,$84.00 ,$54.60 ,$9.71 ,$84.00 ,$62.58 ,$55.02 ,$9.71 ,$44.27 ,$9.71 ,$53.00 ,$53.00 ,$53.00 ,$53.00 ,$75.60 ,$63.00 ,$9.71 ,$73.92 ,$9.71 ,$63.00 ,$63.00 ,$71.40 ,$71.40 ,$9.71 ,$71.40 ,$9.71 ,$66.36 ,$66.36 ,$66.36 ,$75.60 ,$24.28 ,$75.60 ,$9.71 ,$84.00 ,$55.02 ,$9.71 ,$36.46 , N/A ,$10.20 ,$75.60 ,$21.85 ,$53.00 ,$50.40 ,$75.60 ,$9.71 ,$75.60 ,$75.60 ,$9.71 ,$54.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100392,83525,HC INSULIN TOTAL,301,1 ,$96.00 ,$62.40 ,$11.43 ,$96.00 ,$71.52 ,$62.88 ,$11.43 ,$50.59 ,$11.43 ,$60.58 ,$60.58 ,$60.58 ,$60.58 ,$86.40 ,$72.00 ,$11.43 ,$84.48 ,$11.43 ,$72.00 ,$72.00 ,$81.60 ,$81.60 ,$11.43 ,$81.60 ,$11.43 ,$75.84 ,$75.84 ,$75.84 ,$86.40 ,$28.58 ,$86.40 ,$11.43 ,$96.00 ,$62.88 ,$11.43 ,$41.66 , N/A ,$12.00 ,$86.40 ,$25.72 ,$60.58 ,$57.60 ,$86.40 ,$11.43 ,$86.40 ,$86.40 ,$11.43 ,$62.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100393,83540,HC IRON TOTAL,301,1 ,$76.00 ,$49.40 ,$6.47 ,$76.00 ,$56.62 ,$49.78 ,$6.47 ,$40.05 ,$6.47 ,$47.96 ,$47.96 ,$47.96 ,$47.96 ,$68.40 ,$57.00 ,$6.47 ,$66.88 ,$6.47 ,$57.00 ,$57.00 ,$64.60 ,$64.60 ,$6.47 ,$64.60 ,$6.47 ,$60.04 ,$60.04 ,$60.04 ,$68.40 ,$16.18 ,$68.40 ,$6.47 ,$76.00 ,$49.78 ,$6.47 ,$32.98 , N/A ,$6.79 ,$68.40 ,$14.56 ,$47.96 ,$45.60 ,$68.40 ,$6.47 ,$68.40 ,$68.40 ,$6.47 ,$49.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100394,83550,HC IRON BINDING CAPACITY,301,1 ,$89.00 ,$57.85 ,$8.74 ,$89.00 ,$66.31 ,$58.30 ,$8.74 ,$46.90 ,$8.74 ,$56.16 ,$56.16 ,$56.16 ,$56.16 ,$80.10 ,$66.75 ,$8.74 ,$78.32 ,$8.74 ,$66.75 ,$66.75 ,$75.65 ,$75.65 ,$8.74 ,$75.65 ,$8.74 ,$70.31 ,$70.31 ,$70.31 ,$80.10 ,$21.85 ,$80.10 ,$8.74 ,$89.00 ,$58.30 ,$8.74 ,$38.63 , N/A ,$9.18 ,$80.10 ,$19.67 ,$56.16 ,$53.40 ,$80.10 ,$8.74 ,$80.10 ,$80.10 ,$8.74 ,$57.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100396,83605,HC LACTATE/LACTIC ACID,301,1 ,$130.00 ,$84.50 ,$11.57 ,$130.00 ,$96.85 ,$85.15 ,$11.57 ,$68.51 ,$11.57 ,$82.03 ,$82.03 ,$82.03 ,$82.03 ,$117.00 ,$97.50 ,$11.57 ,$114.40 ,$11.57 ,$97.50 ,$97.50 ,$110.50 ,$110.50 ,$11.57 ,$110.50 ,$11.57 ,$102.70 ,$102.70 ,$102.70 ,$117.00 ,$28.93 ,$117.00 ,$11.57 ,$130.00 ,$85.15 ,$11.57 ,$56.42 , N/A ,$12.15 ,$117.00 ,$26.03 ,$82.03 ,$78.00 ,$117.00 ,$11.57 ,$117.00 ,$117.00 ,$11.57 ,$84.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100397,83615,HC LACTATE DEHYDRO (LDH),301,1 ,$117.00 ,$76.05 ,$6.04 ,$117.00 ,$87.17 ,$76.64 ,$6.04 ,$61.66 ,$6.04 ,$73.83 ,$73.83 ,$73.83 ,$73.83 ,$105.30 ,$87.75 ,$6.04 ,$102.96 ,$6.04 ,$87.75 ,$87.75 ,$99.45 ,$99.45 ,$6.04 ,$99.45 ,$6.04 ,$92.43 ,$92.43 ,$92.43 ,$105.30 ,$15.10 ,$105.30 ,$6.04 ,$117.00 ,$76.64 ,$6.04 ,$50.78 , N/A ,$6.34 ,$105.30 ,$13.59 ,$73.83 ,$70.20 ,$105.30 ,$6.04 ,$105.30 ,$105.30 ,$6.04 ,$76.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100409,83690,HC LIPASE,301,1 ,$85.00 ,$55.25 ,$6.89 ,$85.00 ,$63.33 ,$55.68 ,$6.89 ,$44.80 ,$6.89 ,$53.64 ,$53.64 ,$53.64 ,$53.64 ,$76.50 ,$63.75 ,$6.89 ,$74.80 ,$6.89 ,$63.75 ,$63.75 ,$72.25 ,$72.25 ,$6.89 ,$72.25 ,$6.89 ,$67.15 ,$67.15 ,$67.15 ,$76.50 ,$17.23 ,$76.50 ,$6.89 ,$85.00 ,$55.68 ,$6.89 ,$36.89 , N/A ,$7.23 ,$76.50 ,$15.50 ,$53.64 ,$51.00 ,$76.50 ,$6.89 ,$76.50 ,$76.50 ,$6.89 ,$55.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100415,83718,HC CHOLESTEROL HDL,301,1 ,$118.00 ,$76.70 ,$8.19 ,$118.00 ,$87.91 ,$77.29 ,$8.19 ,$62.19 ,$8.19 ,$74.46 ,$74.46 ,$74.46 ,$74.46 ,$106.20 ,$88.50 ,$8.19 ,$103.84 ,$8.19 ,$88.50 ,$88.50 ,$100.30 ,$100.30 ,$8.19 ,$100.30 ,$8.19 ,$93.22 ,$93.22 ,$93.22 ,$106.20 ,$20.48 ,$106.20 ,$8.19 ,$118.00 ,$77.29 ,$8.19 ,$51.21 , N/A ,$8.60 ,$106.20 ,$18.43 ,$74.46 ,$70.80 ,$106.20 ,$8.19 ,$106.20 ,$106.20 ,$8.19 ,$76.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100416,83721,HC CHOLESTEROL LDL,301,1 ,$99.00 ,$64.35 ,$10.50 ,$99.00 ,$73.76 ,$64.85 ,$10.50 ,$52.17 ,$10.50 ,$62.47 ,$62.47 ,$62.47 ,$62.47 ,$89.10 ,$74.25 ,$10.50 ,$87.12 ,$10.50 ,$74.25 ,$74.25 ,$84.15 ,$84.15 ,$10.50 ,$84.15 ,$10.50 ,$78.21 ,$78.21 ,$78.21 ,$89.10 ,$26.25 ,$89.10 ,$10.50 ,$99.00 ,$64.85 ,$10.50 ,$42.97 , N/A ,$11.03 ,$89.10 ,$23.63 ,$62.47 ,$59.40 ,$89.10 ,$10.50 ,$89.10 ,$89.10 ,$10.50 ,$64.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100417,83735,HC MAGNESIUM,301,1 ,$59.00 ,$38.35 ,$6.70 ,$59.00 ,$43.96 ,$38.65 ,$6.70 ,$31.09 ,$6.70 ,$37.23 ,$37.23 ,$37.23 ,$37.23 ,$53.10 ,$44.25 ,$6.70 ,$51.92 ,$6.70 ,$44.25 ,$44.25 ,$50.15 ,$50.15 ,$6.70 ,$50.15 ,$6.70 ,$46.61 ,$46.61 ,$46.61 ,$53.10 ,$16.75 ,$53.10 ,$6.70 ,$59.00 ,$38.65 ,$6.70 ,$25.61 , N/A ,$7.04 ,$53.10 ,$15.08 ,$37.23 ,$35.40 ,$53.10 ,$6.70 ,$53.10 ,$53.10 ,$6.70 ,$38.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100438,83880,HC BNP NATRIURETIC PEPTIDE,301,1 ,$156.00 ,$101.40 ,$39.26 ,$156.00 ,$116.22 ,$102.18 ,$39.26 ,$82.21 ,$39.26 ,$98.44 ,$98.44 ,$98.44 ,$98.44 ,$140.40 ,$117.00 ,$39.26 ,$137.28 ,$39.26 ,$117.00 ,$117.00 ,$132.60 ,$132.60 ,$39.26 ,$132.60 ,$39.26 ,$123.24 ,$123.24 ,$123.24 ,$140.40 ,$98.15 ,$140.40 ,$39.26 ,$156.00 ,$102.18 ,$39.26 ,$67.70 , N/A ,$41.22 ,$140.40 ,$88.34 ,$98.44 ,$93.60 ,$140.40 ,$39.26 ,$140.40 ,$140.40 ,$39.26 ,$101.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100668,83930,HC OSMOLALITY BLOOD,301,1 ,$89.00 ,$57.85 ,$6.61 ,$89.00 ,$66.31 ,$58.30 ,$6.61 ,$46.90 ,$6.61 ,$56.16 ,$56.16 ,$56.16 ,$56.16 ,$80.10 ,$66.75 ,$6.61 ,$78.32 ,$6.61 ,$66.75 ,$66.75 ,$75.65 ,$75.65 ,$6.61 ,$75.65 ,$6.61 ,$70.31 ,$70.31 ,$70.31 ,$80.10 ,$16.53 ,$80.10 ,$6.61 ,$89.00 ,$58.30 ,$6.61 ,$38.63 , N/A ,$6.94 ,$80.10 ,$14.87 ,$56.16 ,$53.40 ,$80.10 ,$6.61 ,$80.10 ,$80.10 ,$6.61 ,$57.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100669,83935,HC OSMOLALITY URINE,301,1 ,$87.00 ,$56.55 ,$6.82 ,$87.00 ,$64.82 ,$56.99 ,$6.82 ,$45.85 ,$6.82 ,$54.90 ,$54.90 ,$54.90 ,$54.90 ,$78.30 ,$65.25 ,$6.82 ,$76.56 ,$6.82 ,$65.25 ,$65.25 ,$73.95 ,$73.95 ,$6.82 ,$73.95 ,$6.82 ,$68.73 ,$68.73 ,$68.73 ,$78.30 ,$17.05 ,$78.30 ,$6.82 ,$87.00 ,$56.99 ,$6.82 ,$37.76 , N/A ,$7.16 ,$78.30 ,$15.35 ,$54.90 ,$52.20 ,$78.30 ,$6.82 ,$78.30 ,$78.30 ,$6.82 ,$56.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100672,83970,HC PARATHYROID HORMONE (PTH),301,1 ,$231.00 ,$150.15 ,$41.28 ,$231.00 ,$172.10 ,$151.31 ,$41.28 ,$121.74 ,$41.28 ,$145.76 ,$145.76 ,$145.76 ,$145.76 ,$207.90 ,$173.25 ,$41.28 ,$203.28 ,$41.28 ,$173.25 ,$173.25 ,$196.35 ,$196.35 ,$41.28 ,$196.35 ,$41.28 ,$182.49 ,$182.49 ,$182.49 ,$207.90 ,$103.20 ,$207.90 ,$41.28 ,$231.00 ,$151.31 ,$41.28 ,$100.25 , N/A ,$43.34 ,$207.90 ,$92.88 ,$145.76 ,$138.60 ,$207.90 ,$41.28 ,$207.90 ,$207.90 ,$41.28 ,$150.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100673,83986,HC PH BODY FLUID,301,1 ,$57.00 ,$37.05 ,$3.58 ,$57.00 ,$42.47 ,$37.34 ,$3.58 ,$30.04 ,$3.58 ,$35.97 ,$35.97 ,$35.97 ,$35.97 ,$51.30 ,$42.75 ,$3.58 ,$50.16 ,$3.58 ,$42.75 ,$42.75 ,$48.45 ,$48.45 ,$3.58 ,$48.45 ,$3.58 ,$45.03 ,$45.03 ,$45.03 ,$51.30 ,$8.95 ,$51.30 ,$3.58 ,$57.00 ,$37.34 ,$3.58 ,$24.74 , N/A ,$3.76 ,$51.30 ,$8.06 ,$35.97 ,$34.20 ,$51.30 ,$3.58 ,$51.30 ,$51.30 ,$3.58 ,$37.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100679,84075,HC ALKALINE PHOSPHATASE,301,1 ,$77.00 ,$50.05 ,$5.18 ,$77.00 ,$57.37 ,$50.44 ,$5.18 ,$40.58 ,$5.18 ,$48.59 ,$48.59 ,$48.59 ,$48.59 ,$69.30 ,$57.75 ,$5.18 ,$67.76 ,$5.18 ,$57.75 ,$57.75 ,$65.45 ,$65.45 ,$5.18 ,$65.45 ,$5.18 ,$60.83 ,$60.83 ,$60.83 ,$69.30 ,$12.95 ,$69.30 ,$5.18 ,$77.00 ,$50.44 ,$5.18 ,$33.42 , N/A ,$5.44 ,$69.30 ,$11.66 ,$48.59 ,$46.20 ,$69.30 ,$5.18 ,$69.30 ,$69.30 ,$5.18 ,$50.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100684,84100,HC PHOSPHORUS,301,1 ,$59.00 ,$38.35 ,$4.74 ,$59.00 ,$43.96 ,$38.65 ,$4.74 ,$31.09 ,$4.74 ,$37.23 ,$37.23 ,$37.23 ,$37.23 ,$53.10 ,$44.25 ,$4.74 ,$51.92 ,$4.74 ,$44.25 ,$44.25 ,$50.15 ,$50.15 ,$4.74 ,$50.15 ,$4.74 ,$46.61 ,$46.61 ,$46.61 ,$53.10 ,$11.85 ,$53.10 ,$4.74 ,$59.00 ,$38.65 ,$4.74 ,$25.61 , N/A ,$4.98 ,$53.10 ,$10.67 ,$37.23 ,$35.40 ,$53.10 ,$4.74 ,$53.10 ,$53.10 ,$4.74 ,$38.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100688,84112,HC PLACENTAL ALPHA MICROGLOBULIN,301,1 ,$241.00 ,$156.65 ,$98.11 ,$241.00 ,$179.55 ,$157.86 ,$98.11 ,$127.01 ,$98.11 ,$152.07 ,$152.07 ,$152.07 ,$152.07 ,$216.90 ,$180.75 ,$98.11 ,$212.08 ,$98.11 ,$180.75 ,$180.75 ,$204.85 ,$204.85 ,$98.11 ,$204.85 ,$98.11 ,$190.39 ,$190.39 ,$190.39 ,$216.90 ,$241.00 ,$216.90 ,$98.11 ,$241.00 ,$157.86 ,$98.11 ,$104.59 , N/A ,$103.02 ,$216.90 ,$220.75 ,$152.07 ,$144.60 ,$216.90 ,$98.11 ,$216.90 ,$216.90 ,$98.11 ,$156.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100691,84132,HC POTASSIUM,301,1 ,$57.00 ,$37.05 ,$4.76 ,$57.00 ,$42.47 ,$37.34 ,$4.76 ,$30.04 ,$4.76 ,$35.97 ,$35.97 ,$35.97 ,$35.97 ,$51.30 ,$42.75 ,$4.76 ,$50.16 ,$4.76 ,$42.75 ,$42.75 ,$48.45 ,$48.45 ,$4.76 ,$48.45 ,$4.76 ,$45.03 ,$45.03 ,$45.03 ,$51.30 ,$11.90 ,$51.30 ,$4.76 ,$57.00 ,$37.34 ,$4.76 ,$24.74 , N/A ,$5.00 ,$51.30 ,$10.71 ,$35.97 ,$34.20 ,$51.30 ,$4.76 ,$51.30 ,$51.30 ,$4.76 ,$37.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100694,84133,HC POTASSIUM URINE,301,1 ,$61.00 ,$39.65 ,$4.73 ,$61.00 ,$45.45 ,$39.96 ,$4.73 ,$32.15 ,$4.73 ,$38.49 ,$38.49 ,$38.49 ,$38.49 ,$54.90 ,$45.75 ,$4.73 ,$53.68 ,$4.73 ,$45.75 ,$45.75 ,$51.85 ,$51.85 ,$4.73 ,$51.85 ,$4.73 ,$48.19 ,$48.19 ,$48.19 ,$54.90 ,$11.83 ,$54.90 ,$4.73 ,$61.00 ,$39.96 ,$4.73 ,$26.47 , N/A ,$4.97 ,$54.90 ,$10.64 ,$38.49 ,$36.60 ,$54.90 ,$4.73 ,$54.90 ,$54.90 ,$4.73 ,$39.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100695,84134,HC PREALBUMIN,301,1 ,$112.00 ,$72.80 ,$14.59 ,$112.00 ,$83.44 ,$73.36 ,$14.59 ,$59.02 ,$14.59 ,$70.67 ,$70.67 ,$70.67 ,$70.67 ,$100.80 ,$84.00 ,$14.59 ,$98.56 ,$14.59 ,$84.00 ,$84.00 ,$95.20 ,$95.20 ,$14.59 ,$95.20 ,$14.59 ,$88.48 ,$88.48 ,$88.48 ,$100.80 ,$36.48 ,$100.80 ,$14.59 ,$112.00 ,$73.36 ,$14.59 ,$48.61 , N/A ,$15.32 ,$100.80 ,$32.83 ,$70.67 ,$67.20 ,$100.80 ,$14.59 ,$100.80 ,$100.80 ,$14.59 ,$72.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100696,84144,HC PROGESTERONE,301,1 ,$176.00 ,$114.40 ,$20.86 ,$176.00 ,$131.12 ,$115.28 ,$20.86 ,$92.75 ,$20.86 ,$111.06 ,$111.06 ,$111.06 ,$111.06 ,$158.40 ,$132.00 ,$20.86 ,$154.88 ,$20.86 ,$132.00 ,$132.00 ,$149.60 ,$149.60 ,$20.86 ,$149.60 ,$20.86 ,$139.04 ,$139.04 ,$139.04 ,$158.40 ,$52.15 ,$158.40 ,$20.86 ,$176.00 ,$115.28 ,$20.86 ,$76.38 , N/A ,$21.90 ,$158.40 ,$46.94 ,$111.06 ,$105.60 ,$158.40 ,$20.86 ,$158.40 ,$158.40 ,$20.86 ,$114.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100697,84146,HC PROLACTIN,301,1 ,$170.00 ,$110.50 ,$19.38 ,$170.00 ,$126.65 ,$111.35 ,$19.38 ,$89.59 ,$19.38 ,$107.27 ,$107.27 ,$107.27 ,$107.27 ,$153.00 ,$127.50 ,$19.38 ,$149.60 ,$19.38 ,$127.50 ,$127.50 ,$144.50 ,$144.50 ,$19.38 ,$144.50 ,$19.38 ,$134.30 ,$134.30 ,$134.30 ,$153.00 ,$48.45 ,$153.00 ,$19.38 ,$170.00 ,$111.35 ,$19.38 ,$73.78 , N/A ,$20.35 ,$153.00 ,$43.61 ,$107.27 ,$102.00 ,$153.00 ,$19.38 ,$153.00 ,$153.00 ,$19.38 ,$110.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100698,84153,HC PSA TOTAL,301,1 ,$266.00 ,$172.90 ,$18.39 ,$266.00 ,$198.17 ,$174.23 ,$18.39 ,$140.18 ,$18.39 ,$167.85 ,$167.85 ,$167.85 ,$167.85 ,$239.40 ,$199.50 ,$18.39 ,$234.08 ,$18.39 ,$199.50 ,$199.50 ,$226.10 ,$226.10 ,$18.39 ,$226.10 ,$18.39 ,$210.14 ,$210.14 ,$210.14 ,$239.40 ,$45.98 ,$239.40 ,$18.39 ,$266.00 ,$174.23 ,$18.39 ,$115.44 , N/A ,$19.31 ,$239.40 ,$41.38 ,$167.85 ,$159.60 ,$239.40 ,$18.39 ,$239.40 ,$239.40 ,$18.39 ,$172.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100700,84155,HC PROTEIN TOTAL,301,1 ,$50.00 ,$32.50 ,$3.67 ,$50.00 ,$37.25 ,$32.75 ,$3.67 ,$26.35 ,$3.67 ,$31.55 ,$31.55 ,$31.55 ,$31.55 ,$45.00 ,$37.50 ,$3.67 ,$44.00 ,$3.67 ,$37.50 ,$37.50 ,$42.50 ,$42.50 ,$3.67 ,$42.50 ,$3.67 ,$39.50 ,$39.50 ,$39.50 ,$45.00 ,$9.18 ,$45.00 ,$3.67 ,$50.00 ,$32.75 ,$3.67 ,$21.70 , N/A ,$3.85 ,$45.00 ,$8.26 ,$31.55 ,$30.00 ,$45.00 ,$3.67 ,$45.00 ,$45.00 ,$3.67 ,$32.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100701,84156,HC PROTEIN TOTAL URINE,301,1 ,$91.00 ,$59.15 ,$3.67 ,$91.00 ,$67.80 ,$59.61 ,$3.67 ,$47.96 ,$3.67 ,$57.42 ,$57.42 ,$57.42 ,$57.42 ,$81.90 ,$68.25 ,$3.67 ,$80.08 ,$3.67 ,$68.25 ,$68.25 ,$77.35 ,$77.35 ,$3.67 ,$77.35 ,$3.67 ,$71.89 ,$71.89 ,$71.89 ,$81.90 ,$9.18 ,$81.90 ,$3.67 ,$91.00 ,$59.61 ,$3.67 ,$39.49 , N/A ,$3.85 ,$81.90 ,$8.26 ,$57.42 ,$54.60 ,$81.90 ,$3.67 ,$81.90 ,$81.90 ,$3.67 ,$59.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100703,84157,HC PROTEIN TOTAL OTH SRC,301,1 ,$125.00 ,$81.25 ,$4.00 ,$125.00 ,$93.13 ,$81.88 ,$4.00 ,$65.88 ,$4.00 ,$78.88 ,$78.88 ,$78.88 ,$78.88 ,$112.50 ,$93.75 ,$4.00 ,$110.00 ,$4.00 ,$93.75 ,$93.75 ,$106.25 ,$106.25 ,$4.00 ,$106.25 ,$4.00 ,$98.75 ,$98.75 ,$98.75 ,$112.50 ,$10.00 ,$112.50 ,$4.00 ,$125.00 ,$81.88 ,$4.00 ,$54.25 , N/A ,$4.20 ,$112.50 ,$9.00 ,$78.88 ,$75.00 ,$112.50 ,$4.00 ,$112.50 ,$112.50 ,$4.00 ,$81.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100721,84295,HC SODIUM,301,1 ,$53.00 ,$34.45 ,$4.81 ,$53.00 ,$39.49 ,$34.72 ,$4.81 ,$27.93 ,$4.81 ,$33.44 ,$33.44 ,$33.44 ,$33.44 ,$47.70 ,$39.75 ,$4.81 ,$46.64 ,$4.81 ,$39.75 ,$39.75 ,$45.05 ,$45.05 ,$4.81 ,$45.05 ,$4.81 ,$41.87 ,$41.87 ,$41.87 ,$47.70 ,$12.03 ,$47.70 ,$4.81 ,$53.00 ,$34.72 ,$4.81 ,$23.00 , N/A ,$5.05 ,$47.70 ,$10.82 ,$33.44 ,$31.80 ,$47.70 ,$4.81 ,$47.70 ,$47.70 ,$4.81 ,$34.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100724,84300,HC SODIUM URINE,301,1 ,$66.00 ,$42.90 ,$5.06 ,$66.00 ,$49.17 ,$43.23 ,$5.06 ,$34.78 ,$5.06 ,$41.65 ,$41.65 ,$41.65 ,$41.65 ,$59.40 ,$49.50 ,$5.06 ,$58.08 ,$5.06 ,$49.50 ,$49.50 ,$56.10 ,$56.10 ,$5.06 ,$56.10 ,$5.06 ,$52.14 ,$52.14 ,$52.14 ,$59.40 ,$12.65 ,$59.40 ,$5.06 ,$66.00 ,$43.23 ,$5.06 ,$28.64 , N/A ,$5.31 ,$59.40 ,$11.39 ,$41.65 ,$39.60 ,$59.40 ,$5.06 ,$59.40 ,$59.40 ,$5.06 ,$42.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100730,84315,HC SPEC GRAVITY NON UR,301,1 ,$41.00 ,$26.65 ,$3.28 ,$41.00 ,$30.55 ,$26.86 ,$3.28 ,$21.61 ,$3.28 ,$25.87 ,$25.87 ,$25.87 ,$25.87 ,$36.90 ,$30.75 ,$3.28 ,$36.08 ,$3.28 ,$30.75 ,$30.75 ,$34.85 ,$34.85 ,$3.28 ,$34.85 ,$3.28 ,$32.39 ,$32.39 ,$32.39 ,$36.90 ,$8.20 ,$36.90 ,$3.28 ,$41.00 ,$26.86 ,$3.28 ,$17.79 , N/A ,$3.44 ,$36.90 ,$7.38 ,$25.87 ,$24.60 ,$36.90 ,$3.28 ,$36.90 ,$36.90 ,$3.28 ,$26.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100739,84436,HC THYROXINE (T-4) TOTAL,301,1 ,$88.00 ,$57.20 ,$6.87 ,$88.00 ,$65.56 ,$57.64 ,$6.87 ,$46.38 ,$6.87 ,$55.53 ,$55.53 ,$55.53 ,$55.53 ,$79.20 ,$66.00 ,$6.87 ,$77.44 ,$6.87 ,$66.00 ,$66.00 ,$74.80 ,$74.80 ,$6.87 ,$74.80 ,$6.87 ,$69.52 ,$69.52 ,$69.52 ,$79.20 ,$17.18 ,$79.20 ,$6.87 ,$88.00 ,$57.64 ,$6.87 ,$38.19 , N/A ,$7.21 ,$79.20 ,$15.46 ,$55.53 ,$52.80 ,$79.20 ,$6.87 ,$79.20 ,$79.20 ,$6.87 ,$57.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100740,84439,HC T4 FREE,301,1 ,$107.00 ,$69.55 ,$9.02 ,$107.00 ,$79.72 ,$70.09 ,$9.02 ,$56.39 ,$9.02 ,$67.52 ,$67.52 ,$67.52 ,$67.52 ,$96.30 ,$80.25 ,$9.02 ,$94.16 ,$9.02 ,$80.25 ,$80.25 ,$90.95 ,$90.95 ,$9.02 ,$90.95 ,$9.02 ,$84.53 ,$84.53 ,$84.53 ,$96.30 ,$22.55 ,$96.30 ,$9.02 ,$107.00 ,$70.09 ,$9.02 ,$46.44 , N/A ,$9.47 ,$96.30 ,$20.30 ,$67.52 ,$64.20 ,$96.30 ,$9.02 ,$96.30 ,$96.30 ,$9.02 ,$69.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100743,84443,HC THYROID STIMULATING HORM,301,1 ,$108.00 ,$70.20 ,$16.80 ,$108.00 ,$80.46 ,$70.74 ,$16.80 ,$56.92 ,$16.80 ,$68.15 ,$68.15 ,$68.15 ,$68.15 ,$97.20 ,$81.00 ,$16.80 ,$95.04 ,$16.80 ,$81.00 ,$81.00 ,$91.80 ,$91.80 ,$16.80 ,$91.80 ,$16.80 ,$85.32 ,$85.32 ,$85.32 ,$97.20 ,$42.00 ,$97.20 ,$16.80 ,$108.00 ,$70.74 ,$16.80 ,$46.87 , N/A ,$17.64 ,$97.20 ,$37.80 ,$68.15 ,$64.80 ,$97.20 ,$16.80 ,$97.20 ,$97.20 ,$16.80 ,$70.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100746,84450,HC AST,301,1 ,$96.00 ,$62.40 ,$5.18 ,$96.00 ,$71.52 ,$62.88 ,$5.18 ,$50.59 ,$5.18 ,$60.58 ,$60.58 ,$60.58 ,$60.58 ,$86.40 ,$72.00 ,$5.18 ,$84.48 ,$5.18 ,$72.00 ,$72.00 ,$81.60 ,$81.60 ,$5.18 ,$81.60 ,$5.18 ,$75.84 ,$75.84 ,$75.84 ,$86.40 ,$12.95 ,$86.40 ,$5.18 ,$96.00 ,$62.88 ,$5.18 ,$41.66 , N/A ,$5.44 ,$86.40 ,$11.66 ,$60.58 ,$57.60 ,$86.40 ,$5.18 ,$86.40 ,$86.40 ,$5.18 ,$62.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100747,84460,HC ALT,301,1 ,$96.00 ,$62.40 ,$5.30 ,$96.00 ,$71.52 ,$62.88 ,$5.30 ,$50.59 ,$5.30 ,$60.58 ,$60.58 ,$60.58 ,$60.58 ,$86.40 ,$72.00 ,$5.30 ,$84.48 ,$5.30 ,$72.00 ,$72.00 ,$81.60 ,$81.60 ,$5.30 ,$81.60 ,$5.30 ,$75.84 ,$75.84 ,$75.84 ,$86.40 ,$13.25 ,$86.40 ,$5.30 ,$96.00 ,$62.88 ,$5.30 ,$41.66 , N/A ,$5.57 ,$86.40 ,$11.93 ,$60.58 ,$57.60 ,$86.40 ,$5.30 ,$86.40 ,$86.40 ,$5.30 ,$62.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100748,84466,HC TRANSFERRIN,301,1 ,$181.00 ,$117.65 ,$12.76 ,$181.00 ,$134.85 ,$118.56 ,$12.76 ,$95.39 ,$12.76 ,$114.21 ,$114.21 ,$114.21 ,$114.21 ,$162.90 ,$135.75 ,$12.76 ,$159.28 ,$12.76 ,$135.75 ,$135.75 ,$153.85 ,$153.85 ,$12.76 ,$153.85 ,$12.76 ,$142.99 ,$142.99 ,$142.99 ,$162.90 ,$31.90 ,$162.90 ,$12.76 ,$181.00 ,$118.56 ,$12.76 ,$78.55 , N/A ,$13.40 ,$162.90 ,$28.71 ,$114.21 ,$108.60 ,$162.90 ,$12.76 ,$162.90 ,$162.90 ,$12.76 ,$117.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100750,84478,HC TRIGLYCERIDES,301,1 ,$65.00 ,$42.25 ,$5.74 ,$65.00 ,$48.43 ,$42.58 ,$5.74 ,$34.26 ,$5.74 ,$41.02 ,$41.02 ,$41.02 ,$41.02 ,$58.50 ,$48.75 ,$5.74 ,$57.20 ,$5.74 ,$48.75 ,$48.75 ,$55.25 ,$55.25 ,$5.74 ,$55.25 ,$5.74 ,$51.35 ,$51.35 ,$51.35 ,$58.50 ,$14.35 ,$58.50 ,$5.74 ,$65.00 ,$42.58 ,$5.74 ,$28.21 , N/A ,$6.03 ,$58.50 ,$12.92 ,$41.02 ,$39.00 ,$58.50 ,$5.74 ,$58.50 ,$58.50 ,$5.74 ,$42.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100753,84479,HC T3 UPTAKE,301,1 ,$18.00 ,$11.70 ,$6.47 ,$18.00 ,$13.41 ,$11.79 ,$6.47 ,$9.49 ,$6.47 ,$11.36 ,$11.36 ,$11.36 ,$11.36 ,$16.20 ,$13.50 ,$6.47 ,$15.84 ,$6.47 ,$13.50 ,$13.50 ,$15.30 ,$15.30 ,$6.47 ,$15.30 ,$6.47 ,$14.22 ,$14.22 ,$14.22 ,$16.20 ,$16.18 ,$16.20 ,$6.47 ,$18.00 ,$11.79 ,$6.47 ,$7.81 , N/A ,$6.79 ,$16.20 ,$14.56 ,$11.36 ,$10.80 ,$16.20 ,$6.47 ,$16.20 ,$16.20 ,$6.47 ,$11.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100754,84480,HC T3 TOTAL,301,1 ,$209.00 ,$135.85 ,$14.18 ,$209.00 ,$155.71 ,$136.90 ,$14.18 ,$110.14 ,$14.18 ,$131.88 ,$131.88 ,$131.88 ,$131.88 ,$188.10 ,$156.75 ,$14.18 ,$183.92 ,$14.18 ,$156.75 ,$156.75 ,$177.65 ,$177.65 ,$14.18 ,$177.65 ,$14.18 ,$165.11 ,$165.11 ,$165.11 ,$188.10 ,$35.45 ,$188.10 ,$14.18 ,$209.00 ,$136.90 ,$14.18 ,$90.71 , N/A ,$14.89 ,$188.10 ,$31.91 ,$131.88 ,$125.40 ,$188.10 ,$14.18 ,$188.10 ,$188.10 ,$14.18 ,$135.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100755,84481,HC T3 FREE,301,1 ,$148.00 ,$96.20 ,$16.94 ,$148.00 ,$110.26 ,$96.94 ,$16.94 ,$78.00 ,$16.94 ,$93.39 ,$93.39 ,$93.39 ,$93.39 ,$133.20 ,$111.00 ,$16.94 ,$130.24 ,$16.94 ,$111.00 ,$111.00 ,$125.80 ,$125.80 ,$16.94 ,$125.80 ,$16.94 ,$116.92 ,$116.92 ,$116.92 ,$133.20 ,$42.35 ,$133.20 ,$16.94 ,$148.00 ,$96.94 ,$16.94 ,$64.23 , N/A ,$17.79 ,$133.20 ,$38.12 ,$93.39 ,$88.80 ,$133.20 ,$16.94 ,$133.20 ,$133.20 ,$16.94 ,$96.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100758,84484,HC TROPONIN QN,301,1 ,$139.00 ,$90.35 ,$12.47 ,$139.00 ,$103.56 ,$91.05 ,$12.47 ,$73.25 ,$12.47 ,$87.71 ,$87.71 ,$87.71 ,$87.71 ,$125.10 ,$104.25 ,$12.47 ,$122.32 ,$12.47 ,$104.25 ,$104.25 ,$118.15 ,$118.15 ,$12.47 ,$118.15 ,$12.47 ,$109.81 ,$109.81 ,$109.81 ,$125.10 ,$31.18 ,$125.10 ,$12.47 ,$139.00 ,$91.05 ,$12.47 ,$60.33 , N/A ,$13.09 ,$125.10 ,$28.06 ,$87.71 ,$83.40 ,$125.10 ,$12.47 ,$125.10 ,$125.10 ,$12.47 ,$90.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100761,84520,HC BUN,301,1 ,$70.00 ,$45.50 ,$3.95 ,$70.00 ,$52.15 ,$45.85 ,$3.95 ,$36.89 ,$3.95 ,$44.17 ,$44.17 ,$44.17 ,$44.17 ,$63.00 ,$52.50 ,$3.95 ,$61.60 ,$3.95 ,$52.50 ,$52.50 ,$59.50 ,$59.50 ,$3.95 ,$59.50 ,$3.95 ,$55.30 ,$55.30 ,$55.30 ,$63.00 ,$9.88 ,$63.00 ,$3.95 ,$3.95 ,$45.85 ,$3.95 ,$30.38 , N/A ,$4.15 ,$63.00 ,$8.89 ,$44.17 ,$42.00 ,$63.00 ,$3.95 ,$63.00 ,$63.00 ,$3.95 ,$45.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100765,84550,HC URIC ACID,301,1 ,$49.00 ,$31.85 ,$4.52 ,$49.00 ,$36.51 ,$32.10 ,$4.52 ,$25.82 ,$4.52 ,$30.92 ,$30.92 ,$30.92 ,$30.92 ,$44.10 ,$36.75 ,$4.52 ,$43.12 ,$4.52 ,$36.75 ,$36.75 ,$41.65 ,$41.65 ,$4.52 ,$41.65 ,$4.52 ,$38.71 ,$38.71 ,$38.71 ,$44.10 ,$11.30 ,$44.10 ,$4.52 ,$49.00 ,$32.10 ,$4.52 ,$21.27 , N/A ,$4.75 ,$44.10 ,$10.17 ,$30.92 ,$29.40 ,$44.10 ,$4.52 ,$44.10 ,$44.10 ,$4.52 ,$31.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100802,84702,HC HCG QN,301,1 ,$276.00 ,$179.40 ,$15.05 ,$276.00 ,$205.62 ,$180.78 ,$15.05 ,$145.45 ,$15.05 ,$174.16 ,$174.16 ,$174.16 ,$174.16 ,$248.40 ,$207.00 ,$15.05 ,$242.88 ,$15.05 ,$207.00 ,$207.00 ,$234.60 ,$234.60 ,$15.05 ,$234.60 ,$15.05 ,$218.04 ,$218.04 ,$218.04 ,$248.40 ,$37.63 ,$248.40 ,$15.05 ,$276.00 ,$180.78 ,$15.05 ,$119.78 , N/A ,$15.80 ,$248.40 ,$33.86 ,$174.16 ,$165.60 ,$248.40 ,$15.05 ,$248.40 ,$248.40 ,$15.05 ,$179.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100808,84703,HC HCG QL,301,1 ,$113.00 ,$73.45 ,$7.52 ,$113.00 ,$84.19 ,$74.02 ,$7.52 ,$59.55 ,$7.52 ,$71.30 ,$71.30 ,$71.30 ,$71.30 ,$101.70 ,$84.75 ,$7.52 ,$99.44 ,$7.52 ,$84.75 ,$84.75 ,$96.05 ,$96.05 ,$7.52 ,$96.05 ,$7.52 ,$89.27 ,$89.27 ,$89.27 ,$101.70 ,$18.80 ,$101.70 ,$7.52 ,$113.00 ,$74.02 ,$7.52 ,$49.04 , N/A ,$7.90 ,$101.70 ,$16.92 ,$71.30 ,$67.80 ,$101.70 ,$7.52 ,$101.70 ,$101.70 ,$7.52 ,$73.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30100810,88720,HC BILICHECK TEST,301,1 ,$82.00 ,$53.30 ,$5.02 ,$82.00 ,$61.09 ,$53.71 ,$5.02 ,$43.21 ,$5.02 ,$51.74 ,$51.74 ,$51.74 ,$51.74 ,$73.80 ,$61.50 ,$5.02 ,$72.16 ,$5.02 ,$61.50 ,$61.50 ,$69.70 ,$69.70 ,$5.02 ,$69.70 ,$5.02 ,$64.78 ,$64.78 ,$64.78 ,$73.80 ,$12.55 ,$73.80 ,$5.02 ,$82.00 ,$53.71 ,$5.02 ,$35.59 , N/A ,$5.27 ,$73.80 ,$11.30 ,$51.74 ,$49.20 ,$73.80 ,$5.02 ,$73.80 ,$73.80 ,$5.02 ,$53.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101023,G0103,HC PSA ANNUAL SCREENING,301,1 ,$311.00 ,$202.15 ,$19.31 ,$311.00 ,$231.70 ,$203.71 ,$19.31 ,$163.90 ,$19.31 ,$196.24 ,$196.24 ,$196.24 ,$196.24 ,$279.90 ,$233.25 ,$19.31 ,$273.68 ,$19.31 ,$233.25 ,$233.25 ,$264.35 ,$264.35 ,$19.31 ,$264.35 ,$19.31 ,$245.69 ,$245.69 ,$245.69 ,$279.90 ,$48.28 ,$279.90 ,$19.31 ,$311.00 ,$203.71 ,$19.31 ,$134.97 , N/A ,$20.28 ,$279.90 ,$43.45 ,$196.24 ,$186.60 ,$279.90 ,$19.31 ,$279.90 ,$279.90 ,$19.31 ,$202.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101063,83519,HC ACETYLCHOLINE RECEPTR AB TIER 1-90,301,1 ,$125.00 ,$81.25 ,$18.40 ,$125.00 ,$93.13 ,$81.88 ,$18.40 ,$65.88 ,$18.40 ,$78.88 ,$78.88 ,$78.88 ,$78.88 ,$112.50 ,$93.75 ,$18.40 ,$110.00 ,$18.40 ,$93.75 ,$93.75 ,$106.25 ,$106.25 ,$18.40 ,$106.25 ,$18.40 ,$98.75 ,$98.75 ,$98.75 ,$112.50 ,$46.00 ,$112.50 ,$18.40 ,$125.00 ,$81.88 ,$18.40 ,$54.25 , N/A ,$19.32 ,$112.50 ,$41.40 ,$78.88 ,$75.00 ,$112.50 ,$18.40 ,$112.50 ,$112.50 ,$18.40 ,$81.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101064,83519,HC ACETYLCHOLINE RECEPTR AB TIER 2-90,301,1 ,$370.50 ,$240.83 ,$18.40 ,$370.50 ,$276.02 ,$242.68 ,$18.40 ,$195.25 ,$18.40 ,$233.79 ,$233.79 ,$233.79 ,$233.79 ,$333.45 ,$277.88 ,$18.40 ,$326.04 ,$18.40 ,$277.88 ,$277.88 ,$314.93 ,$314.93 ,$18.40 ,$314.93 ,$18.40 ,$292.70 ,$292.70 ,$292.70 ,$333.45 ,$46.00 ,$333.45 ,$18.40 ,$370.50 ,$242.68 ,$18.40 ,$160.80 , N/A ,$19.32 ,$333.45 ,$41.40 ,$233.79 ,$222.30 ,$333.45 ,$18.40 ,$333.45 ,$333.45 ,$18.40 ,$240.83 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101089,80150,HC AMIKACIN - 90,301,1 ,$93.00 ,$60.45 ,$15.08 ,$93.00 ,$69.29 ,$60.92 ,$15.08 ,$49.01 ,$15.08 ,$58.68 ,$58.68 ,$58.68 ,$58.68 ,$83.70 ,$69.75 ,$15.08 ,$81.84 ,$15.08 ,$69.75 ,$69.75 ,$79.05 ,$79.05 ,$15.08 ,$79.05 ,$15.08 ,$73.47 ,$73.47 ,$73.47 ,$83.70 ,$37.70 ,$83.70 ,$15.08 ,$93.00 ,$60.92 ,$15.08 ,$40.36 , N/A ,$15.83 ,$83.70 ,$33.93 ,$58.68 ,$55.80 ,$83.70 ,$15.08 ,$83.70 ,$83.70 ,$15.08 ,$60.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101093,80157,HC CARBAMAZEPINE FREE - 90,301,1 ,$102.00 ,$66.30 ,$13.25 ,$102.00 ,$75.99 ,$66.81 ,$13.25 ,$53.75 ,$13.25 ,$64.36 ,$64.36 ,$64.36 ,$64.36 ,$91.80 ,$76.50 ,$13.25 ,$89.76 ,$13.25 ,$76.50 ,$76.50 ,$86.70 ,$86.70 ,$13.25 ,$86.70 ,$13.25 ,$80.58 ,$80.58 ,$80.58 ,$91.80 ,$33.13 ,$91.80 ,$13.25 ,$102.00 ,$66.81 ,$13.25 ,$44.27 , N/A ,$13.91 ,$91.80 ,$29.81 ,$64.36 ,$61.20 ,$91.80 ,$13.25 ,$91.80 ,$91.80 ,$13.25 ,$66.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101094,80158,HC CYCLOSPORINE - 90,301,1 ,$264.00 ,$171.60 ,$18.05 ,$264.00 ,$196.68 ,$172.92 ,$18.05 ,$139.13 ,$18.05 ,$166.58 ,$166.58 ,$166.58 ,$166.58 ,$237.60 ,$198.00 ,$18.05 ,$232.32 ,$18.05 ,$198.00 ,$198.00 ,$224.40 ,$224.40 ,$18.05 ,$224.40 ,$18.05 ,$208.56 ,$208.56 ,$208.56 ,$237.60 ,$45.13 ,$237.60 ,$18.05 ,$264.00 ,$172.92 ,$18.05 ,$114.58 , N/A ,$18.95 ,$237.60 ,$40.61 ,$166.58 ,$158.40 ,$237.60 ,$18.05 ,$237.60 ,$237.60 ,$18.05 ,$171.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101095,80159,HC CLOZAPINE - 90,301,1 ,$99.00 ,$64.35 ,$20.15 ,$99.00 ,$73.76 ,$64.85 ,$20.15 ,$52.17 ,$20.15 ,$62.47 ,$62.47 ,$62.47 ,$62.47 ,$89.10 ,$74.25 ,$20.15 ,$87.12 ,$20.15 ,$74.25 ,$74.25 ,$84.15 ,$84.15 ,$20.15 ,$84.15 ,$20.15 ,$78.21 ,$78.21 ,$78.21 ,$89.10 ,$50.38 ,$89.10 ,$20.15 ,$99.00 ,$64.85 ,$20.15 ,$42.97 , N/A ,$21.16 ,$89.10 ,$45.34 ,$62.47 ,$59.40 ,$89.10 ,$20.15 ,$89.10 ,$89.10 ,$20.15 ,$64.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101099,80168,HC ETHOSUXIMIDE - 90,301,1 ,$101.00 ,$65.65 ,$16.34 ,$101.00 ,$75.25 ,$66.16 ,$16.34 ,$53.23 ,$16.34 ,$63.73 ,$63.73 ,$63.73 ,$63.73 ,$90.90 ,$75.75 ,$16.34 ,$88.88 ,$16.34 ,$75.75 ,$75.75 ,$85.85 ,$85.85 ,$16.34 ,$85.85 ,$16.34 ,$79.79 ,$79.79 ,$79.79 ,$90.90 ,$40.85 ,$90.90 ,$16.34 ,$101.00 ,$66.16 ,$16.34 ,$43.83 , N/A ,$17.16 ,$90.90 ,$36.77 ,$63.73 ,$60.60 ,$90.90 ,$16.34 ,$90.90 ,$90.90 ,$16.34 ,$65.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101100,80169,HC EVEROLIMUS - 90,301,1 ,$140.00 ,$91.00 ,$13.73 ,$140.00 ,$104.30 ,$91.70 ,$13.73 ,$73.78 ,$13.73 ,$88.34 ,$88.34 ,$88.34 ,$88.34 ,$126.00 ,$105.00 ,$13.73 ,$123.20 ,$13.73 ,$105.00 ,$105.00 ,$119.00 ,$119.00 ,$13.73 ,$119.00 ,$13.73 ,$110.60 ,$110.60 ,$110.60 ,$126.00 ,$34.33 ,$126.00 ,$13.73 ,$140.00 ,$91.70 ,$13.73 ,$60.76 , N/A ,$14.42 ,$126.00 ,$30.89 ,$88.34 ,$84.00 ,$126.00 ,$13.73 ,$126.00 ,$126.00 ,$13.73 ,$91.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101102,80171,HC GABAPENTIN PLASMA - 90,301,1 ,$94.00 ,$61.10 ,$21.67 ,$94.00 ,$70.03 ,$61.57 ,$21.67 ,$49.54 ,$21.67 ,$59.31 ,$59.31 ,$59.31 ,$59.31 ,$84.60 ,$70.50 ,$21.67 ,$82.72 ,$21.67 ,$70.50 ,$70.50 ,$79.90 ,$79.90 ,$21.67 ,$79.90 ,$21.67 ,$74.26 ,$74.26 ,$74.26 ,$84.60 ,$54.18 ,$84.60 ,$21.67 ,$94.00 ,$61.57 ,$21.67 ,$40.80 , N/A ,$22.75 ,$84.60 ,$48.76 ,$59.31 ,$56.40 ,$84.60 ,$21.67 ,$84.60 ,$84.60 ,$21.67 ,$61.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101103,80173,HC HALOPERIDOL - 90,301,1 ,$219.47 ,$142.66 ,$15.78 ,$219.47 ,$163.51 ,$143.75 ,$15.78 ,$115.66 ,$15.78 ,$138.49 ,$138.49 ,$138.49 ,$138.49 ,$197.52 ,$164.60 ,$15.78 ,$193.13 ,$15.78 ,$164.60 ,$164.60 ,$186.55 ,$186.55 ,$15.78 ,$186.55 ,$15.78 ,$173.38 ,$173.38 ,$173.38 ,$197.52 ,$39.45 ,$197.52 ,$15.78 ,$219.47 ,$143.75 ,$15.78 ,$95.25 , N/A ,$16.57 ,$197.52 ,$35.51 ,$138.49 ,$131.68 ,$197.52 ,$15.78 ,$197.52 ,$197.52 ,$15.78 ,$142.66 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101104,80175,HC LAMOTRIGINE - 90,301,1 ,$158.00 ,$102.70 ,$13.25 ,$158.00 ,$117.71 ,$103.49 ,$13.25 ,$83.27 ,$13.25 ,$99.70 ,$99.70 ,$99.70 ,$99.70 ,$142.20 ,$118.50 ,$13.25 ,$139.04 ,$13.25 ,$118.50 ,$118.50 ,$134.30 ,$134.30 ,$13.25 ,$134.30 ,$13.25 ,$124.82 ,$124.82 ,$124.82 ,$142.20 ,$33.13 ,$142.20 ,$13.25 ,$158.00 ,$103.49 ,$13.25 ,$68.57 , N/A ,$13.91 ,$142.20 ,$29.81 ,$99.70 ,$94.80 ,$142.20 ,$13.25 ,$142.20 ,$142.20 ,$13.25 ,$102.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101106,80177,HC LEVETIRACETAM - 90,301,1 ,$158.00 ,$102.70 ,$13.25 ,$158.00 ,$117.71 ,$103.49 ,$13.25 ,$83.27 ,$13.25 ,$99.70 ,$99.70 ,$99.70 ,$99.70 ,$142.20 ,$118.50 ,$13.25 ,$139.04 ,$13.25 ,$118.50 ,$118.50 ,$134.30 ,$134.30 ,$13.25 ,$134.30 ,$13.25 ,$124.82 ,$124.82 ,$124.82 ,$142.20 ,$33.13 ,$142.20 ,$13.25 ,$158.00 ,$103.49 ,$13.25 ,$68.57 , N/A ,$13.91 ,$142.20 ,$29.81 ,$99.70 ,$94.80 ,$142.20 ,$13.25 ,$142.20 ,$142.20 ,$13.25 ,$102.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101109,80183,HC OXCARBAZEPINE - 90,301,1 ,$71.00 ,$46.15 ,$13.25 ,$71.00 ,$52.90 ,$46.51 ,$13.25 ,$37.42 ,$13.25 ,$44.80 ,$44.80 ,$44.80 ,$44.80 ,$63.90 ,$53.25 ,$13.25 ,$62.48 ,$13.25 ,$53.25 ,$53.25 ,$60.35 ,$60.35 ,$13.25 ,$60.35 ,$13.25 ,$56.09 ,$56.09 ,$56.09 ,$63.90 ,$33.13 ,$63.90 ,$13.25 ,$71.00 ,$46.51 ,$13.25 ,$30.81 , N/A ,$13.91 ,$63.90 ,$29.81 ,$44.80 ,$42.60 ,$63.90 ,$13.25 ,$63.90 ,$63.90 ,$13.25 ,$46.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101110,80184,HC PHENOBARBITAL - 90,301,1 ,$77.00 ,$50.05 ,$15.30 ,$77.00 ,$57.37 ,$50.44 ,$15.30 ,$40.58 ,$15.30 ,$48.59 ,$48.59 ,$48.59 ,$48.59 ,$69.30 ,$57.75 ,$15.30 ,$67.76 ,$15.30 ,$57.75 ,$57.75 ,$65.45 ,$65.45 ,$15.30 ,$65.45 ,$15.30 ,$60.83 ,$60.83 ,$60.83 ,$69.30 ,$38.25 ,$69.30 ,$15.30 ,$77.00 ,$50.44 ,$15.30 ,$33.42 , N/A ,$16.07 ,$69.30 ,$34.43 ,$48.59 ,$46.20 ,$69.30 ,$15.30 ,$69.30 ,$69.30 ,$15.30 ,$50.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101113,80185,HC PHENYTOIN TOTAL - 90,301,1 ,$39.75 ,$25.84 ,$13.25 ,$39.75 ,$29.61 ,$26.04 ,$13.25 ,$20.95 ,$13.25 ,$25.08 ,$25.08 ,$25.08 ,$25.08 ,$35.78 ,$29.81 ,$13.25 ,$34.98 ,$13.25 ,$29.81 ,$29.81 ,$33.79 ,$33.79 ,$13.25 ,$33.79 ,$13.25 ,$31.40 ,$31.40 ,$31.40 ,$35.78 ,$33.13 ,$35.78 ,$13.25 ,$39.75 ,$26.04 ,$13.25 ,$17.25 , N/A ,$13.91 ,$35.78 ,$29.81 ,$25.08 ,$23.85 ,$35.78 ,$13.25 ,$35.78 ,$35.78 ,$13.25 ,$25.84 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101114,80186,HC PHENYTOIN FREE - 90,301,1 ,$41.28 ,$26.83 ,$13.76 ,$41.28 ,$30.75 ,$27.04 ,$13.76 ,$21.75 ,$13.76 ,$26.05 ,$26.05 ,$26.05 ,$26.05 ,$37.15 ,$30.96 ,$13.76 ,$36.33 ,$13.76 ,$30.96 ,$30.96 ,$35.09 ,$35.09 ,$13.76 ,$35.09 ,$13.76 ,$32.61 ,$32.61 ,$32.61 ,$37.15 ,$34.40 ,$37.15 ,$13.76 ,$41.28 ,$27.04 ,$13.76 ,$17.92 , N/A ,$14.45 ,$37.15 ,$30.96 ,$26.05 ,$24.77 ,$37.15 ,$13.76 ,$37.15 ,$37.15 ,$13.76 ,$26.83 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101115,80188,HC PRIMIDONE - 90,301,1 ,$102.00 ,$66.30 ,$16.59 ,$102.00 ,$75.99 ,$66.81 ,$16.59 ,$53.75 ,$16.59 ,$64.36 ,$64.36 ,$64.36 ,$64.36 ,$91.80 ,$76.50 ,$16.59 ,$89.76 ,$16.59 ,$76.50 ,$76.50 ,$86.70 ,$86.70 ,$16.59 ,$86.70 ,$16.59 ,$80.58 ,$80.58 ,$80.58 ,$91.80 ,$41.48 ,$91.80 ,$16.59 ,$102.00 ,$66.81 ,$16.59 ,$44.27 , N/A ,$17.42 ,$91.80 ,$37.33 ,$64.36 ,$61.20 ,$91.80 ,$16.59 ,$91.80 ,$91.80 ,$16.59 ,$66.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101116,80192,HC PROCAINEAMIDE - 90,301,1 ,$111.00 ,$72.15 ,$16.75 ,$111.00 ,$82.70 ,$72.71 ,$16.75 ,$58.50 ,$16.75 ,$70.04 ,$70.04 ,$70.04 ,$70.04 ,$99.90 ,$83.25 ,$16.75 ,$97.68 ,$16.75 ,$83.25 ,$83.25 ,$94.35 ,$94.35 ,$16.75 ,$94.35 ,$16.75 ,$87.69 ,$87.69 ,$87.69 ,$99.90 ,$41.88 ,$99.90 ,$16.75 ,$111.00 ,$72.71 ,$16.75 ,$48.17 , N/A ,$17.59 ,$99.90 ,$37.69 ,$70.04 ,$66.60 ,$99.90 ,$16.75 ,$99.90 ,$99.90 ,$16.75 ,$72.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101117,80194,HC QUINIDINE - 90,301,1 ,$90.00 ,$58.50 ,$14.60 ,$90.00 ,$67.05 ,$58.95 ,$14.60 ,$47.43 ,$14.60 ,$56.79 ,$56.79 ,$56.79 ,$56.79 ,$81.00 ,$67.50 ,$14.60 ,$79.20 ,$14.60 ,$67.50 ,$67.50 ,$76.50 ,$76.50 ,$14.60 ,$76.50 ,$14.60 ,$71.10 ,$71.10 ,$71.10 ,$81.00 ,$36.50 ,$81.00 ,$14.60 ,$90.00 ,$58.95 ,$14.60 ,$39.06 , N/A ,$15.33 ,$81.00 ,$32.85 ,$56.79 ,$54.00 ,$81.00 ,$14.60 ,$81.00 ,$81.00 ,$14.60 ,$58.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101118,80195,HC RAPAMYCIN (SIROLIMUS) - 90,301,1 ,$139.00 ,$90.35 ,$13.73 ,$139.00 ,$103.56 ,$91.05 ,$13.73 ,$73.25 ,$13.73 ,$87.71 ,$87.71 ,$87.71 ,$87.71 ,$125.10 ,$104.25 ,$13.73 ,$122.32 ,$13.73 ,$104.25 ,$104.25 ,$118.15 ,$118.15 ,$13.73 ,$118.15 ,$13.73 ,$109.81 ,$109.81 ,$109.81 ,$125.10 ,$34.33 ,$125.10 ,$13.73 ,$139.00 ,$91.05 ,$13.73 ,$60.33 , N/A ,$14.42 ,$125.10 ,$30.89 ,$87.71 ,$83.40 ,$125.10 ,$13.73 ,$125.10 ,$125.10 ,$13.73 ,$90.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101119,80197,HC TACROLIMUS - 90,301,1 ,$133.00 ,$86.45 ,$13.73 ,$133.00 ,$99.09 ,$87.12 ,$13.73 ,$70.09 ,$13.73 ,$83.92 ,$83.92 ,$83.92 ,$83.92 ,$119.70 ,$99.75 ,$13.73 ,$117.04 ,$13.73 ,$99.75 ,$99.75 ,$113.05 ,$113.05 ,$13.73 ,$113.05 ,$13.73 ,$105.07 ,$105.07 ,$105.07 ,$119.70 ,$34.33 ,$119.70 ,$13.73 ,$133.00 ,$87.12 ,$13.73 ,$57.72 , N/A ,$14.42 ,$119.70 ,$30.89 ,$83.92 ,$79.80 ,$119.70 ,$13.73 ,$119.70 ,$119.70 ,$13.73 ,$86.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101124,80201,HC TOPIRAMATE - 90,301,1 ,$74.00 ,$48.10 ,$11.92 ,$74.00 ,$55.13 ,$48.47 ,$11.92 ,$39.00 ,$11.92 ,$46.69 ,$46.69 ,$46.69 ,$46.69 ,$66.60 ,$55.50 ,$11.92 ,$65.12 ,$11.92 ,$55.50 ,$55.50 ,$62.90 ,$62.90 ,$11.92 ,$62.90 ,$11.92 ,$58.46 ,$58.46 ,$58.46 ,$66.60 ,$29.80 ,$66.60 ,$11.92 ,$74.00 ,$48.47 ,$11.92 ,$32.12 , N/A ,$12.52 ,$66.60 ,$26.82 ,$46.69 ,$44.40 ,$66.60 ,$11.92 ,$66.60 ,$66.60 ,$11.92 ,$48.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101130,80299,HC ITRACONAZOLE HPLC - 90,301,1 ,$93.00 ,$60.45 ,$18.64 ,$93.00 ,$69.29 ,$60.92 ,$18.64 ,$49.01 ,$18.64 ,$58.68 ,$58.68 ,$58.68 ,$58.68 ,$83.70 ,$69.75 ,$18.64 ,$81.84 ,$18.64 ,$69.75 ,$69.75 ,$79.05 ,$79.05 ,$18.64 ,$79.05 ,$18.64 ,$73.47 ,$73.47 ,$73.47 ,$83.70 ,$46.60 ,$83.70 ,$18.64 ,$93.00 ,$60.92 ,$18.64 ,$40.36 , N/A ,$19.57 ,$83.70 ,$41.94 ,$58.68 ,$55.80 ,$83.70 ,$18.64 ,$83.70 ,$83.70 ,$18.64 ,$60.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101131,80299,HC THERAPEUTIC DRUG OTHER - 90,301,1 ,$134.00 ,$87.10 ,$18.64 ,$134.00 ,$99.83 ,$87.77 ,$18.64 ,$70.62 ,$18.64 ,$84.55 ,$84.55 ,$84.55 ,$84.55 ,$120.60 ,$100.50 ,$18.64 ,$117.92 ,$18.64 ,$100.50 ,$100.50 ,$113.90 ,$113.90 ,$18.64 ,$113.90 ,$18.64 ,$105.86 ,$105.86 ,$105.86 ,$120.60 ,$46.60 ,$120.60 ,$18.64 ,$134.00 ,$87.77 ,$18.64 ,$58.16 , N/A ,$19.57 ,$120.60 ,$41.94 ,$84.55 ,$80.40 ,$120.60 ,$18.64 ,$120.60 ,$120.60 ,$18.64 ,$87.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101133,80306,HC DRUG SCREEN PRESUMPTIVE INSTRMNT ASSIST DIR OPTICAL T2,301,1 ,$87.00 ,$56.55 ,$17.14 ,$87.00 ,$64.82 ,$56.99 ,$17.14 ,$45.85 ,$17.14 ,$54.90 ,$54.90 ,$54.90 ,$54.90 ,$78.30 ,$65.25 ,$17.14 ,$76.56 ,$17.14 ,$65.25 ,$65.25 ,$73.95 ,$73.95 ,$17.14 ,$73.95 ,$17.14 ,$68.73 ,$68.73 ,$68.73 ,$78.30 ,$42.85 ,$78.30 ,$17.14 ,$87.00 ,$56.99 ,$17.14 ,$37.76 , N/A ,$18.00 ,$78.30 ,$38.57 ,$54.90 ,$52.20 ,$78.30 ,$17.14 ,$78.30 ,$78.30 ,$17.14 ,$56.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101135,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T2,301,1 ,$325.00 ,$211.25 ,$62.14 ,$325.00 ,$242.13 ,$212.88 ,$62.14 ,$171.28 ,$62.14 ,$205.08 ,$205.08 ,$205.08 ,$205.08 ,$292.50 ,$243.75 ,$62.14 ,$286.00 ,$62.14 ,$243.75 ,$243.75 ,$276.25 ,$276.25 ,$62.14 ,$276.25 ,$62.14 ,$256.75 ,$256.75 ,$256.75 ,$292.50 ,$155.35 ,$292.50 ,$62.14 ,$325.00 ,$212.88 ,$62.14 ,$141.05 , N/A ,$65.25 ,$292.50 ,$139.82 ,$205.08 ,$195.00 ,$292.50 ,$62.14 ,$292.50 ,$292.50 ,$62.14 ,$211.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101137,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T4,301,1 ,$325.00 ,$211.25 ,$62.14 ,$325.00 ,$242.13 ,$212.88 ,$62.14 ,$171.28 ,$62.14 ,$205.08 ,$205.08 ,$205.08 ,$205.08 ,$292.50 ,$243.75 ,$62.14 ,$286.00 ,$62.14 ,$243.75 ,$243.75 ,$276.25 ,$276.25 ,$62.14 ,$276.25 ,$62.14 ,$256.75 ,$256.75 ,$256.75 ,$292.50 ,$155.35 ,$292.50 ,$62.14 ,$325.00 ,$212.88 ,$62.14 ,$141.05 , N/A ,$65.25 ,$292.50 ,$139.82 ,$205.08 ,$195.00 ,$292.50 ,$62.14 ,$292.50 ,$292.50 ,$62.14 ,$211.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101140,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T1-90,301,1 ,$325.00 ,$211.25 ,$62.14 ,$325.00 ,$242.13 ,$212.88 ,$62.14 ,$171.28 ,$62.14 ,$205.08 ,$205.08 ,$205.08 ,$205.08 ,$292.50 ,$243.75 ,$62.14 ,$286.00 ,$62.14 ,$243.75 ,$243.75 ,$276.25 ,$276.25 ,$62.14 ,$276.25 ,$62.14 ,$256.75 ,$256.75 ,$256.75 ,$292.50 ,$155.35 ,$292.50 ,$62.14 ,$325.00 ,$212.88 ,$62.14 ,$141.05 , N/A ,$65.25 ,$292.50 ,$139.82 ,$205.08 ,$195.00 ,$292.50 ,$62.14 ,$292.50 ,$292.50 ,$62.14 ,$211.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101141,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T2-90,301,1 ,$50.00 ,$32.50 ,$21.70 ,$112.50 ,$37.25 ,$32.75 ,$50.00 ,$26.35 ,$50.00 ,$31.55 ,$31.55 ,$31.55 ,$31.55 ,$45.00 ,$37.50 ,$50.00 ,$44.00 ,$50.00 ,$37.50 ,$37.50 ,$42.50 ,$42.50 ,$50.00 ,$42.50 ,$50.00 ,$39.50 ,$39.50 ,$39.50 ,$45.00 ,$50.00 ,$45.00 ,$50.00 ,$50.00 ,$32.75 ,$50.00 ,$21.70 , N/A ,$50.00 ,$45.00 ,$112.50 ,$31.55 ,$30.00 ,$45.00 ,$50.00 ,$45.00 ,$45.00 ,$50.00 ,$32.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101142,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T3-90,301,1 ,$96.48 ,$62.71 ,$41.87 ,$139.82 ,$71.88 ,$63.19 ,$62.14 ,$50.85 ,$62.14 ,$60.88 ,$60.88 ,$60.88 ,$60.88 ,$86.83 ,$72.36 ,$62.14 ,$84.90 ,$62.14 ,$72.36 ,$72.36 ,$82.01 ,$82.01 ,$62.14 ,$82.01 ,$62.14 ,$76.22 ,$76.22 ,$76.22 ,$86.83 ,$96.48 ,$86.83 ,$62.14 ,$96.48 ,$63.19 ,$62.14 ,$41.87 , N/A ,$65.25 ,$86.83 ,$139.82 ,$60.88 ,$57.89 ,$86.83 ,$62.14 ,$86.83 ,$86.83 ,$62.14 ,$62.71 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101144,80307,HC DRUG SCREEN PRESUMPTIVE INSTRUMENT T5-90,301,1 ,$460.50 ,$299.33 ,$62.14 ,$460.50 ,$343.07 ,$301.63 ,$62.14 ,$242.68 ,$62.14 ,$290.58 ,$290.58 ,$290.58 ,$290.58 ,$414.45 ,$345.38 ,$62.14 ,$405.24 ,$62.14 ,$345.38 ,$345.38 ,$391.43 ,$391.43 ,$62.14 ,$391.43 ,$62.14 ,$363.80 ,$363.80 ,$363.80 ,$414.45 ,$155.35 ,$414.45 ,$62.14 ,$460.50 ,$301.63 ,$62.14 ,$199.86 , N/A ,$65.25 ,$414.45 ,$139.82 ,$290.58 ,$276.30 ,$414.45 ,$62.14 ,$414.45 ,$414.45 ,$62.14 ,$299.33 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101146,80323,HC NICOTINE - 90,301,1 ,$84.00 ,$54.60 ,$36.46 ,$84.00 ,$62.58 ,$55.02 , N/A ,$44.27 , N/A ,$53.00 ,$53.00 ,$53.00 ,$53.00 ,$75.60 ,$63.00 , N/A ,$73.92 , N/A ,$63.00 ,$63.00 ,$71.40 ,$71.40 , N/A ,$71.40 , N/A ,$66.36 ,$66.36 ,$66.36 ,$75.60 , N/A ,$75.60 , N/A ,$84.00 ,$55.02 , N/A ,$36.46 , N/A , N/A ,$75.60 , N/A ,$53.00 ,$50.40 ,$75.60 , N/A ,$75.60 ,$75.60 , N/A ,$54.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101150,80346,HC BENZODIAZEPINES 1-12 -90,301,1 ,$183.52 ,$119.29 ,$79.65 ,$183.52 ,$136.72 ,$120.21 , N/A ,$96.72 , N/A ,$115.80 ,$115.80 ,$115.80 ,$115.80 ,$165.17 ,$137.64 , N/A ,$161.50 , N/A ,$137.64 ,$137.64 ,$155.99 ,$155.99 , N/A ,$155.99 , N/A ,$144.98 ,$144.98 ,$144.98 ,$165.17 , N/A ,$165.17 , N/A ,$183.52 ,$120.21 , N/A ,$79.65 , N/A , N/A ,$165.17 , N/A ,$115.80 ,$110.11 ,$165.17 , N/A ,$165.17 ,$165.17 , N/A ,$119.29 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101151,80349,HC CANNABINOIDS NATURAL -90,301,1 ,$184.00 ,$119.60 ,$79.86 ,$184.00 ,$137.08 ,$120.52 , N/A ,$96.97 , N/A ,$116.10 ,$116.10 ,$116.10 ,$116.10 ,$165.60 ,$138.00 , N/A ,$161.92 , N/A ,$138.00 ,$138.00 ,$156.40 ,$156.40 , N/A ,$156.40 , N/A ,$145.36 ,$145.36 ,$145.36 ,$165.60 , N/A ,$165.60 , N/A ,$184.00 ,$120.52 , N/A ,$79.86 , N/A , N/A ,$165.60 , N/A ,$116.10 ,$110.40 ,$165.60 , N/A ,$165.60 ,$165.60 , N/A ,$119.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101152,80353,HC COCAINE QN -90,301,1 ,$228.86 ,$148.76 ,$99.33 ,$228.86 ,$170.50 ,$149.90 , N/A ,$120.61 , N/A ,$144.41 ,$144.41 ,$144.41 ,$144.41 ,$205.97 ,$171.65 , N/A ,$201.40 , N/A ,$171.65 ,$171.65 ,$194.53 ,$194.53 , N/A ,$194.53 , N/A ,$180.80 ,$180.80 ,$180.80 ,$205.97 , N/A ,$205.97 , N/A ,$228.86 ,$149.90 , N/A ,$99.33 , N/A , N/A ,$205.97 , N/A ,$144.41 ,$137.32 ,$205.97 , N/A ,$205.97 ,$205.97 , N/A ,$148.76 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101153,80359,HC METHYLENEDIOXYAMPHETAMINES MDA MDEA MDMA -90,301,1 ,$457.72 ,$297.52 ,$198.65 ,$457.72 ,$341.00 ,$299.81 , N/A ,$241.22 , N/A ,$288.82 ,$288.82 ,$288.82 ,$288.82 ,$411.95 ,$343.29 , N/A ,$402.79 , N/A ,$343.29 ,$343.29 ,$389.06 ,$389.06 , N/A ,$389.06 , N/A ,$361.60 ,$361.60 ,$361.60 ,$411.95 , N/A ,$411.95 , N/A ,$457.72 ,$299.81 , N/A ,$198.65 , N/A , N/A ,$411.95 , N/A ,$288.82 ,$274.63 ,$411.95 , N/A ,$411.95 ,$411.95 , N/A ,$297.52 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101154,80361,HC OPIATES 1 OR MORE -90,301,1 ,$367.04 ,$238.58 ,$159.30 ,$367.04 ,$273.44 ,$240.41 , N/A ,$193.43 , N/A ,$231.60 ,$231.60 ,$231.60 ,$231.60 ,$330.34 ,$275.28 , N/A ,$323.00 , N/A ,$275.28 ,$275.28 ,$311.98 ,$311.98 , N/A ,$311.98 , N/A ,$289.96 ,$289.96 ,$289.96 ,$330.34 , N/A ,$330.34 , N/A ,$367.04 ,$240.41 , N/A ,$159.30 , N/A , N/A ,$330.34 , N/A ,$231.60 ,$220.22 ,$330.34 , N/A ,$330.34 ,$330.34 , N/A ,$238.58 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101157,82017,HC ACYLCARNITINES QN EA SPEC-90,301,1 ,$290.00 ,$188.50 ,$16.87 ,$290.00 ,$216.05 ,$189.95 ,$16.87 ,$152.83 ,$16.87 ,$182.99 ,$182.99 ,$182.99 ,$182.99 ,$261.00 ,$217.50 ,$16.87 ,$255.20 ,$16.87 ,$217.50 ,$217.50 ,$246.50 ,$246.50 ,$16.87 ,$246.50 ,$16.87 ,$229.10 ,$229.10 ,$229.10 ,$261.00 ,$42.18 ,$261.00 ,$16.87 ,$290.00 ,$189.95 ,$16.87 ,$125.86 , N/A ,$17.71 ,$261.00 ,$37.96 ,$182.99 ,$174.00 ,$261.00 ,$16.87 ,$261.00 ,$261.00 ,$16.87 ,$188.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101158,82024,HC ACTH -90,301,1 ,$266.00 ,$172.90 ,$38.62 ,$266.00 ,$198.17 ,$174.23 ,$38.62 ,$140.18 ,$38.62 ,$167.85 ,$167.85 ,$167.85 ,$167.85 ,$239.40 ,$199.50 ,$38.62 ,$234.08 ,$38.62 ,$199.50 ,$199.50 ,$226.10 ,$226.10 ,$38.62 ,$226.10 ,$38.62 ,$210.14 ,$210.14 ,$210.14 ,$239.40 ,$96.55 ,$239.40 ,$38.62 ,$266.00 ,$174.23 ,$38.62 ,$115.44 , N/A ,$40.55 ,$239.40 ,$86.90 ,$167.85 ,$159.60 ,$239.40 ,$38.62 ,$239.40 ,$239.40 ,$38.62 ,$172.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101159,82040,HC ALBUMIN-90,301,1 ,$80.00 ,$52.00 ,$4.95 ,$80.00 ,$59.60 ,$52.40 ,$4.95 ,$42.16 ,$4.95 ,$50.48 ,$50.48 ,$50.48 ,$50.48 ,$72.00 ,$60.00 ,$4.95 ,$70.40 ,$4.95 ,$60.00 ,$60.00 ,$68.00 ,$68.00 ,$4.95 ,$68.00 ,$4.95 ,$63.20 ,$63.20 ,$63.20 ,$72.00 ,$12.38 ,$72.00 ,$4.95 ,$80.00 ,$52.40 ,$4.95 ,$34.72 , N/A ,$5.20 ,$72.00 ,$11.14 ,$50.48 ,$48.00 ,$72.00 ,$4.95 ,$72.00 ,$72.00 ,$4.95 ,$52.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101162,82085,HC ALDOLASE-90,301,1 ,$71.00 ,$46.15 ,$9.71 ,$71.00 ,$52.90 ,$46.51 ,$9.71 ,$37.42 ,$9.71 ,$44.80 ,$44.80 ,$44.80 ,$44.80 ,$63.90 ,$53.25 ,$9.71 ,$62.48 ,$9.71 ,$53.25 ,$53.25 ,$60.35 ,$60.35 ,$9.71 ,$60.35 ,$9.71 ,$56.09 ,$56.09 ,$56.09 ,$63.90 ,$24.28 ,$63.90 ,$9.71 ,$71.00 ,$46.51 ,$9.71 ,$30.81 , N/A ,$10.20 ,$63.90 ,$21.85 ,$44.80 ,$42.60 ,$63.90 ,$9.71 ,$63.90 ,$63.90 ,$9.71 ,$46.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101163,82088,HC ALDOSTERONE-90,301,1 ,$254.00 ,$165.10 ,$40.75 ,$254.00 ,$189.23 ,$166.37 ,$40.75 ,$133.86 ,$40.75 ,$160.27 ,$160.27 ,$160.27 ,$160.27 ,$228.60 ,$190.50 ,$40.75 ,$223.52 ,$40.75 ,$190.50 ,$190.50 ,$215.90 ,$215.90 ,$40.75 ,$215.90 ,$40.75 ,$200.66 ,$200.66 ,$200.66 ,$228.60 ,$101.88 ,$228.60 ,$40.75 ,$254.00 ,$166.37 ,$40.75 ,$110.24 , N/A ,$42.79 ,$228.60 ,$91.69 ,$160.27 ,$152.40 ,$228.60 ,$40.75 ,$228.60 ,$228.60 ,$40.75 ,$165.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101164,82103,HC ALPHA-1 ANTITRYPSIN TOTAL-90,301,1 ,$145.00 ,$94.25 ,$13.44 ,$145.00 ,$108.03 ,$94.98 ,$13.44 ,$76.42 ,$13.44 ,$91.50 ,$91.50 ,$91.50 ,$91.50 ,$130.50 ,$108.75 ,$13.44 ,$127.60 ,$13.44 ,$108.75 ,$108.75 ,$123.25 ,$123.25 ,$13.44 ,$123.25 ,$13.44 ,$114.55 ,$114.55 ,$114.55 ,$130.50 ,$33.60 ,$130.50 ,$13.44 ,$145.00 ,$94.98 ,$13.44 ,$62.93 , N/A ,$14.11 ,$130.50 ,$30.24 ,$91.50 ,$87.00 ,$130.50 ,$13.44 ,$130.50 ,$130.50 ,$13.44 ,$94.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101165,82104,HC ALPHA-1 ANTITRYPSIN PHENO-90,301,1 ,$89.00 ,$57.85 ,$14.46 ,$89.00 ,$66.31 ,$58.30 ,$14.46 ,$46.90 ,$14.46 ,$56.16 ,$56.16 ,$56.16 ,$56.16 ,$80.10 ,$66.75 ,$14.46 ,$78.32 ,$14.46 ,$66.75 ,$66.75 ,$75.65 ,$75.65 ,$14.46 ,$75.65 ,$14.46 ,$70.31 ,$70.31 ,$70.31 ,$80.10 ,$36.15 ,$80.10 ,$14.46 ,$89.00 ,$58.30 ,$14.46 ,$38.63 , N/A ,$15.18 ,$80.10 ,$32.54 ,$56.16 ,$53.40 ,$80.10 ,$14.46 ,$80.10 ,$80.10 ,$14.46 ,$57.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101166,82105,HC ALPHA FETOPROTEIN SERUM-90,301,1 ,$178.00 ,$115.70 ,$16.77 ,$178.00 ,$132.61 ,$116.59 ,$16.77 ,$93.81 ,$16.77 ,$112.32 ,$112.32 ,$112.32 ,$112.32 ,$160.20 ,$133.50 ,$16.77 ,$156.64 ,$16.77 ,$133.50 ,$133.50 ,$151.30 ,$151.30 ,$16.77 ,$151.30 ,$16.77 ,$140.62 ,$140.62 ,$140.62 ,$160.20 ,$41.93 ,$160.20 ,$16.77 ,$178.00 ,$116.59 ,$16.77 ,$77.25 , N/A ,$17.61 ,$160.20 ,$37.73 ,$112.32 ,$106.80 ,$160.20 ,$16.77 ,$160.20 ,$160.20 ,$16.77 ,$115.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101167,82105,HC ALPHA FETOPROTEIN SERUM SINGLE-90,301,1 ,$16.00 ,$10.40 ,$6.94 ,$36.00 ,$11.92 ,$10.48 ,$16.00 ,$8.43 ,$16.00 ,$10.10 ,$10.10 ,$10.10 ,$10.10 ,$14.40 ,$12.00 ,$16.00 ,$14.08 ,$16.00 ,$12.00 ,$12.00 ,$13.60 ,$13.60 ,$16.00 ,$13.60 ,$16.00 ,$12.64 ,$12.64 ,$12.64 ,$14.40 ,$16.00 ,$14.40 ,$16.00 ,$16.00 ,$10.48 ,$16.00 ,$6.94 , N/A ,$16.00 ,$14.40 ,$36.00 ,$10.10 ,$9.60 ,$14.40 ,$16.00 ,$14.40 ,$14.40 ,$16.00 ,$10.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101169,82108,HC ALUMINUM-90,301,1 ,$157.00 ,$102.05 ,$25.48 ,$157.00 ,$116.97 ,$102.84 ,$25.48 ,$82.74 ,$25.48 ,$99.07 ,$99.07 ,$99.07 ,$99.07 ,$141.30 ,$117.75 ,$25.48 ,$138.16 ,$25.48 ,$117.75 ,$117.75 ,$133.45 ,$133.45 ,$25.48 ,$133.45 ,$25.48 ,$124.03 ,$124.03 ,$124.03 ,$141.30 ,$63.70 ,$141.30 ,$25.48 ,$157.00 ,$102.84 ,$25.48 ,$68.14 , N/A ,$26.75 ,$141.30 ,$57.33 ,$99.07 ,$94.20 ,$141.30 ,$25.48 ,$141.30 ,$141.30 ,$25.48 ,$102.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101172,82131,HC AMINO ACID QN SINGLE-90,301,1 ,$115.00 ,$74.75 ,$22.98 ,$115.00 ,$85.68 ,$75.33 ,$22.98 ,$60.61 ,$22.98 ,$72.57 ,$72.57 ,$72.57 ,$72.57 ,$103.50 ,$86.25 ,$22.98 ,$101.20 ,$22.98 ,$86.25 ,$86.25 ,$97.75 ,$97.75 ,$22.98 ,$97.75 ,$22.98 ,$90.85 ,$90.85 ,$90.85 ,$103.50 ,$57.45 ,$103.50 ,$22.98 ,$115.00 ,$75.33 ,$22.98 ,$49.91 , N/A ,$24.13 ,$103.50 ,$51.71 ,$72.57 ,$69.00 ,$103.50 ,$22.98 ,$103.50 ,$103.50 ,$22.98 ,$74.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101175,82139,HC AMINO ACIDS 6+ QN CSF-90,301,1 ,$230.00 ,$149.50 ,$16.87 ,$230.00 ,$171.35 ,$150.65 ,$16.87 ,$121.21 ,$16.87 ,$145.13 ,$145.13 ,$145.13 ,$145.13 ,$207.00 ,$172.50 ,$16.87 ,$202.40 ,$16.87 ,$172.50 ,$172.50 ,$195.50 ,$195.50 ,$16.87 ,$195.50 ,$16.87 ,$181.70 ,$181.70 ,$181.70 ,$207.00 ,$42.18 ,$207.00 ,$16.87 ,$230.00 ,$150.65 ,$16.87 ,$99.82 , N/A ,$17.71 ,$207.00 ,$37.96 ,$145.13 ,$138.00 ,$207.00 ,$16.87 ,$207.00 ,$207.00 ,$16.87 ,$149.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101178,82157,HC ANDROSTENEDIONE-90,301,1 ,$181.00 ,$117.65 ,$29.28 ,$181.00 ,$134.85 ,$118.56 ,$29.28 ,$95.39 ,$29.28 ,$114.21 ,$114.21 ,$114.21 ,$114.21 ,$162.90 ,$135.75 ,$29.28 ,$159.28 ,$29.28 ,$135.75 ,$135.75 ,$153.85 ,$153.85 ,$29.28 ,$153.85 ,$29.28 ,$142.99 ,$142.99 ,$142.99 ,$162.90 ,$73.20 ,$162.90 ,$29.28 ,$181.00 ,$118.56 ,$29.28 ,$78.55 , N/A ,$30.74 ,$162.90 ,$65.88 ,$114.21 ,$108.60 ,$162.90 ,$29.28 ,$162.90 ,$162.90 ,$29.28 ,$117.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101179,82164,HC ANGIOTENSIN 1 ENZYME (ACE)-90,301,1 ,$132.00 ,$85.80 ,$14.60 ,$132.00 ,$98.34 ,$86.46 ,$14.60 ,$69.56 ,$14.60 ,$83.29 ,$83.29 ,$83.29 ,$83.29 ,$118.80 ,$99.00 ,$14.60 ,$116.16 ,$14.60 ,$99.00 ,$99.00 ,$112.20 ,$112.20 ,$14.60 ,$112.20 ,$14.60 ,$104.28 ,$104.28 ,$104.28 ,$118.80 ,$36.50 ,$118.80 ,$14.60 ,$132.00 ,$86.46 ,$14.60 ,$57.29 , N/A ,$15.33 ,$118.80 ,$32.85 ,$83.29 ,$79.20 ,$118.80 ,$14.60 ,$118.80 ,$118.80 ,$14.60 ,$85.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101181,82175,HC ARSENIC-90,301,1 ,$117.00 ,$76.05 ,$18.97 ,$117.00 ,$87.17 ,$76.64 ,$18.97 ,$61.66 ,$18.97 ,$73.83 ,$73.83 ,$73.83 ,$73.83 ,$105.30 ,$87.75 ,$18.97 ,$102.96 ,$18.97 ,$87.75 ,$87.75 ,$99.45 ,$99.45 ,$18.97 ,$99.45 ,$18.97 ,$92.43 ,$92.43 ,$92.43 ,$105.30 ,$47.43 ,$105.30 ,$18.97 ,$117.00 ,$76.64 ,$18.97 ,$50.78 , N/A ,$19.92 ,$105.30 ,$42.68 ,$73.83 ,$70.20 ,$105.30 ,$18.97 ,$105.30 ,$105.30 ,$18.97 ,$76.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101182,82180,HC VITAMIN C (ASCORBIC ACID)-90,301,1 ,$61.00 ,$39.65 ,$9.89 ,$61.00 ,$45.45 ,$39.96 ,$9.89 ,$32.15 ,$9.89 ,$38.49 ,$38.49 ,$38.49 ,$38.49 ,$54.90 ,$45.75 ,$9.89 ,$53.68 ,$9.89 ,$45.75 ,$45.75 ,$51.85 ,$51.85 ,$9.89 ,$51.85 ,$9.89 ,$48.19 ,$48.19 ,$48.19 ,$54.90 ,$24.73 ,$54.90 ,$9.89 ,$61.00 ,$39.96 ,$9.89 ,$26.47 , N/A ,$10.38 ,$54.90 ,$22.25 ,$38.49 ,$36.60 ,$54.90 ,$9.89 ,$54.90 ,$54.90 ,$9.89 ,$39.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101184,82232,HC BETA 2 MICROGLOBULIN-90,301,1 ,$100.00 ,$65.00 ,$16.18 ,$100.00 ,$74.50 ,$65.50 ,$16.18 ,$52.70 ,$16.18 ,$63.10 ,$63.10 ,$63.10 ,$63.10 ,$90.00 ,$75.00 ,$16.18 ,$88.00 ,$16.18 ,$75.00 ,$75.00 ,$85.00 ,$85.00 ,$16.18 ,$85.00 ,$16.18 ,$79.00 ,$79.00 ,$79.00 ,$90.00 ,$40.45 ,$90.00 ,$16.18 ,$100.00 ,$65.50 ,$16.18 ,$43.40 , N/A ,$16.99 ,$90.00 ,$36.41 ,$63.10 ,$60.00 ,$90.00 ,$16.18 ,$90.00 ,$90.00 ,$16.18 ,$65.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101185,82239,HC BILE ACID TOTAL-90,301,1 ,$30.00 ,$19.50 ,$13.02 ,$38.52 ,$22.35 ,$19.65 ,$17.12 ,$15.81 ,$17.12 ,$18.93 ,$18.93 ,$18.93 ,$18.93 ,$27.00 ,$22.50 ,$17.12 ,$26.40 ,$17.12 ,$22.50 ,$22.50 ,$25.50 ,$25.50 ,$17.12 ,$25.50 ,$17.12 ,$23.70 ,$23.70 ,$23.70 ,$27.00 ,$30.00 ,$27.00 ,$17.12 ,$30.00 ,$19.65 ,$17.12 ,$13.02 , N/A ,$17.98 ,$27.00 ,$38.52 ,$18.93 ,$18.00 ,$27.00 ,$17.12 ,$27.00 ,$27.00 ,$17.12 ,$19.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101191,82271,HC OCCULT BLOOD GASTRIC,301,1 ,$52.00 ,$33.80 ,$5.32 ,$52.00 ,$38.74 ,$34.06 ,$5.32 ,$27.40 ,$5.32 ,$32.81 ,$32.81 ,$32.81 ,$32.81 ,$46.80 ,$39.00 ,$5.32 ,$45.76 ,$5.32 ,$39.00 ,$39.00 ,$44.20 ,$44.20 ,$5.32 ,$44.20 ,$5.32 ,$41.08 ,$41.08 ,$41.08 ,$46.80 ,$13.30 ,$46.80 ,$5.32 ,$52.00 ,$34.06 ,$5.32 ,$22.57 , N/A ,$5.59 ,$46.80 ,$11.97 ,$32.81 ,$31.20 ,$46.80 ,$5.32 ,$46.80 ,$46.80 ,$5.32 ,$33.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101197,82306,HC VITAMIN D 25 OH-90,301,1 ,$18.00 ,$11.70 ,$7.81 ,$40.50 ,$13.41 ,$11.79 ,$18.00 ,$9.49 ,$18.00 ,$11.36 ,$11.36 ,$11.36 ,$11.36 ,$16.20 ,$13.50 ,$18.00 ,$15.84 ,$18.00 ,$13.50 ,$13.50 ,$15.30 ,$15.30 ,$18.00 ,$15.30 ,$18.00 ,$14.22 ,$14.22 ,$14.22 ,$16.20 ,$18.00 ,$16.20 ,$18.00 ,$18.00 ,$11.79 ,$18.00 ,$7.81 , N/A ,$18.00 ,$16.20 ,$40.50 ,$11.36 ,$10.80 ,$16.20 ,$18.00 ,$16.20 ,$16.20 ,$18.00 ,$11.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101199,82308,HC CALCITONIN-90,301,1 ,$133.00 ,$86.45 ,$26.79 ,$133.00 ,$99.09 ,$87.12 ,$26.79 ,$70.09 ,$26.79 ,$83.92 ,$83.92 ,$83.92 ,$83.92 ,$119.70 ,$99.75 ,$26.79 ,$117.04 ,$26.79 ,$99.75 ,$99.75 ,$113.05 ,$113.05 ,$26.79 ,$113.05 ,$26.79 ,$105.07 ,$105.07 ,$105.07 ,$119.70 ,$66.98 ,$119.70 ,$26.79 ,$133.00 ,$87.12 ,$26.79 ,$57.72 , N/A ,$28.13 ,$119.70 ,$60.28 ,$83.92 ,$79.80 ,$119.70 ,$26.79 ,$119.70 ,$119.70 ,$26.79 ,$86.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101205,82365,HC CALCULUS ANLYS INFRARED-90,301,1 ,$141.00 ,$91.65 ,$12.90 ,$141.00 ,$105.05 ,$92.36 ,$12.90 ,$74.31 ,$12.90 ,$88.97 ,$88.97 ,$88.97 ,$88.97 ,$126.90 ,$105.75 ,$12.90 ,$124.08 ,$12.90 ,$105.75 ,$105.75 ,$119.85 ,$119.85 ,$12.90 ,$119.85 ,$12.90 ,$111.39 ,$111.39 ,$111.39 ,$126.90 ,$32.25 ,$126.90 ,$12.90 ,$141.00 ,$92.36 ,$12.90 ,$61.19 , N/A ,$13.55 ,$126.90 ,$29.03 ,$88.97 ,$84.60 ,$126.90 ,$12.90 ,$126.90 ,$126.90 ,$12.90 ,$91.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101209,82379,HC CARNITINE TOTAL AND FREE QN-90,301,1 ,$299.00 ,$194.35 ,$16.87 ,$299.00 ,$222.76 ,$195.85 ,$16.87 ,$157.57 ,$16.87 ,$188.67 ,$188.67 ,$188.67 ,$188.67 ,$269.10 ,$224.25 ,$16.87 ,$263.12 ,$16.87 ,$224.25 ,$224.25 ,$254.15 ,$254.15 ,$16.87 ,$254.15 ,$16.87 ,$236.21 ,$236.21 ,$236.21 ,$269.10 ,$42.18 ,$269.10 ,$16.87 ,$299.00 ,$195.85 ,$16.87 ,$129.77 , N/A ,$17.71 ,$269.10 ,$37.96 ,$188.67 ,$179.40 ,$269.10 ,$16.87 ,$269.10 ,$269.10 ,$16.87 ,$194.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101210,82380,HC CAROTENE-90,301,1 ,$57.00 ,$37.05 ,$9.22 ,$57.00 ,$42.47 ,$37.34 ,$9.22 ,$30.04 ,$9.22 ,$35.97 ,$35.97 ,$35.97 ,$35.97 ,$51.30 ,$42.75 ,$9.22 ,$50.16 ,$9.22 ,$42.75 ,$42.75 ,$48.45 ,$48.45 ,$9.22 ,$48.45 ,$9.22 ,$45.03 ,$45.03 ,$45.03 ,$51.30 ,$23.05 ,$51.30 ,$9.22 ,$57.00 ,$37.34 ,$9.22 ,$24.74 , N/A ,$9.68 ,$51.30 ,$20.75 ,$35.97 ,$34.20 ,$51.30 ,$9.22 ,$51.30 ,$51.30 ,$9.22 ,$37.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101211,82384,HC CATECHOLAMINE FRACTION-90,301,1 ,$232.00 ,$150.80 ,$25.25 ,$232.00 ,$172.84 ,$151.96 ,$25.25 ,$122.26 ,$25.25 ,$146.39 ,$146.39 ,$146.39 ,$146.39 ,$208.80 ,$174.00 ,$25.25 ,$204.16 ,$25.25 ,$174.00 ,$174.00 ,$197.20 ,$197.20 ,$25.25 ,$197.20 ,$25.25 ,$183.28 ,$183.28 ,$183.28 ,$208.80 ,$63.13 ,$208.80 ,$25.25 ,$232.00 ,$151.96 ,$25.25 ,$100.69 , N/A ,$26.51 ,$208.80 ,$56.81 ,$146.39 ,$139.20 ,$208.80 ,$25.25 ,$208.80 ,$208.80 ,$25.25 ,$150.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101212,82390,HC CERULOPLASMIN-90,301,1 ,$120.00 ,$78.00 ,$10.74 ,$120.00 ,$89.40 ,$78.60 ,$10.74 ,$63.24 ,$10.74 ,$75.72 ,$75.72 ,$75.72 ,$75.72 ,$108.00 ,$90.00 ,$10.74 ,$105.60 ,$10.74 ,$90.00 ,$90.00 ,$102.00 ,$102.00 ,$10.74 ,$102.00 ,$10.74 ,$94.80 ,$94.80 ,$94.80 ,$108.00 ,$26.85 ,$108.00 ,$10.74 ,$120.00 ,$78.60 ,$10.74 ,$52.08 , N/A ,$11.28 ,$108.00 ,$24.17 ,$75.72 ,$72.00 ,$108.00 ,$10.74 ,$108.00 ,$108.00 ,$10.74 ,$78.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101213,82397,HC CHEMILUMINESCENT ASSAY-90,301,1 ,$48.00 ,$31.20 ,$14.12 ,$48.00 ,$35.76 ,$31.44 ,$14.12 ,$25.30 ,$14.12 ,$30.29 ,$30.29 ,$30.29 ,$30.29 ,$43.20 ,$36.00 ,$14.12 ,$42.24 ,$14.12 ,$36.00 ,$36.00 ,$40.80 ,$40.80 ,$14.12 ,$40.80 ,$14.12 ,$37.92 ,$37.92 ,$37.92 ,$43.20 ,$35.30 ,$43.20 ,$14.12 ,$48.00 ,$31.44 ,$14.12 ,$20.83 , N/A ,$14.83 ,$43.20 ,$31.77 ,$30.29 ,$28.80 ,$43.20 ,$14.12 ,$43.20 ,$43.20 ,$14.12 ,$31.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101215,82438,HC CHLORIDE OTHER SOURCE-90,301,1 ,$33.00 ,$21.45 ,$5.00 ,$33.00 ,$24.59 ,$21.62 ,$5.00 ,$17.39 ,$5.00 ,$20.82 ,$20.82 ,$20.82 ,$20.82 ,$29.70 ,$24.75 ,$5.00 ,$29.04 ,$5.00 ,$24.75 ,$24.75 ,$28.05 ,$28.05 ,$5.00 ,$28.05 ,$5.00 ,$26.07 ,$26.07 ,$26.07 ,$29.70 ,$12.50 ,$29.70 ,$5.00 ,$33.00 ,$21.62 ,$5.00 ,$14.32 , N/A ,$5.25 ,$29.70 ,$11.25 ,$20.82 ,$19.80 ,$29.70 ,$5.00 ,$29.70 ,$29.70 ,$5.00 ,$21.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101218,82495,HC CHROMIUM SERUM-90,301,1 ,$126.00 ,$81.90 ,$20.28 ,$126.00 ,$93.87 ,$82.53 ,$20.28 ,$66.40 ,$20.28 ,$79.51 ,$79.51 ,$79.51 ,$79.51 ,$113.40 ,$94.50 ,$20.28 ,$110.88 ,$20.28 ,$94.50 ,$94.50 ,$107.10 ,$107.10 ,$20.28 ,$107.10 ,$20.28 ,$99.54 ,$99.54 ,$99.54 ,$113.40 ,$50.70 ,$113.40 ,$20.28 ,$126.00 ,$82.53 ,$20.28 ,$54.68 , N/A ,$21.29 ,$113.40 ,$45.63 ,$79.51 ,$75.60 ,$113.40 ,$20.28 ,$113.40 ,$113.40 ,$20.28 ,$81.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101219,82507,HC CITRATE-90,301,1 ,$20.00 ,$13.00 ,$8.68 ,$45.00 ,$14.90 ,$13.10 ,$20.00 ,$10.54 ,$20.00 ,$12.62 ,$12.62 ,$12.62 ,$12.62 ,$18.00 ,$15.00 ,$20.00 ,$17.60 ,$20.00 ,$15.00 ,$15.00 ,$17.00 ,$17.00 ,$20.00 ,$17.00 ,$20.00 ,$15.80 ,$15.80 ,$15.80 ,$18.00 ,$20.00 ,$18.00 ,$20.00 ,$20.00 ,$13.10 ,$20.00 ,$8.68 , N/A ,$20.00 ,$18.00 ,$45.00 ,$12.62 ,$12.00 ,$18.00 ,$20.00 ,$18.00 ,$18.00 ,$20.00 ,$13.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101220,82523,HC COLLAGEN CROSS LINKS ANY METHOD-90,301,1 ,$115.00 ,$74.75 ,$18.68 ,$115.00 ,$85.68 ,$75.33 ,$18.68 ,$60.61 ,$18.68 ,$72.57 ,$72.57 ,$72.57 ,$72.57 ,$103.50 ,$86.25 ,$18.68 ,$101.20 ,$18.68 ,$86.25 ,$86.25 ,$97.75 ,$97.75 ,$18.68 ,$97.75 ,$18.68 ,$90.85 ,$90.85 ,$90.85 ,$103.50 ,$46.70 ,$103.50 ,$18.68 ,$115.00 ,$75.33 ,$18.68 ,$49.91 , N/A ,$19.61 ,$103.50 ,$42.03 ,$72.57 ,$69.00 ,$103.50 ,$18.68 ,$103.50 ,$103.50 ,$18.68 ,$74.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101221,82525,HC COPPER-90,301,1 ,$108.00 ,$70.20 ,$12.41 ,$108.00 ,$80.46 ,$70.74 ,$12.41 ,$56.92 ,$12.41 ,$68.15 ,$68.15 ,$68.15 ,$68.15 ,$97.20 ,$81.00 ,$12.41 ,$95.04 ,$12.41 ,$81.00 ,$81.00 ,$91.80 ,$91.80 ,$12.41 ,$91.80 ,$12.41 ,$85.32 ,$85.32 ,$85.32 ,$97.20 ,$31.03 ,$97.20 ,$12.41 ,$108.00 ,$70.74 ,$12.41 ,$46.87 , N/A ,$13.03 ,$97.20 ,$27.92 ,$68.15 ,$64.80 ,$97.20 ,$12.41 ,$97.20 ,$97.20 ,$12.41 ,$70.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101222,82530,HC CORTISOL FREE-90,301,1 ,$103.00 ,$66.95 ,$16.71 ,$103.00 ,$76.74 ,$67.47 ,$16.71 ,$54.28 ,$16.71 ,$64.99 ,$64.99 ,$64.99 ,$64.99 ,$92.70 ,$77.25 ,$16.71 ,$90.64 ,$16.71 ,$77.25 ,$77.25 ,$87.55 ,$87.55 ,$16.71 ,$87.55 ,$16.71 ,$81.37 ,$81.37 ,$81.37 ,$92.70 ,$41.78 ,$92.70 ,$16.71 ,$103.00 ,$67.47 ,$16.71 ,$44.70 , N/A ,$17.55 ,$92.70 ,$37.60 ,$64.99 ,$61.80 ,$92.70 ,$16.71 ,$92.70 ,$92.70 ,$16.71 ,$66.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101223,82533,HC CORTISOL TOTAL-90,301,1 ,$18.60 ,$12.09 ,$8.07 ,$36.68 ,$13.86 ,$12.18 ,$16.30 ,$9.80 ,$16.30 ,$11.74 ,$11.74 ,$11.74 ,$11.74 ,$16.74 ,$13.95 ,$16.30 ,$16.37 ,$16.30 ,$13.95 ,$13.95 ,$15.81 ,$15.81 ,$16.30 ,$15.81 ,$16.30 ,$14.69 ,$14.69 ,$14.69 ,$16.74 ,$18.60 ,$16.74 ,$16.30 ,$18.60 ,$12.18 ,$16.30 ,$8.07 , N/A ,$17.12 ,$16.74 ,$36.68 ,$11.74 ,$11.16 ,$16.74 ,$16.30 ,$16.74 ,$16.74 ,$16.30 ,$12.09 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101224,82542,HC CHROMO SPECTROMETRY -90,301,1 ,$125.92 ,$81.85 ,$24.09 ,$125.92 ,$93.81 ,$82.48 ,$24.09 ,$66.36 ,$24.09 ,$79.46 ,$79.46 ,$79.46 ,$79.46 ,$113.33 ,$94.44 ,$24.09 ,$110.81 ,$24.09 ,$94.44 ,$94.44 ,$107.03 ,$107.03 ,$24.09 ,$107.03 ,$24.09 ,$99.48 ,$99.48 ,$99.48 ,$113.33 ,$60.23 ,$113.33 ,$24.09 ,$125.92 ,$82.48 ,$24.09 ,$54.65 , N/A ,$25.29 ,$113.33 ,$54.20 ,$79.46 ,$75.55 ,$113.33 ,$24.09 ,$113.33 ,$113.33 ,$24.09 ,$81.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101225,82550,HC CREATINE KINASE (CPK) TOTAL-90,301,1 ,$40.00 ,$26.00 ,$6.51 ,$40.00 ,$29.80 ,$26.20 ,$6.51 ,$21.08 ,$6.51 ,$25.24 ,$25.24 ,$25.24 ,$25.24 ,$36.00 ,$30.00 ,$6.51 ,$35.20 ,$6.51 ,$30.00 ,$30.00 ,$34.00 ,$34.00 ,$6.51 ,$34.00 ,$6.51 ,$31.60 ,$31.60 ,$31.60 ,$36.00 ,$16.28 ,$36.00 ,$6.51 ,$40.00 ,$26.20 ,$6.51 ,$17.36 , N/A ,$6.84 ,$36.00 ,$14.65 ,$25.24 ,$24.00 ,$36.00 ,$6.51 ,$36.00 ,$36.00 ,$6.51 ,$26.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101226,82552,HC CREATINE KINASE (CPK) ISO-90,301,1 ,$83.00 ,$53.95 ,$13.39 ,$83.00 ,$61.84 ,$54.37 ,$13.39 ,$43.74 ,$13.39 ,$52.37 ,$52.37 ,$52.37 ,$52.37 ,$74.70 ,$62.25 ,$13.39 ,$73.04 ,$13.39 ,$62.25 ,$62.25 ,$70.55 ,$70.55 ,$13.39 ,$70.55 ,$13.39 ,$65.57 ,$65.57 ,$65.57 ,$74.70 ,$33.48 ,$74.70 ,$13.39 ,$83.00 ,$54.37 ,$13.39 ,$36.02 , N/A ,$14.06 ,$74.70 ,$30.13 ,$52.37 ,$49.80 ,$74.70 ,$13.39 ,$74.70 ,$74.70 ,$13.39 ,$53.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101227,82565,HC CREATININE-QW,301,1 ,$55.00 ,$35.75 ,$5.12 ,$55.00 ,$40.98 ,$36.03 ,$5.12 ,$28.99 ,$5.12 ,$34.71 ,$34.71 ,$34.71 ,$34.71 ,$49.50 ,$41.25 ,$5.12 ,$48.40 ,$5.12 ,$41.25 ,$41.25 ,$46.75 ,$46.75 ,$5.12 ,$46.75 ,$5.12 ,$43.45 ,$43.45 ,$43.45 ,$49.50 ,$12.80 ,$49.50 ,$5.12 ,$5.12 ,$36.03 ,$5.12 ,$23.87 , N/A ,$5.38 ,$49.50 ,$11.52 ,$34.71 ,$33.00 ,$49.50 ,$5.12 ,$49.50 ,$49.50 ,$5.12 ,$35.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101231,82570,HC CREATININE OTH SOURCE-90,301,1 ,$113.00 ,$73.45 ,$5.18 ,$113.00 ,$84.19 ,$74.02 ,$5.18 ,$59.55 ,$5.18 ,$71.30 ,$71.30 ,$71.30 ,$71.30 ,$101.70 ,$84.75 ,$5.18 ,$99.44 ,$5.18 ,$84.75 ,$84.75 ,$96.05 ,$96.05 ,$5.18 ,$96.05 ,$5.18 ,$89.27 ,$89.27 ,$89.27 ,$101.70 ,$12.95 ,$101.70 ,$5.18 ,$113.00 ,$74.02 ,$5.18 ,$49.04 , N/A ,$5.44 ,$101.70 ,$11.66 ,$71.30 ,$67.80 ,$101.70 ,$5.18 ,$101.70 ,$101.70 ,$5.18 ,$73.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101233,82595,HC CRYOGLOBULIN QL OR SQN-90,301,1 ,$40.00 ,$26.00 ,$6.47 ,$40.00 ,$29.80 ,$26.20 ,$6.47 ,$21.08 ,$6.47 ,$25.24 ,$25.24 ,$25.24 ,$25.24 ,$36.00 ,$30.00 ,$6.47 ,$35.20 ,$6.47 ,$30.00 ,$30.00 ,$34.00 ,$34.00 ,$6.47 ,$34.00 ,$6.47 ,$31.60 ,$31.60 ,$31.60 ,$36.00 ,$16.18 ,$36.00 ,$6.47 ,$40.00 ,$26.20 ,$6.47 ,$17.36 , N/A ,$6.79 ,$36.00 ,$14.56 ,$25.24 ,$24.00 ,$36.00 ,$6.47 ,$36.00 ,$36.00 ,$6.47 ,$26.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101236,82608,HC VITAMIN B-12 BINDING CAPACITY-90,301,1 ,$17.72 ,$11.52 ,$7.69 ,$32.22 ,$13.20 ,$11.61 ,$14.32 ,$9.34 ,$14.32 ,$11.18 ,$11.18 ,$11.18 ,$11.18 ,$15.95 ,$13.29 ,$14.32 ,$15.59 ,$14.32 ,$13.29 ,$13.29 ,$15.06 ,$15.06 ,$14.32 ,$15.06 ,$14.32 ,$14.00 ,$14.00 ,$14.00 ,$15.95 ,$17.72 ,$15.95 ,$14.32 ,$17.72 ,$11.61 ,$14.32 ,$7.69 , N/A ,$15.04 ,$15.95 ,$32.22 ,$11.18 ,$10.63 ,$15.95 ,$14.32 ,$15.95 ,$15.95 ,$14.32 ,$11.52 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101238,82627,HC DHEA SULFATE-90,301,1 ,$95.00 ,$61.75 ,$22.23 ,$95.00 ,$70.78 ,$62.23 ,$22.23 ,$50.07 ,$22.23 ,$59.95 ,$59.95 ,$59.95 ,$59.95 ,$85.50 ,$71.25 ,$22.23 ,$83.60 ,$22.23 ,$71.25 ,$71.25 ,$80.75 ,$80.75 ,$22.23 ,$80.75 ,$22.23 ,$75.05 ,$75.05 ,$75.05 ,$85.50 ,$55.58 ,$85.50 ,$22.23 ,$95.00 ,$62.23 ,$22.23 ,$41.23 , N/A ,$23.34 ,$85.50 ,$50.02 ,$59.95 ,$57.00 ,$85.50 ,$22.23 ,$85.50 ,$85.50 ,$22.23 ,$61.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101239,82634,HC DEOXYCORTISOL-90,301,1 ,$93.20 ,$60.58 ,$29.28 ,$93.20 ,$69.43 ,$61.05 ,$29.28 ,$49.12 ,$29.28 ,$58.81 ,$58.81 ,$58.81 ,$58.81 ,$83.88 ,$69.90 ,$29.28 ,$82.02 ,$29.28 ,$69.90 ,$69.90 ,$79.22 ,$79.22 ,$29.28 ,$79.22 ,$29.28 ,$73.63 ,$73.63 ,$73.63 ,$83.88 ,$73.20 ,$83.88 ,$29.28 ,$93.20 ,$61.05 ,$29.28 ,$40.45 , N/A ,$30.74 ,$83.88 ,$65.88 ,$58.81 ,$55.92 ,$83.88 ,$29.28 ,$83.88 ,$83.88 ,$29.28 ,$60.58 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101240,82652,HC VITAMIN D (1 25 DIHYDROXY)-90,301,1 ,$183.00 ,$118.95 ,$38.50 ,$183.00 ,$136.34 ,$119.87 ,$38.50 ,$96.44 ,$38.50 ,$115.47 ,$115.47 ,$115.47 ,$115.47 ,$164.70 ,$137.25 ,$38.50 ,$161.04 ,$38.50 ,$137.25 ,$137.25 ,$155.55 ,$155.55 ,$38.50 ,$155.55 ,$38.50 ,$144.57 ,$144.57 ,$144.57 ,$164.70 ,$96.25 ,$164.70 ,$38.50 ,$183.00 ,$119.87 ,$38.50 ,$79.42 , N/A ,$40.43 ,$164.70 ,$86.63 ,$115.47 ,$109.80 ,$164.70 ,$38.50 ,$164.70 ,$164.70 ,$38.50 ,$118.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101241,82656,HC ELASTASE PANCREATIC EL1 FECAL QL OR SQN-90,301,1 ,$78.00 ,$50.70 ,$11.53 ,$78.00 ,$58.11 ,$51.09 ,$11.53 ,$41.11 ,$11.53 ,$49.22 ,$49.22 ,$49.22 ,$49.22 ,$70.20 ,$58.50 ,$11.53 ,$68.64 ,$11.53 ,$58.50 ,$58.50 ,$66.30 ,$66.30 ,$11.53 ,$66.30 ,$11.53 ,$61.62 ,$61.62 ,$61.62 ,$70.20 ,$28.83 ,$70.20 ,$11.53 ,$78.00 ,$51.09 ,$11.53 ,$33.85 , N/A ,$12.11 ,$70.20 ,$25.94 ,$49.22 ,$46.80 ,$70.20 ,$11.53 ,$70.20 ,$70.20 ,$11.53 ,$50.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101242,82657,HC ENZYME ACT NONRAD SUBS-90,301,1 ,$550.06 ,$357.54 ,$22.17 ,$550.06 ,$409.79 ,$360.29 ,$22.17 ,$289.88 ,$22.17 ,$347.09 ,$347.09 ,$347.09 ,$347.09 ,$495.05 ,$412.55 ,$22.17 ,$484.05 ,$22.17 ,$412.55 ,$412.55 ,$467.55 ,$467.55 ,$22.17 ,$467.55 ,$22.17 ,$434.55 ,$434.55 ,$434.55 ,$495.05 ,$55.43 ,$495.05 ,$22.17 ,$550.06 ,$360.29 ,$22.17 ,$238.73 , N/A ,$23.28 ,$495.05 ,$49.88 ,$347.09 ,$330.04 ,$495.05 ,$22.17 ,$495.05 ,$495.05 ,$22.17 ,$357.54 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101245,82668,HC ERYTHROPOIETIN-90,301,1 ,$193.00 ,$125.45 ,$18.79 ,$193.00 ,$143.79 ,$126.42 ,$18.79 ,$101.71 ,$18.79 ,$121.78 ,$121.78 ,$121.78 ,$121.78 ,$173.70 ,$144.75 ,$18.79 ,$169.84 ,$18.79 ,$144.75 ,$144.75 ,$164.05 ,$164.05 ,$18.79 ,$164.05 ,$18.79 ,$152.47 ,$152.47 ,$152.47 ,$173.70 ,$46.98 ,$173.70 ,$18.79 ,$193.00 ,$126.42 ,$18.79 ,$83.76 , N/A ,$19.73 ,$173.70 ,$42.28 ,$121.78 ,$115.80 ,$173.70 ,$18.79 ,$173.70 ,$173.70 ,$18.79 ,$125.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101246,82670,HC ESTRADIOL-90,301,1 ,$256.00 ,$166.40 ,$27.94 ,$256.00 ,$190.72 ,$167.68 ,$27.94 ,$134.91 ,$27.94 ,$161.54 ,$161.54 ,$161.54 ,$161.54 ,$230.40 ,$192.00 ,$27.94 ,$225.28 ,$27.94 ,$192.00 ,$192.00 ,$217.60 ,$217.60 ,$27.94 ,$217.60 ,$27.94 ,$202.24 ,$202.24 ,$202.24 ,$230.40 ,$69.85 ,$230.40 ,$27.94 ,$256.00 ,$167.68 ,$27.94 ,$111.10 , N/A ,$29.34 ,$230.40 ,$62.87 ,$161.54 ,$153.60 ,$230.40 ,$27.94 ,$230.40 ,$230.40 ,$27.94 ,$166.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101249,82672,HC ESTROGEN TOTAL-90,301,1 ,$83.00 ,$53.95 ,$21.70 ,$83.00 ,$61.84 ,$54.37 ,$21.70 ,$43.74 ,$21.70 ,$52.37 ,$52.37 ,$52.37 ,$52.37 ,$74.70 ,$62.25 ,$21.70 ,$73.04 ,$21.70 ,$62.25 ,$62.25 ,$70.55 ,$70.55 ,$21.70 ,$70.55 ,$21.70 ,$65.57 ,$65.57 ,$65.57 ,$74.70 ,$54.25 ,$74.70 ,$21.70 ,$83.00 ,$54.37 ,$21.70 ,$36.02 , N/A ,$22.79 ,$74.70 ,$48.83 ,$52.37 ,$49.80 ,$74.70 ,$21.70 ,$74.70 ,$74.70 ,$21.70 ,$53.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101250,82677,HC ESTRIOL-90,301,1 ,$102.00 ,$66.30 ,$24.18 ,$102.00 ,$75.99 ,$66.81 ,$24.18 ,$53.75 ,$24.18 ,$64.36 ,$64.36 ,$64.36 ,$64.36 ,$91.80 ,$76.50 ,$24.18 ,$89.76 ,$24.18 ,$76.50 ,$76.50 ,$86.70 ,$86.70 ,$24.18 ,$86.70 ,$24.18 ,$80.58 ,$80.58 ,$80.58 ,$91.80 ,$60.45 ,$91.80 ,$24.18 ,$102.00 ,$66.81 ,$24.18 ,$44.27 , N/A ,$25.39 ,$91.80 ,$54.41 ,$64.36 ,$61.20 ,$91.80 ,$24.18 ,$91.80 ,$91.80 ,$24.18 ,$66.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101251,82679,HC ESTRONE-90,301,1 ,$97.00 ,$63.05 ,$24.95 ,$97.00 ,$72.27 ,$63.54 ,$24.95 ,$51.12 ,$24.95 ,$61.21 ,$61.21 ,$61.21 ,$61.21 ,$87.30 ,$72.75 ,$24.95 ,$85.36 ,$24.95 ,$72.75 ,$72.75 ,$82.45 ,$82.45 ,$24.95 ,$82.45 ,$24.95 ,$76.63 ,$76.63 ,$76.63 ,$87.30 ,$62.38 ,$87.30 ,$24.95 ,$97.00 ,$63.54 ,$24.95 ,$42.10 , N/A ,$26.20 ,$87.30 ,$56.14 ,$61.21 ,$58.20 ,$87.30 ,$24.95 ,$87.30 ,$87.30 ,$24.95 ,$63.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101252,82693,HC ETHYLENE GLYCOL-90,301,1 ,$31.00 ,$20.15 ,$13.45 ,$33.53 ,$23.10 ,$20.31 ,$14.90 ,$16.34 ,$14.90 ,$19.56 ,$19.56 ,$19.56 ,$19.56 ,$27.90 ,$23.25 ,$14.90 ,$27.28 ,$14.90 ,$23.25 ,$23.25 ,$26.35 ,$26.35 ,$14.90 ,$26.35 ,$14.90 ,$24.49 ,$24.49 ,$24.49 ,$27.90 ,$31.00 ,$27.90 ,$14.90 ,$31.00 ,$20.31 ,$14.90 ,$13.45 , N/A ,$15.65 ,$27.90 ,$33.53 ,$19.56 ,$18.60 ,$27.90 ,$14.90 ,$27.90 ,$27.90 ,$14.90 ,$20.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101253,82705,HC FECAL FAT QUALITATIVE-90,301,1 ,$31.00 ,$20.15 ,$5.10 ,$31.00 ,$23.10 ,$20.31 ,$5.10 ,$16.34 ,$5.10 ,$19.56 ,$19.56 ,$19.56 ,$19.56 ,$27.90 ,$23.25 ,$5.10 ,$27.28 ,$5.10 ,$23.25 ,$23.25 ,$26.35 ,$26.35 ,$5.10 ,$26.35 ,$5.10 ,$24.49 ,$24.49 ,$24.49 ,$27.90 ,$12.75 ,$27.90 ,$5.10 ,$31.00 ,$20.31 ,$5.10 ,$13.45 , N/A ,$5.36 ,$27.90 ,$11.48 ,$19.56 ,$18.60 ,$27.90 ,$5.10 ,$27.90 ,$27.90 ,$5.10 ,$20.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101259,82747,HC FOLIC ACID RBC-90,301,1 ,$147.00 ,$95.55 ,$17.65 ,$147.00 ,$109.52 ,$96.29 ,$17.65 ,$77.47 ,$17.65 ,$92.76 ,$92.76 ,$92.76 ,$92.76 ,$132.30 ,$110.25 ,$17.65 ,$129.36 ,$17.65 ,$110.25 ,$110.25 ,$124.95 ,$124.95 ,$17.65 ,$124.95 ,$17.65 ,$116.13 ,$116.13 ,$116.13 ,$132.30 ,$44.13 ,$132.30 ,$17.65 ,$147.00 ,$96.29 ,$17.65 ,$63.80 , N/A ,$18.53 ,$132.30 ,$39.71 ,$92.76 ,$88.20 ,$132.30 ,$17.65 ,$132.30 ,$132.30 ,$17.65 ,$95.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101262,82784,HC GAMMAGLOBULIN-90,301,1 ,$125.00 ,$81.25 ,$9.30 ,$125.00 ,$93.13 ,$81.88 ,$9.30 ,$65.88 ,$9.30 ,$78.88 ,$78.88 ,$78.88 ,$78.88 ,$112.50 ,$93.75 ,$9.30 ,$110.00 ,$9.30 ,$93.75 ,$93.75 ,$106.25 ,$106.25 ,$9.30 ,$106.25 ,$9.30 ,$98.75 ,$98.75 ,$98.75 ,$112.50 ,$23.25 ,$112.50 ,$9.30 ,$125.00 ,$81.88 ,$9.30 ,$54.25 , N/A ,$9.77 ,$112.50 ,$20.93 ,$78.88 ,$75.00 ,$112.50 ,$9.30 ,$112.50 ,$112.50 ,$9.30 ,$81.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101263,82785,HC GAMMAGLOBULIN IGE-90,301,1 ,$115.00 ,$74.75 ,$16.46 ,$115.00 ,$85.68 ,$75.33 ,$16.46 ,$60.61 ,$16.46 ,$72.57 ,$72.57 ,$72.57 ,$72.57 ,$103.50 ,$86.25 ,$16.46 ,$101.20 ,$16.46 ,$86.25 ,$86.25 ,$97.75 ,$97.75 ,$16.46 ,$97.75 ,$16.46 ,$90.85 ,$90.85 ,$90.85 ,$103.50 ,$41.15 ,$103.50 ,$16.46 ,$115.00 ,$75.33 ,$16.46 ,$49.91 , N/A ,$17.28 ,$103.50 ,$37.04 ,$72.57 ,$69.00 ,$103.50 ,$16.46 ,$103.50 ,$103.50 ,$16.46 ,$74.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101265,82787,HC IMMUNOGLOBULIN SUBCLASSES-90,301,1 ,$150.00 ,$97.50 ,$8.02 ,$150.00 ,$111.75 ,$98.25 ,$8.02 ,$79.05 ,$8.02 ,$94.65 ,$94.65 ,$94.65 ,$94.65 ,$135.00 ,$112.50 ,$8.02 ,$132.00 ,$8.02 ,$112.50 ,$112.50 ,$127.50 ,$127.50 ,$8.02 ,$127.50 ,$8.02 ,$118.50 ,$118.50 ,$118.50 ,$135.00 ,$20.05 ,$135.00 ,$8.02 ,$150.00 ,$98.25 ,$8.02 ,$65.10 , N/A ,$8.42 ,$135.00 ,$18.05 ,$94.65 ,$90.00 ,$135.00 ,$8.02 ,$135.00 ,$135.00 ,$8.02 ,$97.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101268,82941,HC GASTRIN-90,301,1 ,$107.00 ,$69.55 ,$17.63 ,$107.00 ,$79.72 ,$70.09 ,$17.63 ,$56.39 ,$17.63 ,$67.52 ,$67.52 ,$67.52 ,$67.52 ,$96.30 ,$80.25 ,$17.63 ,$94.16 ,$17.63 ,$80.25 ,$80.25 ,$90.95 ,$90.95 ,$17.63 ,$90.95 ,$17.63 ,$84.53 ,$84.53 ,$84.53 ,$96.30 ,$44.08 ,$96.30 ,$17.63 ,$107.00 ,$70.09 ,$17.63 ,$46.44 , N/A ,$18.51 ,$96.30 ,$39.67 ,$67.52 ,$64.20 ,$96.30 ,$17.63 ,$96.30 ,$96.30 ,$17.63 ,$69.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101269,82945,HC GLUCOSE BODY FLUID-90,301,1 ,$15.00 ,$9.75 ,$3.93 ,$15.00 ,$11.18 ,$9.83 ,$3.93 ,$7.91 ,$3.93 ,$9.47 ,$9.47 ,$9.47 ,$9.47 ,$13.50 ,$11.25 ,$3.93 ,$13.20 ,$3.93 ,$11.25 ,$11.25 ,$12.75 ,$12.75 ,$3.93 ,$12.75 ,$3.93 ,$11.85 ,$11.85 ,$11.85 ,$13.50 ,$9.83 ,$13.50 ,$3.93 ,$15.00 ,$9.83 ,$3.93 ,$6.51 , N/A ,$4.13 ,$13.50 ,$8.84 ,$9.47 ,$9.00 ,$13.50 ,$3.93 ,$13.50 ,$13.50 ,$3.93 ,$9.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101274,82955,HC G6PD ENZYME QN-90,301,1 ,$11.62 ,$7.55 ,$5.04 ,$21.83 ,$8.66 ,$7.61 ,$9.70 ,$6.12 ,$9.70 ,$7.33 ,$7.33 ,$7.33 ,$7.33 ,$10.46 ,$8.72 ,$9.70 ,$10.23 ,$9.70 ,$8.72 ,$8.72 ,$9.88 ,$9.88 ,$9.70 ,$9.88 ,$9.70 ,$9.18 ,$9.18 ,$9.18 ,$10.46 ,$11.62 ,$10.46 ,$9.70 ,$11.62 ,$7.61 ,$9.70 ,$5.04 , N/A ,$10.19 ,$10.46 ,$21.83 ,$7.33 ,$6.97 ,$10.46 ,$9.70 ,$10.46 ,$10.46 ,$9.70 ,$7.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101276,82985,HC FRUCTOSAMINE-90,301,1 ,$93.00 ,$60.45 ,$16.76 ,$93.00 ,$69.29 ,$60.92 ,$16.76 ,$49.01 ,$16.76 ,$58.68 ,$58.68 ,$58.68 ,$58.68 ,$83.70 ,$69.75 ,$16.76 ,$81.84 ,$16.76 ,$69.75 ,$69.75 ,$79.05 ,$79.05 ,$16.76 ,$79.05 ,$16.76 ,$73.47 ,$73.47 ,$73.47 ,$83.70 ,$41.90 ,$83.70 ,$16.76 ,$93.00 ,$60.92 ,$16.76 ,$40.36 , N/A ,$17.60 ,$83.70 ,$37.71 ,$58.68 ,$55.80 ,$83.70 ,$16.76 ,$83.70 ,$83.70 ,$16.76 ,$60.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101280,83003,HC GROWTH HORMONE (HGH) STIM-90,301,1 ,$103.00 ,$66.95 ,$16.67 ,$103.00 ,$76.74 ,$67.47 ,$16.67 ,$54.28 ,$16.67 ,$64.99 ,$64.99 ,$64.99 ,$64.99 ,$92.70 ,$77.25 ,$16.67 ,$90.64 ,$16.67 ,$77.25 ,$77.25 ,$87.55 ,$87.55 ,$16.67 ,$87.55 ,$16.67 ,$81.37 ,$81.37 ,$81.37 ,$92.70 ,$41.68 ,$92.70 ,$16.67 ,$103.00 ,$67.47 ,$16.67 ,$44.70 , N/A ,$17.50 ,$92.70 ,$37.51 ,$64.99 ,$61.80 ,$92.70 ,$16.67 ,$92.70 ,$92.70 ,$16.67 ,$66.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101282,83013,HC H PYLORI BREATH TEST-90,301,1 ,$191.00 ,$124.15 ,$67.36 ,$191.00 ,$142.30 ,$125.11 ,$67.36 ,$100.66 ,$67.36 ,$120.52 ,$120.52 ,$120.52 ,$120.52 ,$171.90 ,$143.25 ,$67.36 ,$168.08 ,$67.36 ,$143.25 ,$143.25 ,$162.35 ,$162.35 ,$67.36 ,$162.35 ,$67.36 ,$150.89 ,$150.89 ,$150.89 ,$171.90 ,$168.40 ,$171.90 ,$67.36 ,$191.00 ,$125.11 ,$67.36 ,$82.89 , N/A ,$70.73 ,$171.90 ,$151.56 ,$120.52 ,$114.60 ,$171.90 ,$67.36 ,$171.90 ,$171.90 ,$67.36 ,$124.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101283,83018,HC HEAVY METAL QN EACH-90,301,1 ,$137.00 ,$89.05 ,$21.96 ,$137.00 ,$102.07 ,$89.74 ,$21.96 ,$72.20 ,$21.96 ,$86.45 ,$86.45 ,$86.45 ,$86.45 ,$123.30 ,$102.75 ,$21.96 ,$120.56 ,$21.96 ,$102.75 ,$102.75 ,$116.45 ,$116.45 ,$21.96 ,$116.45 ,$21.96 ,$108.23 ,$108.23 ,$108.23 ,$123.30 ,$54.90 ,$123.30 ,$21.96 ,$137.00 ,$89.74 ,$21.96 ,$59.46 , N/A ,$23.06 ,$123.30 ,$49.41 ,$86.45 ,$82.20 ,$123.30 ,$21.96 ,$123.30 ,$123.30 ,$21.96 ,$89.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101289,83051,HC HEMOGLOBIN PLASMA-90,301,1 ,$23.00 ,$14.95 ,$7.31 ,$23.00 ,$17.14 ,$15.07 ,$7.31 ,$12.12 ,$7.31 ,$14.51 ,$14.51 ,$14.51 ,$14.51 ,$20.70 ,$17.25 ,$7.31 ,$20.24 ,$7.31 ,$17.25 ,$17.25 ,$19.55 ,$19.55 ,$7.31 ,$19.55 ,$7.31 ,$18.17 ,$18.17 ,$18.17 ,$20.70 ,$18.28 ,$20.70 ,$7.31 ,$23.00 ,$15.07 ,$7.31 ,$9.98 , N/A ,$7.68 ,$20.70 ,$16.45 ,$14.51 ,$13.80 ,$20.70 ,$7.31 ,$20.70 ,$20.70 ,$7.31 ,$14.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101291,83088,HC HISTAMINE-90,301,1 ,$229.02 ,$148.86 ,$29.53 ,$229.02 ,$170.62 ,$150.01 ,$29.53 ,$120.69 ,$29.53 ,$144.51 ,$144.51 ,$144.51 ,$144.51 ,$206.12 ,$171.77 ,$29.53 ,$201.54 ,$29.53 ,$171.77 ,$171.77 ,$194.67 ,$194.67 ,$29.53 ,$194.67 ,$29.53 ,$180.93 ,$180.93 ,$180.93 ,$206.12 ,$73.83 ,$206.12 ,$29.53 ,$229.02 ,$150.01 ,$29.53 ,$99.39 , N/A ,$31.01 ,$206.12 ,$66.44 ,$144.51 ,$137.41 ,$206.12 ,$29.53 ,$206.12 ,$206.12 ,$29.53 ,$148.86 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101294,83497,HC HYDROXYINDOLACET 5 (HIAA)-90,301,1 ,$100.00 ,$65.00 ,$12.90 ,$100.00 ,$74.50 ,$65.50 ,$12.90 ,$52.70 ,$12.90 ,$63.10 ,$63.10 ,$63.10 ,$63.10 ,$90.00 ,$75.00 ,$12.90 ,$88.00 ,$12.90 ,$75.00 ,$75.00 ,$85.00 ,$85.00 ,$12.90 ,$85.00 ,$12.90 ,$79.00 ,$79.00 ,$79.00 ,$90.00 ,$32.25 ,$90.00 ,$12.90 ,$100.00 ,$65.50 ,$12.90 ,$43.40 , N/A ,$13.55 ,$90.00 ,$29.03 ,$63.10 ,$60.00 ,$90.00 ,$12.90 ,$90.00 ,$90.00 ,$12.90 ,$65.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101295,83498,HC HYDROXYPROGESTERONE 17D-90,301,1 ,$80.00 ,$52.00 ,$27.17 ,$80.00 ,$59.60 ,$52.40 ,$27.17 ,$42.16 ,$27.17 ,$50.48 ,$50.48 ,$50.48 ,$50.48 ,$72.00 ,$60.00 ,$27.17 ,$70.40 ,$27.17 ,$60.00 ,$60.00 ,$68.00 ,$68.00 ,$27.17 ,$68.00 ,$27.17 ,$63.20 ,$63.20 ,$63.20 ,$72.00 ,$67.93 ,$72.00 ,$27.17 ,$80.00 ,$52.40 ,$27.17 ,$34.72 , N/A ,$28.53 ,$72.00 ,$61.13 ,$50.48 ,$48.00 ,$72.00 ,$27.17 ,$72.00 ,$72.00 ,$27.17 ,$52.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101297,83516,HC MLT NON INFECT QL/SQ-90,301,1 ,$127.00 ,$82.55 ,$11.53 ,$127.00 ,$94.62 ,$83.19 ,$11.53 ,$66.93 ,$11.53 ,$80.14 ,$80.14 ,$80.14 ,$80.14 ,$114.30 ,$95.25 ,$11.53 ,$111.76 ,$11.53 ,$95.25 ,$95.25 ,$107.95 ,$107.95 ,$11.53 ,$107.95 ,$11.53 ,$100.33 ,$100.33 ,$100.33 ,$114.30 ,$28.83 ,$114.30 ,$11.53 ,$127.00 ,$83.19 ,$11.53 ,$55.12 , N/A ,$12.11 ,$114.30 ,$25.94 ,$80.14 ,$76.20 ,$114.30 ,$11.53 ,$114.30 ,$114.30 ,$11.53 ,$82.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101300,83516,HC MLT NON INFECT QL/SQ TTG-90,301,1 ,$127.00 ,$82.55 ,$11.53 ,$127.00 ,$94.62 ,$83.19 ,$11.53 ,$66.93 ,$11.53 ,$80.14 ,$80.14 ,$80.14 ,$80.14 ,$114.30 ,$95.25 ,$11.53 ,$111.76 ,$11.53 ,$95.25 ,$95.25 ,$107.95 ,$107.95 ,$11.53 ,$107.95 ,$11.53 ,$100.33 ,$100.33 ,$100.33 ,$114.30 ,$28.83 ,$114.30 ,$11.53 ,$127.00 ,$83.19 ,$11.53 ,$55.12 , N/A ,$12.11 ,$114.30 ,$25.94 ,$80.14 ,$76.20 ,$114.30 ,$11.53 ,$114.30 ,$114.30 ,$11.53 ,$82.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101302,83519,HC QN RIA-90,301,1 ,$92.00 ,$59.80 ,$18.40 ,$92.00 ,$68.54 ,$60.26 ,$18.40 ,$48.48 ,$18.40 ,$58.05 ,$58.05 ,$58.05 ,$58.05 ,$82.80 ,$69.00 ,$18.40 ,$80.96 ,$18.40 ,$69.00 ,$69.00 ,$78.20 ,$78.20 ,$18.40 ,$78.20 ,$18.40 ,$72.68 ,$72.68 ,$72.68 ,$82.80 ,$46.00 ,$82.80 ,$18.40 ,$92.00 ,$60.26 ,$18.40 ,$39.93 , N/A ,$19.32 ,$82.80 ,$41.40 ,$58.05 ,$55.20 ,$82.80 ,$18.40 ,$82.80 ,$82.80 ,$18.40 ,$59.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101303,83520,HC IMMUNOASSAY QN OTHER-90,301,1 ,$69.00 ,$44.85 ,$17.27 ,$69.00 ,$51.41 ,$45.20 ,$17.27 ,$36.36 ,$17.27 ,$43.54 ,$43.54 ,$43.54 ,$43.54 ,$62.10 ,$51.75 ,$17.27 ,$60.72 ,$17.27 ,$51.75 ,$51.75 ,$58.65 ,$58.65 ,$17.27 ,$58.65 ,$17.27 ,$54.51 ,$54.51 ,$54.51 ,$62.10 ,$43.18 ,$62.10 ,$17.27 ,$69.00 ,$45.20 ,$17.27 ,$29.95 , N/A ,$18.13 ,$62.10 ,$38.86 ,$43.54 ,$41.40 ,$62.10 ,$17.27 ,$62.10 ,$62.10 ,$17.27 ,$44.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101305,83520,HC IMMUNOASSAY QN OTHER MBL-90,301,1 ,$215.00 ,$139.75 ,$17.27 ,$215.00 ,$160.18 ,$140.83 ,$17.27 ,$113.31 ,$17.27 ,$135.67 ,$135.67 ,$135.67 ,$135.67 ,$193.50 ,$161.25 ,$17.27 ,$189.20 ,$17.27 ,$161.25 ,$161.25 ,$182.75 ,$182.75 ,$17.27 ,$182.75 ,$17.27 ,$169.85 ,$169.85 ,$169.85 ,$193.50 ,$43.18 ,$193.50 ,$17.27 ,$215.00 ,$140.83 ,$17.27 ,$93.31 , N/A ,$18.13 ,$193.50 ,$38.86 ,$135.67 ,$129.00 ,$193.50 ,$17.27 ,$193.50 ,$193.50 ,$17.27 ,$139.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101306,83520,HC IMMUNOASSAY QN ENZYME-90,301,1 ,$215.00 ,$139.75 ,$17.27 ,$215.00 ,$160.18 ,$140.83 ,$17.27 ,$113.31 ,$17.27 ,$135.67 ,$135.67 ,$135.67 ,$135.67 ,$193.50 ,$161.25 ,$17.27 ,$189.20 ,$17.27 ,$161.25 ,$161.25 ,$182.75 ,$182.75 ,$17.27 ,$182.75 ,$17.27 ,$169.85 ,$169.85 ,$169.85 ,$193.50 ,$43.18 ,$193.50 ,$17.27 ,$215.00 ,$140.83 ,$17.27 ,$93.31 , N/A ,$18.13 ,$193.50 ,$38.86 ,$135.67 ,$129.00 ,$193.50 ,$17.27 ,$193.50 ,$193.50 ,$17.27 ,$139.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101307,83525,HC INSULIN TOTAL-90,301,1 ,$39.00 ,$25.35 ,$11.43 ,$39.00 ,$29.06 ,$25.55 ,$11.43 ,$20.55 ,$11.43 ,$24.61 ,$24.61 ,$24.61 ,$24.61 ,$35.10 ,$29.25 ,$11.43 ,$34.32 ,$11.43 ,$29.25 ,$29.25 ,$33.15 ,$33.15 ,$11.43 ,$33.15 ,$11.43 ,$30.81 ,$30.81 ,$30.81 ,$35.10 ,$28.58 ,$35.10 ,$11.43 ,$39.00 ,$25.55 ,$11.43 ,$16.93 , N/A ,$12.00 ,$35.10 ,$25.72 ,$24.61 ,$23.40 ,$35.10 ,$11.43 ,$35.10 ,$35.10 ,$11.43 ,$25.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101308,83527,HC INSULIN FREE-90,301,1 ,$25.40 ,$16.51 ,$11.02 ,$29.14 ,$18.92 ,$16.64 ,$12.95 ,$13.39 ,$12.95 ,$16.03 ,$16.03 ,$16.03 ,$16.03 ,$22.86 ,$19.05 ,$12.95 ,$22.35 ,$12.95 ,$19.05 ,$19.05 ,$21.59 ,$21.59 ,$12.95 ,$21.59 ,$12.95 ,$20.07 ,$20.07 ,$20.07 ,$22.86 ,$25.40 ,$22.86 ,$12.95 ,$25.40 ,$16.64 ,$12.95 ,$11.02 , N/A ,$13.60 ,$22.86 ,$29.14 ,$16.03 ,$15.24 ,$22.86 ,$12.95 ,$22.86 ,$22.86 ,$12.95 ,$16.51 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101310,83586,HC KETOSTEROIDS (17-KS)-90,301,1 ,$79.00 ,$51.35 ,$12.80 ,$79.00 ,$58.86 ,$51.75 ,$12.80 ,$41.63 ,$12.80 ,$49.85 ,$49.85 ,$49.85 ,$49.85 ,$71.10 ,$59.25 ,$12.80 ,$69.52 ,$12.80 ,$59.25 ,$59.25 ,$67.15 ,$67.15 ,$12.80 ,$67.15 ,$12.80 ,$62.41 ,$62.41 ,$62.41 ,$71.10 ,$32.00 ,$71.10 ,$12.80 ,$79.00 ,$51.75 ,$12.80 ,$34.29 , N/A ,$13.44 ,$71.10 ,$28.80 ,$49.85 ,$47.40 ,$71.10 ,$12.80 ,$71.10 ,$71.10 ,$12.80 ,$51.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101312,83615,HC LACTATE DEHYDRO (LDH)-90,301,1 ,$117.00 ,$76.05 ,$6.04 ,$117.00 ,$87.17 ,$76.64 ,$6.04 ,$61.66 ,$6.04 ,$73.83 ,$73.83 ,$73.83 ,$73.83 ,$105.30 ,$87.75 ,$6.04 ,$102.96 ,$6.04 ,$87.75 ,$87.75 ,$99.45 ,$99.45 ,$6.04 ,$99.45 ,$6.04 ,$92.43 ,$92.43 ,$92.43 ,$105.30 ,$15.10 ,$105.30 ,$6.04 ,$117.00 ,$76.64 ,$6.04 ,$50.78 , N/A ,$6.34 ,$105.30 ,$13.59 ,$73.83 ,$70.20 ,$105.30 ,$6.04 ,$105.30 ,$105.30 ,$6.04 ,$76.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101313,83625,HC LDH ISOENZYMES-90,301,1 ,$79.00 ,$51.35 ,$12.79 ,$79.00 ,$58.86 ,$51.75 ,$12.79 ,$41.63 ,$12.79 ,$49.85 ,$49.85 ,$49.85 ,$49.85 ,$71.10 ,$59.25 ,$12.79 ,$69.52 ,$12.79 ,$59.25 ,$59.25 ,$67.15 ,$67.15 ,$12.79 ,$67.15 ,$12.79 ,$62.41 ,$62.41 ,$62.41 ,$71.10 ,$31.98 ,$71.10 ,$12.79 ,$79.00 ,$51.75 ,$12.79 ,$34.29 , N/A ,$13.43 ,$71.10 ,$28.78 ,$49.85 ,$47.40 ,$71.10 ,$12.79 ,$71.10 ,$71.10 ,$12.79 ,$51.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101316,83655,HC LEAD-90,301,1 ,$85.00 ,$55.25 ,$12.11 ,$85.00 ,$63.33 ,$55.68 ,$12.11 ,$44.80 ,$12.11 ,$53.64 ,$53.64 ,$53.64 ,$53.64 ,$76.50 ,$63.75 ,$12.11 ,$74.80 ,$12.11 ,$63.75 ,$63.75 ,$72.25 ,$72.25 ,$12.11 ,$72.25 ,$12.11 ,$67.15 ,$67.15 ,$67.15 ,$76.50 ,$30.28 ,$76.50 ,$12.11 ,$85.00 ,$55.68 ,$12.11 ,$36.89 , N/A ,$12.72 ,$76.50 ,$27.25 ,$53.64 ,$51.00 ,$76.50 ,$12.11 ,$76.50 ,$76.50 ,$12.11 ,$55.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101319,83695,HC LIPOPROTEIN-90,301,1 ,$112.00 ,$72.80 ,$14.32 ,$112.00 ,$83.44 ,$73.36 ,$14.32 ,$59.02 ,$14.32 ,$70.67 ,$70.67 ,$70.67 ,$70.67 ,$100.80 ,$84.00 ,$14.32 ,$98.56 ,$14.32 ,$84.00 ,$84.00 ,$95.20 ,$95.20 ,$14.32 ,$95.20 ,$14.32 ,$88.48 ,$88.48 ,$88.48 ,$100.80 ,$35.80 ,$100.80 ,$14.32 ,$112.00 ,$73.36 ,$14.32 ,$48.61 , N/A ,$15.04 ,$100.80 ,$32.22 ,$70.67 ,$67.20 ,$100.80 ,$14.32 ,$100.80 ,$100.80 ,$14.32 ,$72.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101326,83735,HC MAGNESIUM-90,301,1 ,$7.28 ,$4.73 ,$3.16 ,$15.08 ,$5.42 ,$4.77 ,$6.70 ,$3.84 ,$6.70 ,$4.59 ,$4.59 ,$4.59 ,$4.59 ,$6.55 ,$5.46 ,$6.70 ,$6.41 ,$6.70 ,$5.46 ,$5.46 ,$6.19 ,$6.19 ,$6.70 ,$6.19 ,$6.70 ,$5.75 ,$5.75 ,$5.75 ,$6.55 ,$7.28 ,$6.55 ,$6.70 ,$7.28 ,$4.77 ,$6.70 ,$3.16 , N/A ,$7.04 ,$6.55 ,$15.08 ,$4.59 ,$4.37 ,$6.55 ,$6.70 ,$6.55 ,$6.55 ,$6.70 ,$4.73 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101327,83785,HC MANGANESE-90,301,1 ,$152.00 ,$98.80 ,$26.65 ,$152.00 ,$113.24 ,$99.56 ,$26.65 ,$80.10 ,$26.65 ,$95.91 ,$95.91 ,$95.91 ,$95.91 ,$136.80 ,$114.00 ,$26.65 ,$133.76 ,$26.65 ,$114.00 ,$114.00 ,$129.20 ,$129.20 ,$26.65 ,$129.20 ,$26.65 ,$120.08 ,$120.08 ,$120.08 ,$136.80 ,$66.63 ,$136.80 ,$26.65 ,$152.00 ,$99.56 ,$26.65 ,$65.97 , N/A ,$27.98 ,$136.80 ,$59.96 ,$95.91 ,$91.20 ,$136.80 ,$26.65 ,$136.80 ,$136.80 ,$26.65 ,$98.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101328,83789,HC MASS SPEC QN EACH-90,301,1 ,$176.00 ,$114.40 ,$24.11 ,$176.00 ,$131.12 ,$115.28 ,$24.11 ,$92.75 ,$24.11 ,$111.06 ,$111.06 ,$111.06 ,$111.06 ,$158.40 ,$132.00 ,$24.11 ,$154.88 ,$24.11 ,$132.00 ,$132.00 ,$149.60 ,$149.60 ,$24.11 ,$149.60 ,$24.11 ,$139.04 ,$139.04 ,$139.04 ,$158.40 ,$60.28 ,$158.40 ,$24.11 ,$176.00 ,$115.28 ,$24.11 ,$76.38 , N/A ,$25.32 ,$158.40 ,$54.25 ,$111.06 ,$105.60 ,$158.40 ,$24.11 ,$158.40 ,$158.40 ,$24.11 ,$114.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101329,83825,HC MERCURY-90,301,1 ,$100.00 ,$65.00 ,$16.26 ,$100.00 ,$74.50 ,$65.50 ,$16.26 ,$52.70 ,$16.26 ,$63.10 ,$63.10 ,$63.10 ,$63.10 ,$90.00 ,$75.00 ,$16.26 ,$88.00 ,$16.26 ,$75.00 ,$75.00 ,$85.00 ,$85.00 ,$16.26 ,$85.00 ,$16.26 ,$79.00 ,$79.00 ,$79.00 ,$90.00 ,$40.65 ,$90.00 ,$16.26 ,$100.00 ,$65.50 ,$16.26 ,$43.40 , N/A ,$17.07 ,$90.00 ,$36.59 ,$63.10 ,$60.00 ,$90.00 ,$16.26 ,$90.00 ,$90.00 ,$16.26 ,$65.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101330,83835,HC METANEPHRINES-90,301,1 ,$162.00 ,$105.30 ,$16.94 ,$162.00 ,$120.69 ,$106.11 ,$16.94 ,$85.37 ,$16.94 ,$102.22 ,$102.22 ,$102.22 ,$102.22 ,$145.80 ,$121.50 ,$16.94 ,$142.56 ,$16.94 ,$121.50 ,$121.50 ,$137.70 ,$137.70 ,$16.94 ,$137.70 ,$16.94 ,$127.98 ,$127.98 ,$127.98 ,$145.80 ,$42.35 ,$145.80 ,$16.94 ,$162.00 ,$106.11 ,$16.94 ,$70.31 , N/A ,$17.79 ,$145.80 ,$38.12 ,$102.22 ,$97.20 ,$145.80 ,$16.94 ,$145.80 ,$145.80 ,$16.94 ,$105.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101333,83873,HC MYELIN BASIC PROTEIN (CSF)-90,301,1 ,$153.00 ,$99.45 ,$17.20 ,$153.00 ,$113.99 ,$100.22 ,$17.20 ,$80.63 ,$17.20 ,$96.54 ,$96.54 ,$96.54 ,$96.54 ,$137.70 ,$114.75 ,$17.20 ,$134.64 ,$17.20 ,$114.75 ,$114.75 ,$130.05 ,$130.05 ,$17.20 ,$130.05 ,$17.20 ,$120.87 ,$120.87 ,$120.87 ,$137.70 ,$43.00 ,$137.70 ,$17.20 ,$153.00 ,$100.22 ,$17.20 ,$66.40 , N/A ,$18.06 ,$137.70 ,$38.70 ,$96.54 ,$91.80 ,$137.70 ,$17.20 ,$137.70 ,$137.70 ,$17.20 ,$99.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101334,83874,HC MYOGLOBIN-90,301,1 ,$136.00 ,$88.40 ,$12.92 ,$136.00 ,$101.32 ,$89.08 ,$12.92 ,$71.67 ,$12.92 ,$85.82 ,$85.82 ,$85.82 ,$85.82 ,$122.40 ,$102.00 ,$12.92 ,$119.68 ,$12.92 ,$102.00 ,$102.00 ,$115.60 ,$115.60 ,$12.92 ,$115.60 ,$12.92 ,$107.44 ,$107.44 ,$107.44 ,$122.40 ,$32.30 ,$122.40 ,$12.92 ,$136.00 ,$89.08 ,$12.92 ,$59.02 , N/A ,$13.57 ,$122.40 ,$29.07 ,$85.82 ,$81.60 ,$122.40 ,$12.92 ,$122.40 ,$122.40 ,$12.92 ,$88.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101337,83883,HC NEPHELOMETRY EA ANALYTE-90,301,1 ,$140.00 ,$91.00 ,$13.60 ,$140.00 ,$104.30 ,$91.70 ,$13.60 ,$73.78 ,$13.60 ,$88.34 ,$88.34 ,$88.34 ,$88.34 ,$126.00 ,$105.00 ,$13.60 ,$123.20 ,$13.60 ,$105.00 ,$105.00 ,$119.00 ,$119.00 ,$13.60 ,$119.00 ,$13.60 ,$110.60 ,$110.60 ,$110.60 ,$126.00 ,$34.00 ,$126.00 ,$13.60 ,$140.00 ,$91.70 ,$13.60 ,$60.76 , N/A ,$14.28 ,$126.00 ,$30.60 ,$88.34 ,$84.00 ,$126.00 ,$13.60 ,$126.00 ,$126.00 ,$13.60 ,$91.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101339,83915,HC NUCLEOTIDASE 5 -90,301,1 ,$61.00 ,$39.65 ,$11.15 ,$61.00 ,$45.45 ,$39.96 ,$11.15 ,$32.15 ,$11.15 ,$38.49 ,$38.49 ,$38.49 ,$38.49 ,$54.90 ,$45.75 ,$11.15 ,$53.68 ,$11.15 ,$45.75 ,$45.75 ,$51.85 ,$51.85 ,$11.15 ,$51.85 ,$11.15 ,$48.19 ,$48.19 ,$48.19 ,$54.90 ,$27.88 ,$54.90 ,$11.15 ,$61.00 ,$39.96 ,$11.15 ,$26.47 , N/A ,$11.71 ,$54.90 ,$25.09 ,$38.49 ,$36.60 ,$54.90 ,$11.15 ,$54.90 ,$54.90 ,$11.15 ,$39.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101340,83916,HC OLIGOCLONAL BANDS-90,301,1 ,$166.00 ,$107.90 ,$27.39 ,$166.00 ,$123.67 ,$108.73 ,$27.39 ,$87.48 ,$27.39 ,$104.75 ,$104.75 ,$104.75 ,$104.75 ,$149.40 ,$124.50 ,$27.39 ,$146.08 ,$27.39 ,$124.50 ,$124.50 ,$141.10 ,$141.10 ,$27.39 ,$141.10 ,$27.39 ,$131.14 ,$131.14 ,$131.14 ,$149.40 ,$68.48 ,$149.40 ,$27.39 ,$166.00 ,$108.73 ,$27.39 ,$72.04 , N/A ,$28.76 ,$149.40 ,$61.63 ,$104.75 ,$99.60 ,$149.40 ,$27.39 ,$149.40 ,$149.40 ,$27.39 ,$107.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101345,83945,HC OXALATE-90,301,1 ,$79.00 ,$51.35 ,$14.45 ,$79.00 ,$58.86 ,$51.75 ,$14.45 ,$41.63 ,$14.45 ,$49.85 ,$49.85 ,$49.85 ,$49.85 ,$71.10 ,$59.25 ,$14.45 ,$69.52 ,$14.45 ,$59.25 ,$59.25 ,$67.15 ,$67.15 ,$14.45 ,$67.15 ,$14.45 ,$62.41 ,$62.41 ,$62.41 ,$71.10 ,$36.13 ,$71.10 ,$14.45 ,$79.00 ,$51.75 ,$14.45 ,$34.29 , N/A ,$15.17 ,$71.10 ,$32.51 ,$49.85 ,$47.40 ,$71.10 ,$14.45 ,$71.10 ,$71.10 ,$14.45 ,$51.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101349,83992,HC PHENCYCLIDINE (PCP)-90,301,1 ,$228.86 ,$148.76 ,$99.33 ,$228.86 ,$170.50 ,$149.90 , N/A ,$120.61 , N/A ,$144.41 ,$144.41 ,$144.41 ,$144.41 ,$205.97 ,$171.65 , N/A ,$201.40 , N/A ,$171.65 ,$171.65 ,$194.53 ,$194.53 , N/A ,$194.53 , N/A ,$180.80 ,$180.80 ,$180.80 ,$205.97 , N/A ,$205.97 , N/A ,$228.86 ,$149.90 , N/A ,$99.33 , N/A , N/A ,$205.97 , N/A ,$144.41 ,$137.32 ,$205.97 , N/A ,$205.97 ,$205.97 , N/A ,$148.76 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101351,83993,HC CALPROTECTIN STOOL-90,301,1 ,$263.00 ,$170.95 ,$19.63 ,$263.00 ,$195.94 ,$172.27 ,$19.63 ,$138.60 ,$19.63 ,$165.95 ,$165.95 ,$165.95 ,$165.95 ,$236.70 ,$197.25 ,$19.63 ,$231.44 ,$19.63 ,$197.25 ,$197.25 ,$223.55 ,$223.55 ,$19.63 ,$223.55 ,$19.63 ,$207.77 ,$207.77 ,$207.77 ,$236.70 ,$49.08 ,$236.70 ,$19.63 ,$263.00 ,$172.27 ,$19.63 ,$114.14 , N/A ,$20.61 ,$236.70 ,$44.17 ,$165.95 ,$157.80 ,$236.70 ,$19.63 ,$236.70 ,$236.70 ,$19.63 ,$170.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101352,84030,HC NEWBORN SCREEN PKU-90,301,1 ,$233.00 ,$151.45 ,$5.50 ,$233.00 ,$173.59 ,$152.62 ,$5.50 ,$122.79 ,$5.50 ,$147.02 ,$147.02 ,$147.02 ,$147.02 ,$209.70 ,$174.75 ,$5.50 ,$205.04 ,$5.50 ,$174.75 ,$174.75 ,$198.05 ,$198.05 ,$5.50 ,$198.05 ,$5.50 ,$184.07 ,$184.07 ,$184.07 ,$209.70 ,$13.75 ,$209.70 ,$5.50 ,$233.00 ,$152.62 ,$5.50 ,$101.12 , N/A ,$5.78 ,$209.70 ,$12.38 ,$147.02 ,$139.80 ,$209.70 ,$5.50 ,$209.70 ,$209.70 ,$5.50 ,$151.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101353,84066,HC PHOSPHATASE ACID PROSTATIC-90,301,1 ,$68.00 ,$44.20 ,$9.66 ,$68.00 ,$50.66 ,$44.54 ,$9.66 ,$35.84 ,$9.66 ,$42.91 ,$42.91 ,$42.91 ,$42.91 ,$61.20 ,$51.00 ,$9.66 ,$59.84 ,$9.66 ,$51.00 ,$51.00 ,$57.80 ,$57.80 ,$9.66 ,$57.80 ,$9.66 ,$53.72 ,$53.72 ,$53.72 ,$61.20 ,$24.15 ,$61.20 ,$9.66 ,$68.00 ,$44.54 ,$9.66 ,$29.51 , N/A ,$10.14 ,$61.20 ,$21.74 ,$42.91 ,$40.80 ,$61.20 ,$9.66 ,$61.20 ,$61.20 ,$9.66 ,$44.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101354,84075,HC ALKALINE PHOSPHATASE-90,301,1 ,$32.00 ,$20.80 ,$5.18 ,$32.00 ,$23.84 ,$20.96 ,$5.18 ,$16.86 ,$5.18 ,$20.19 ,$20.19 ,$20.19 ,$20.19 ,$28.80 ,$24.00 ,$5.18 ,$28.16 ,$5.18 ,$24.00 ,$24.00 ,$27.20 ,$27.20 ,$5.18 ,$27.20 ,$5.18 ,$25.28 ,$25.28 ,$25.28 ,$28.80 ,$12.95 ,$28.80 ,$5.18 ,$32.00 ,$20.96 ,$5.18 ,$13.89 , N/A ,$5.44 ,$28.80 ,$11.66 ,$20.19 ,$19.20 ,$28.80 ,$5.18 ,$28.80 ,$28.80 ,$5.18 ,$20.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101356,84080,HC ALK PHOS ISOENZ-90,301,1 ,$91.00 ,$59.15 ,$14.78 ,$91.00 ,$67.80 ,$59.61 ,$14.78 ,$47.96 ,$14.78 ,$57.42 ,$57.42 ,$57.42 ,$57.42 ,$81.90 ,$68.25 ,$14.78 ,$80.08 ,$14.78 ,$68.25 ,$68.25 ,$77.35 ,$77.35 ,$14.78 ,$77.35 ,$14.78 ,$71.89 ,$71.89 ,$71.89 ,$81.90 ,$36.95 ,$81.90 ,$14.78 ,$91.00 ,$59.61 ,$14.78 ,$39.49 , N/A ,$15.52 ,$81.90 ,$33.26 ,$57.42 ,$54.60 ,$81.90 ,$14.78 ,$81.90 ,$81.90 ,$14.78 ,$59.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101359,84110,HC PORPHOBILINOGEN QN-90,301,1 ,$88.00 ,$57.20 ,$8.44 ,$88.00 ,$65.56 ,$57.64 ,$8.44 ,$46.38 ,$8.44 ,$55.53 ,$55.53 ,$55.53 ,$55.53 ,$79.20 ,$66.00 ,$8.44 ,$77.44 ,$8.44 ,$66.00 ,$66.00 ,$74.80 ,$74.80 ,$8.44 ,$74.80 ,$8.44 ,$69.52 ,$69.52 ,$69.52 ,$79.20 ,$21.10 ,$79.20 ,$8.44 ,$88.00 ,$57.64 ,$8.44 ,$38.19 , N/A ,$8.86 ,$79.20 ,$18.99 ,$55.53 ,$52.80 ,$79.20 ,$8.44 ,$79.20 ,$79.20 ,$8.44 ,$57.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101366,84140,HC PREGNENOLONE-90,301,1 ,$108.00 ,$70.20 ,$20.67 ,$108.00 ,$80.46 ,$70.74 ,$20.67 ,$56.92 ,$20.67 ,$68.15 ,$68.15 ,$68.15 ,$68.15 ,$97.20 ,$81.00 ,$20.67 ,$95.04 ,$20.67 ,$81.00 ,$81.00 ,$91.80 ,$91.80 ,$20.67 ,$91.80 ,$20.67 ,$85.32 ,$85.32 ,$85.32 ,$97.20 ,$51.68 ,$97.20 ,$20.67 ,$108.00 ,$70.74 ,$20.67 ,$46.87 , N/A ,$21.70 ,$97.20 ,$46.51 ,$68.15 ,$64.80 ,$97.20 ,$20.67 ,$97.20 ,$97.20 ,$20.67 ,$70.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101367,84143,HC 17-HYDROXYPREGNENOLONE-90,301,1 ,$172.36 ,$112.03 ,$22.81 ,$172.36 ,$128.41 ,$112.90 ,$22.81 ,$90.83 ,$22.81 ,$108.76 ,$108.76 ,$108.76 ,$108.76 ,$155.12 ,$129.27 ,$22.81 ,$151.68 ,$22.81 ,$129.27 ,$129.27 ,$146.51 ,$146.51 ,$22.81 ,$146.51 ,$22.81 ,$136.16 ,$136.16 ,$136.16 ,$155.12 ,$57.03 ,$155.12 ,$22.81 ,$172.36 ,$112.90 ,$22.81 ,$74.80 , N/A ,$23.95 ,$155.12 ,$51.32 ,$108.76 ,$103.42 ,$155.12 ,$22.81 ,$155.12 ,$155.12 ,$22.81 ,$112.03 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101369,84145,HC PROCALCITONIN (PCT)-90,301,1 ,$230.00 ,$149.50 ,$27.22 ,$230.00 ,$171.35 ,$150.65 ,$27.22 ,$121.21 ,$27.22 ,$145.13 ,$145.13 ,$145.13 ,$145.13 ,$207.00 ,$172.50 ,$27.22 ,$202.40 ,$27.22 ,$172.50 ,$172.50 ,$195.50 ,$195.50 ,$27.22 ,$195.50 ,$27.22 ,$181.70 ,$181.70 ,$181.70 ,$207.00 ,$68.05 ,$207.00 ,$27.22 ,$230.00 ,$150.65 ,$27.22 ,$99.82 , N/A ,$28.58 ,$207.00 ,$61.25 ,$145.13 ,$138.00 ,$207.00 ,$27.22 ,$207.00 ,$207.00 ,$27.22 ,$149.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101373,84156,HC PROTEIN TOTAL URINE-90,301,1 ,$91.00 ,$59.15 ,$3.67 ,$91.00 ,$67.80 ,$59.61 ,$3.67 ,$47.96 ,$3.67 ,$57.42 ,$57.42 ,$57.42 ,$57.42 ,$81.90 ,$68.25 ,$3.67 ,$80.08 ,$3.67 ,$68.25 ,$68.25 ,$77.35 ,$77.35 ,$3.67 ,$77.35 ,$3.67 ,$71.89 ,$71.89 ,$71.89 ,$81.90 ,$9.18 ,$81.90 ,$3.67 ,$91.00 ,$59.61 ,$3.67 ,$39.49 , N/A ,$3.85 ,$81.90 ,$8.26 ,$57.42 ,$54.60 ,$81.90 ,$3.67 ,$81.90 ,$81.90 ,$3.67 ,$59.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101379,84181,HC PROTEIN WESTERN BLOT-90,301,1 ,$100.00 ,$65.00 ,$17.03 ,$100.00 ,$74.50 ,$65.50 ,$17.03 ,$52.70 ,$17.03 ,$63.10 ,$63.10 ,$63.10 ,$63.10 ,$90.00 ,$75.00 ,$17.03 ,$88.00 ,$17.03 ,$75.00 ,$75.00 ,$85.00 ,$85.00 ,$17.03 ,$85.00 ,$17.03 ,$79.00 ,$79.00 ,$79.00 ,$90.00 ,$42.58 ,$90.00 ,$17.03 ,$100.00 ,$65.50 ,$17.03 ,$43.40 , N/A ,$17.88 ,$90.00 ,$38.32 ,$63.10 ,$60.00 ,$90.00 ,$17.03 ,$90.00 ,$90.00 ,$17.03 ,$65.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101381,84202,HC PROTOPORPHYRIN-90,301,1 ,$19.54 ,$12.70 ,$8.48 ,$32.29 ,$14.56 ,$12.80 ,$14.35 ,$10.30 ,$14.35 ,$12.33 ,$12.33 ,$12.33 ,$12.33 ,$17.59 ,$14.66 ,$14.35 ,$17.20 ,$14.35 ,$14.66 ,$14.66 ,$16.61 ,$16.61 ,$14.35 ,$16.61 ,$14.35 ,$15.44 ,$15.44 ,$15.44 ,$17.59 ,$19.54 ,$17.59 ,$14.35 ,$19.54 ,$12.80 ,$14.35 ,$8.48 , N/A ,$15.07 ,$17.59 ,$32.29 ,$12.33 ,$11.72 ,$17.59 ,$14.35 ,$17.59 ,$17.59 ,$14.35 ,$12.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101382,84206,HC PROINSULIN-90,301,1 ,$111.00 ,$72.15 ,$26.69 ,$111.00 ,$82.70 ,$72.71 ,$26.69 ,$58.50 ,$26.69 ,$70.04 ,$70.04 ,$70.04 ,$70.04 ,$99.90 ,$83.25 ,$26.69 ,$97.68 ,$26.69 ,$83.25 ,$83.25 ,$94.35 ,$94.35 ,$26.69 ,$94.35 ,$26.69 ,$87.69 ,$87.69 ,$87.69 ,$99.90 ,$66.73 ,$99.90 ,$26.69 ,$111.00 ,$72.71 ,$26.69 ,$48.17 , N/A ,$28.02 ,$99.90 ,$60.05 ,$70.04 ,$66.60 ,$99.90 ,$26.69 ,$99.90 ,$99.90 ,$26.69 ,$72.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101383,84207,HC VITAMIN B6-90,301,1 ,$174.00 ,$113.10 ,$28.10 ,$174.00 ,$129.63 ,$113.97 ,$28.10 ,$91.70 ,$28.10 ,$109.79 ,$109.79 ,$109.79 ,$109.79 ,$156.60 ,$130.50 ,$28.10 ,$153.12 ,$28.10 ,$130.50 ,$130.50 ,$147.90 ,$147.90 ,$28.10 ,$147.90 ,$28.10 ,$137.46 ,$137.46 ,$137.46 ,$156.60 ,$70.25 ,$156.60 ,$28.10 ,$174.00 ,$113.97 ,$28.10 ,$75.52 , N/A ,$29.51 ,$156.60 ,$63.23 ,$109.79 ,$104.40 ,$156.60 ,$28.10 ,$156.60 ,$156.60 ,$28.10 ,$113.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101387,84244,HC RENIN-90,301,1 ,$200.00 ,$130.00 ,$21.99 ,$200.00 ,$149.00 ,$131.00 ,$21.99 ,$105.40 ,$21.99 ,$126.20 ,$126.20 ,$126.20 ,$126.20 ,$180.00 ,$150.00 ,$21.99 ,$176.00 ,$21.99 ,$150.00 ,$150.00 ,$170.00 ,$170.00 ,$21.99 ,$170.00 ,$21.99 ,$158.00 ,$158.00 ,$158.00 ,$180.00 ,$54.98 ,$180.00 ,$21.99 ,$200.00 ,$131.00 ,$21.99 ,$86.80 , N/A ,$23.09 ,$180.00 ,$49.48 ,$126.20 ,$120.00 ,$180.00 ,$21.99 ,$180.00 ,$180.00 ,$21.99 ,$130.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101388,84255,HC SELENIUM-90,301,1 ,$158.00 ,$102.70 ,$25.53 ,$158.00 ,$117.71 ,$103.49 ,$25.53 ,$83.27 ,$25.53 ,$99.70 ,$99.70 ,$99.70 ,$99.70 ,$142.20 ,$118.50 ,$25.53 ,$139.04 ,$25.53 ,$118.50 ,$118.50 ,$134.30 ,$134.30 ,$25.53 ,$134.30 ,$25.53 ,$124.82 ,$124.82 ,$124.82 ,$142.20 ,$63.83 ,$142.20 ,$25.53 ,$158.00 ,$103.49 ,$25.53 ,$68.57 , N/A ,$26.81 ,$142.20 ,$57.44 ,$99.70 ,$94.80 ,$142.20 ,$25.53 ,$142.20 ,$142.20 ,$25.53 ,$102.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101389,84252,HC VITAMIN B-2 (RIBOFLAVIN)-90,301,1 ,$47.20 ,$30.68 ,$20.24 ,$47.20 ,$35.16 ,$30.92 ,$20.24 ,$24.87 ,$20.24 ,$29.78 ,$29.78 ,$29.78 ,$29.78 ,$42.48 ,$35.40 ,$20.24 ,$41.54 ,$20.24 ,$35.40 ,$35.40 ,$40.12 ,$40.12 ,$20.24 ,$40.12 ,$20.24 ,$37.29 ,$37.29 ,$37.29 ,$42.48 ,$47.20 ,$42.48 ,$20.24 ,$47.20 ,$30.92 ,$20.24 ,$20.48 , N/A ,$21.25 ,$42.48 ,$45.54 ,$29.78 ,$28.32 ,$42.48 ,$20.24 ,$42.48 ,$42.48 ,$20.24 ,$30.68 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101395,84302,HC SODIUM OTHER FLUID-90,301,1 ,$33.00 ,$21.45 ,$4.86 ,$33.00 ,$24.59 ,$21.62 ,$4.86 ,$17.39 ,$4.86 ,$20.82 ,$20.82 ,$20.82 ,$20.82 ,$29.70 ,$24.75 ,$4.86 ,$29.04 ,$4.86 ,$24.75 ,$24.75 ,$28.05 ,$28.05 ,$4.86 ,$28.05 ,$4.86 ,$26.07 ,$26.07 ,$26.07 ,$29.70 ,$12.15 ,$29.70 ,$4.86 ,$33.00 ,$21.62 ,$4.86 ,$14.32 , N/A ,$5.10 ,$29.70 ,$10.94 ,$20.82 ,$19.80 ,$29.70 ,$4.86 ,$29.70 ,$29.70 ,$4.86 ,$21.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101396,84305,HC SOMATOMEDIN-90,301,1 ,$131.00 ,$85.15 ,$21.26 ,$131.00 ,$97.60 ,$85.81 ,$21.26 ,$69.04 ,$21.26 ,$82.66 ,$82.66 ,$82.66 ,$82.66 ,$117.90 ,$98.25 ,$21.26 ,$115.28 ,$21.26 ,$98.25 ,$98.25 ,$111.35 ,$111.35 ,$21.26 ,$111.35 ,$21.26 ,$103.49 ,$103.49 ,$103.49 ,$117.90 ,$53.15 ,$117.90 ,$21.26 ,$131.00 ,$85.81 ,$21.26 ,$56.85 , N/A ,$22.32 ,$117.90 ,$47.84 ,$82.66 ,$78.60 ,$117.90 ,$21.26 ,$117.90 ,$117.90 ,$21.26 ,$85.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101397,84307,HC SOMATOSTATIN-90,301,1 ,$351.00 ,$228.15 ,$18.28 ,$351.00 ,$261.50 ,$229.91 ,$18.28 ,$184.98 ,$18.28 ,$221.48 ,$221.48 ,$221.48 ,$221.48 ,$315.90 ,$263.25 ,$18.28 ,$308.88 ,$18.28 ,$263.25 ,$263.25 ,$298.35 ,$298.35 ,$18.28 ,$298.35 ,$18.28 ,$277.29 ,$277.29 ,$277.29 ,$315.90 ,$45.70 ,$315.90 ,$18.28 ,$351.00 ,$229.91 ,$18.28 ,$152.33 , N/A ,$19.19 ,$315.90 ,$41.13 ,$221.48 ,$210.60 ,$315.90 ,$18.28 ,$315.90 ,$315.90 ,$18.28 ,$228.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101398,84311,HC SPECTROPHOTOMETRY-90,301,1 ,$48.00 ,$31.20 ,$8.10 ,$48.00 ,$35.76 ,$31.44 ,$8.10 ,$25.30 ,$8.10 ,$30.29 ,$30.29 ,$30.29 ,$30.29 ,$43.20 ,$36.00 ,$8.10 ,$42.24 ,$8.10 ,$36.00 ,$36.00 ,$40.80 ,$40.80 ,$8.10 ,$40.80 ,$8.10 ,$37.92 ,$37.92 ,$37.92 ,$43.20 ,$20.25 ,$43.20 ,$8.10 ,$48.00 ,$31.44 ,$8.10 ,$20.83 , N/A ,$8.51 ,$43.20 ,$18.23 ,$30.29 ,$28.80 ,$43.20 ,$8.10 ,$43.20 ,$43.20 ,$8.10 ,$31.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101406,84402,HC TESTOSTERONE FREE-90,301,1 ,$116.00 ,$75.40 ,$25.47 ,$116.00 ,$86.42 ,$75.98 ,$25.47 ,$61.13 ,$25.47 ,$73.20 ,$73.20 ,$73.20 ,$73.20 ,$104.40 ,$87.00 ,$25.47 ,$102.08 ,$25.47 ,$87.00 ,$87.00 ,$98.60 ,$98.60 ,$25.47 ,$98.60 ,$25.47 ,$91.64 ,$91.64 ,$91.64 ,$104.40 ,$63.68 ,$104.40 ,$25.47 ,$116.00 ,$75.98 ,$25.47 ,$50.34 , N/A ,$26.74 ,$104.40 ,$57.31 ,$73.20 ,$69.60 ,$104.40 ,$25.47 ,$104.40 ,$104.40 ,$25.47 ,$75.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101407,84403,HC TESTOSTERONE TOTAL-90,301,1 ,$167.00 ,$108.55 ,$25.81 ,$167.00 ,$124.42 ,$109.39 ,$25.81 ,$88.01 ,$25.81 ,$105.38 ,$105.38 ,$105.38 ,$105.38 ,$150.30 ,$125.25 ,$25.81 ,$146.96 ,$25.81 ,$125.25 ,$125.25 ,$141.95 ,$141.95 ,$25.81 ,$141.95 ,$25.81 ,$131.93 ,$131.93 ,$131.93 ,$150.30 ,$64.53 ,$150.30 ,$25.81 ,$167.00 ,$109.39 ,$25.81 ,$72.48 , N/A ,$27.10 ,$150.30 ,$58.07 ,$105.38 ,$100.20 ,$150.30 ,$25.81 ,$150.30 ,$150.30 ,$25.81 ,$108.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101408,84425,HC VITAMIN B1-90,301,1 ,$130.00 ,$84.50 ,$21.23 ,$130.00 ,$96.85 ,$85.15 ,$21.23 ,$68.51 ,$21.23 ,$82.03 ,$82.03 ,$82.03 ,$82.03 ,$117.00 ,$97.50 ,$21.23 ,$114.40 ,$21.23 ,$97.50 ,$97.50 ,$110.50 ,$110.50 ,$21.23 ,$110.50 ,$21.23 ,$102.70 ,$102.70 ,$102.70 ,$117.00 ,$53.08 ,$117.00 ,$21.23 ,$130.00 ,$85.15 ,$21.23 ,$56.42 , N/A ,$22.29 ,$117.00 ,$47.77 ,$82.03 ,$78.00 ,$117.00 ,$21.23 ,$117.00 ,$117.00 ,$21.23 ,$84.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101410,84432,HC THYROGLOBULIN-90,301,1 ,$65.00 ,$42.25 ,$16.06 ,$65.00 ,$48.43 ,$42.58 ,$16.06 ,$34.26 ,$16.06 ,$41.02 ,$41.02 ,$41.02 ,$41.02 ,$58.50 ,$48.75 ,$16.06 ,$57.20 ,$16.06 ,$48.75 ,$48.75 ,$55.25 ,$55.25 ,$16.06 ,$55.25 ,$16.06 ,$51.35 ,$51.35 ,$51.35 ,$58.50 ,$40.15 ,$58.50 ,$16.06 ,$65.00 ,$42.58 ,$16.06 ,$28.21 , N/A ,$16.86 ,$58.50 ,$36.14 ,$41.02 ,$39.00 ,$58.50 ,$16.06 ,$58.50 ,$58.50 ,$16.06 ,$42.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101417,84445,HC THYROID STIM IMMUNO GLOB-90,301,1 ,$314.00 ,$204.10 ,$50.86 ,$314.00 ,$233.93 ,$205.67 ,$50.86 ,$165.48 ,$50.86 ,$198.13 ,$198.13 ,$198.13 ,$198.13 ,$282.60 ,$235.50 ,$50.86 ,$276.32 ,$50.86 ,$235.50 ,$235.50 ,$266.90 ,$266.90 ,$50.86 ,$266.90 ,$50.86 ,$248.06 ,$248.06 ,$248.06 ,$282.60 ,$127.15 ,$282.60 ,$50.86 ,$314.00 ,$205.67 ,$50.86 ,$136.28 , N/A ,$53.40 ,$282.60 ,$114.44 ,$198.13 ,$188.40 ,$282.60 ,$50.86 ,$282.60 ,$282.60 ,$50.86 ,$204.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101418,84446,HC VITAMIN E-90,301,1 ,$88.00 ,$57.20 ,$14.18 ,$88.00 ,$65.56 ,$57.64 ,$14.18 ,$46.38 ,$14.18 ,$55.53 ,$55.53 ,$55.53 ,$55.53 ,$79.20 ,$66.00 ,$14.18 ,$77.44 ,$14.18 ,$66.00 ,$66.00 ,$74.80 ,$74.80 ,$14.18 ,$74.80 ,$14.18 ,$69.52 ,$69.52 ,$69.52 ,$79.20 ,$35.45 ,$79.20 ,$14.18 ,$88.00 ,$57.64 ,$14.18 ,$38.19 , N/A ,$14.89 ,$79.20 ,$31.91 ,$55.53 ,$52.80 ,$79.20 ,$14.18 ,$79.20 ,$79.20 ,$14.18 ,$57.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101419,84460,HC ALT-90,301,1 ,$4.10 ,$2.67 ,$1.78 ,$9.23 ,$3.05 ,$2.69 ,$4.10 ,$2.16 ,$4.10 ,$2.59 ,$2.59 ,$2.59 ,$2.59 ,$3.69 ,$3.08 ,$4.10 ,$3.61 ,$4.10 ,$3.08 ,$3.08 ,$3.49 ,$3.49 ,$4.10 ,$3.49 ,$4.10 ,$3.24 ,$3.24 ,$3.24 ,$3.69 ,$4.10 ,$3.69 ,$4.10 ,$4.10 ,$2.69 ,$4.10 ,$1.78 , N/A ,$4.10 ,$3.69 ,$9.23 ,$2.59 ,$2.46 ,$3.69 ,$4.10 ,$3.69 ,$3.69 ,$4.10 ,$2.67 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101422,84479,HC T3 UPTAKE-90,301,1 ,$109.00 ,$70.85 ,$6.47 ,$109.00 ,$81.21 ,$71.40 ,$6.47 ,$57.44 ,$6.47 ,$68.78 ,$68.78 ,$68.78 ,$68.78 ,$98.10 ,$81.75 ,$6.47 ,$95.92 ,$6.47 ,$81.75 ,$81.75 ,$92.65 ,$92.65 ,$6.47 ,$92.65 ,$6.47 ,$86.11 ,$86.11 ,$86.11 ,$98.10 ,$16.18 ,$98.10 ,$6.47 ,$109.00 ,$71.40 ,$6.47 ,$47.31 , N/A ,$6.79 ,$98.10 ,$14.56 ,$68.78 ,$65.40 ,$98.10 ,$6.47 ,$98.10 ,$98.10 ,$6.47 ,$70.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101425,84482,HC T3 REVERSE-90,301,1 ,$97.00 ,$63.05 ,$15.76 ,$97.00 ,$72.27 ,$63.54 ,$15.76 ,$51.12 ,$15.76 ,$61.21 ,$61.21 ,$61.21 ,$61.21 ,$87.30 ,$72.75 ,$15.76 ,$85.36 ,$15.76 ,$72.75 ,$72.75 ,$82.45 ,$82.45 ,$15.76 ,$82.45 ,$15.76 ,$76.63 ,$76.63 ,$76.63 ,$87.30 ,$39.40 ,$87.30 ,$15.76 ,$97.00 ,$63.54 ,$15.76 ,$42.10 , N/A ,$16.55 ,$87.30 ,$35.46 ,$61.21 ,$58.20 ,$87.30 ,$15.76 ,$87.30 ,$87.30 ,$15.76 ,$63.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101434,84560,HC URIC ACID OTH SRC-90,301,1 ,$9.52 ,$6.19 ,$4.13 ,$11.43 ,$7.09 ,$6.24 ,$5.08 ,$5.02 ,$5.08 ,$6.01 ,$6.01 ,$6.01 ,$6.01 ,$8.57 ,$7.14 ,$5.08 ,$8.38 ,$5.08 ,$7.14 ,$7.14 ,$8.09 ,$8.09 ,$5.08 ,$8.09 ,$5.08 ,$7.52 ,$7.52 ,$7.52 ,$8.57 ,$9.52 ,$8.57 ,$5.08 ,$9.52 ,$6.24 ,$5.08 ,$4.13 , N/A ,$5.33 ,$8.57 ,$11.43 ,$6.01 ,$5.71 ,$8.57 ,$5.08 ,$8.57 ,$8.57 ,$5.08 ,$6.19 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101435,84585,HC VANILLYLMAND AC (VMA)-90,301,1 ,$192.00 ,$124.80 ,$15.50 ,$192.00 ,$143.04 ,$125.76 ,$15.50 ,$101.18 ,$15.50 ,$121.15 ,$121.15 ,$121.15 ,$121.15 ,$172.80 ,$144.00 ,$15.50 ,$168.96 ,$15.50 ,$144.00 ,$144.00 ,$163.20 ,$163.20 ,$15.50 ,$163.20 ,$15.50 ,$151.68 ,$151.68 ,$151.68 ,$172.80 ,$38.75 ,$172.80 ,$15.50 ,$192.00 ,$125.76 ,$15.50 ,$83.33 , N/A ,$16.28 ,$172.80 ,$34.88 ,$121.15 ,$115.20 ,$172.80 ,$15.50 ,$172.80 ,$172.80 ,$15.50 ,$124.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101436,84586,HC VASOACTIVE INTEST PEPTIDE-90,301,1 ,$173.00 ,$112.45 ,$35.33 ,$173.00 ,$128.89 ,$113.32 ,$35.33 ,$91.17 ,$35.33 ,$109.16 ,$109.16 ,$109.16 ,$109.16 ,$155.70 ,$129.75 ,$35.33 ,$152.24 ,$35.33 ,$129.75 ,$129.75 ,$147.05 ,$147.05 ,$35.33 ,$147.05 ,$35.33 ,$136.67 ,$136.67 ,$136.67 ,$155.70 ,$88.33 ,$155.70 ,$35.33 ,$173.00 ,$113.32 ,$35.33 ,$75.08 , N/A ,$37.10 ,$155.70 ,$79.49 ,$109.16 ,$103.80 ,$155.70 ,$35.33 ,$155.70 ,$155.70 ,$35.33 ,$112.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101437,84588,HC VASOPRESSIN (ADH)-90,301,1 ,$126.00 ,$81.90 ,$33.94 ,$126.00 ,$93.87 ,$82.53 ,$33.94 ,$66.40 ,$33.94 ,$79.51 ,$79.51 ,$79.51 ,$79.51 ,$113.40 ,$94.50 ,$33.94 ,$110.88 ,$33.94 ,$94.50 ,$94.50 ,$107.10 ,$107.10 ,$33.94 ,$107.10 ,$33.94 ,$99.54 ,$99.54 ,$99.54 ,$113.40 ,$84.85 ,$113.40 ,$33.94 ,$126.00 ,$82.53 ,$33.94 ,$54.68 , N/A ,$35.64 ,$113.40 ,$76.37 ,$79.51 ,$75.60 ,$113.40 ,$33.94 ,$113.40 ,$113.40 ,$33.94 ,$81.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101438,84590,HC VITAMIN A-90,301,1 ,$72.00 ,$46.80 ,$11.61 ,$72.00 ,$53.64 ,$47.16 ,$11.61 ,$37.94 ,$11.61 ,$45.43 ,$45.43 ,$45.43 ,$45.43 ,$64.80 ,$54.00 ,$11.61 ,$63.36 ,$11.61 ,$54.00 ,$54.00 ,$61.20 ,$61.20 ,$11.61 ,$61.20 ,$11.61 ,$56.88 ,$56.88 ,$56.88 ,$64.80 ,$29.03 ,$64.80 ,$11.61 ,$72.00 ,$47.16 ,$11.61 ,$31.25 , N/A ,$12.19 ,$64.80 ,$26.12 ,$45.43 ,$43.20 ,$64.80 ,$11.61 ,$64.80 ,$64.80 ,$11.61 ,$46.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101440,84597,HC VITAMIN K-90,301,1 ,$90.62 ,$58.90 ,$13.72 ,$90.62 ,$67.51 ,$59.36 ,$13.72 ,$47.76 ,$13.72 ,$57.18 ,$57.18 ,$57.18 ,$57.18 ,$81.56 ,$67.97 ,$13.72 ,$79.75 ,$13.72 ,$67.97 ,$67.97 ,$77.03 ,$77.03 ,$13.72 ,$77.03 ,$13.72 ,$71.59 ,$71.59 ,$71.59 ,$81.56 ,$34.30 ,$81.56 ,$13.72 ,$90.62 ,$59.36 ,$13.72 ,$39.33 , N/A ,$14.41 ,$81.56 ,$30.87 ,$57.18 ,$54.37 ,$81.56 ,$13.72 ,$81.56 ,$81.56 ,$13.72 ,$58.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101442,84630,HC ZINC-90,301,1 ,$103.00 ,$66.95 ,$11.39 ,$103.00 ,$76.74 ,$67.47 ,$11.39 ,$54.28 ,$11.39 ,$64.99 ,$64.99 ,$64.99 ,$64.99 ,$92.70 ,$77.25 ,$11.39 ,$90.64 ,$11.39 ,$77.25 ,$77.25 ,$87.55 ,$87.55 ,$11.39 ,$87.55 ,$11.39 ,$81.37 ,$81.37 ,$81.37 ,$92.70 ,$28.48 ,$92.70 ,$11.39 ,$103.00 ,$67.47 ,$11.39 ,$44.70 , N/A ,$11.96 ,$92.70 ,$25.63 ,$64.99 ,$61.80 ,$92.70 ,$11.39 ,$92.70 ,$92.70 ,$11.39 ,$66.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101443,84681,HC C PEPTIDE-90,301,1 ,$176.00 ,$114.40 ,$20.81 ,$176.00 ,$131.12 ,$115.28 ,$20.81 ,$92.75 ,$20.81 ,$111.06 ,$111.06 ,$111.06 ,$111.06 ,$158.40 ,$132.00 ,$20.81 ,$154.88 ,$20.81 ,$132.00 ,$132.00 ,$149.60 ,$149.60 ,$20.81 ,$149.60 ,$20.81 ,$139.04 ,$139.04 ,$139.04 ,$158.40 ,$52.03 ,$158.40 ,$20.81 ,$176.00 ,$115.28 ,$20.81 ,$76.38 , N/A ,$21.85 ,$158.40 ,$46.82 ,$111.06 ,$105.60 ,$158.40 ,$20.81 ,$158.40 ,$158.40 ,$20.81 ,$114.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101444,84702,HC HCG QN-90,301,1 ,$276.00 ,$179.40 ,$15.05 ,$276.00 ,$205.62 ,$180.78 ,$15.05 ,$145.45 ,$15.05 ,$174.16 ,$174.16 ,$174.16 ,$174.16 ,$248.40 ,$207.00 ,$15.05 ,$242.88 ,$15.05 ,$207.00 ,$207.00 ,$234.60 ,$234.60 ,$15.05 ,$234.60 ,$15.05 ,$218.04 ,$218.04 ,$218.04 ,$248.40 ,$37.63 ,$248.40 ,$15.05 ,$276.00 ,$180.78 ,$15.05 ,$119.78 , N/A ,$15.80 ,$248.40 ,$33.86 ,$174.16 ,$165.60 ,$248.40 ,$15.05 ,$248.40 ,$248.40 ,$15.05 ,$179.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101455,G0480,HC DRUG SCRN DEFNT 1-7 CLS T1-90,301,1 ,$240.00 ,$156.00 ,$104.16 ,$257.47 ,$178.80 ,$157.20 ,$114.43 ,$126.48 ,$114.43 ,$151.44 ,$151.44 ,$151.44 ,$151.44 ,$216.00 ,$180.00 ,$114.43 ,$211.20 ,$114.43 ,$180.00 ,$180.00 ,$204.00 ,$204.00 ,$114.43 ,$204.00 ,$114.43 ,$189.60 ,$189.60 ,$189.60 ,$216.00 ,$240.00 ,$216.00 ,$114.43 ,$240.00 ,$157.20 ,$114.43 ,$104.16 , N/A ,$120.15 ,$216.00 ,$257.47 ,$151.44 ,$144.00 ,$216.00 ,$114.43 ,$216.00 ,$216.00 ,$114.43 ,$156.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101465,83921,HC ORGANIC ACIDS QN SINGLE-90,301,1 ,$141.00 ,$91.65 ,$21.21 ,$141.00 ,$105.05 ,$92.36 ,$21.21 ,$74.31 ,$21.21 ,$88.97 ,$88.97 ,$88.97 ,$88.97 ,$126.90 ,$105.75 ,$21.21 ,$124.08 ,$21.21 ,$105.75 ,$105.75 ,$119.85 ,$119.85 ,$21.21 ,$119.85 ,$21.21 ,$111.39 ,$111.39 ,$111.39 ,$126.90 ,$53.03 ,$126.90 ,$21.21 ,$141.00 ,$92.36 ,$21.21 ,$61.19 , N/A ,$22.27 ,$126.90 ,$47.72 ,$88.97 ,$84.60 ,$126.90 ,$21.21 ,$126.90 ,$126.90 ,$21.21 ,$91.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101476,82610,HC CYSTATIN C -90,301,1 ,$93.00 ,$60.45 ,$18.52 ,$93.00 ,$69.29 ,$60.92 ,$18.52 ,$49.01 ,$18.52 ,$58.68 ,$58.68 ,$58.68 ,$58.68 ,$83.70 ,$69.75 ,$18.52 ,$81.84 ,$18.52 ,$69.75 ,$69.75 ,$79.05 ,$79.05 ,$18.52 ,$79.05 ,$18.52 ,$73.47 ,$73.47 ,$73.47 ,$83.70 ,$46.30 ,$83.70 ,$18.52 ,$93.00 ,$60.92 ,$18.52 ,$40.36 , N/A ,$19.45 ,$83.70 ,$41.67 ,$58.68 ,$55.80 ,$83.70 ,$18.52 ,$83.70 ,$83.70 ,$18.52 ,$60.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101477,83519,HC QN RIA MUSK-90,301,1 ,"$1,992.00 ","$1,294.80 ",$18.40 ,"$1,992.00 ","$1,484.04 ","$1,304.76 ",$18.40 ,"$1,049.78 ",$18.40 ,"$1,256.95 ","$1,256.95 ","$1,256.95 ","$1,256.95 ","$1,792.80 ","$1,494.00 ",$18.40 ,"$1,752.96 ",$18.40 ,"$1,494.00 ","$1,494.00 ","$1,693.20 ","$1,693.20 ",$18.40 ,"$1,693.20 ",$18.40 ,"$1,573.68 ","$1,573.68 ","$1,573.68 ","$1,792.80 ",$46.00 ,"$1,792.80 ",$18.40 ,"$1,992.00 ","$1,304.76 ",$18.40 ,$864.53 , N/A ,$19.32 ,"$1,792.80 ",$41.40 ,"$1,256.95 ","$1,195.20 ","$1,792.80 ",$18.40 ,"$1,792.80 ","$1,792.80 ",$18.40 ,"$1,294.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101479,82803,HC BLOOD GAS PH PO2 AND /OR PCO2,301,1 ,$259.00 ,$168.35 ,$26.07 ,$259.00 ,$192.96 ,$169.65 ,$26.07 ,$136.49 ,$26.07 ,$163.43 ,$163.43 ,$163.43 ,$163.43 ,$233.10 ,$194.25 ,$26.07 ,$227.92 ,$26.07 ,$194.25 ,$194.25 ,$220.15 ,$220.15 ,$26.07 ,$220.15 ,$26.07 ,$204.61 ,$204.61 ,$204.61 ,$233.10 ,$65.18 ,$233.10 ,$26.07 ,$259.00 ,$169.65 ,$26.07 ,$112.41 , N/A ,$27.37 ,$233.10 ,$58.66 ,$163.43 ,$155.40 ,$233.10 ,$26.07 ,$233.10 ,$233.10 ,$26.07 ,$168.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101480,82805,HC BLOOD GASES W/O2 SAT,301,1 ,$353.00 ,$229.45 ,$78.77 ,$353.00 ,$262.99 ,$231.22 ,$78.77 ,$186.03 ,$78.77 ,$222.74 ,$222.74 ,$222.74 ,$222.74 ,$317.70 ,$264.75 ,$78.77 ,$310.64 ,$78.77 ,$264.75 ,$264.75 ,$300.05 ,$300.05 ,$78.77 ,$300.05 ,$78.77 ,$278.87 ,$278.87 ,$278.87 ,$317.70 ,$196.93 ,$317.70 ,$78.77 ,$353.00 ,$231.22 ,$78.77 ,$153.20 , N/A ,$82.71 ,$317.70 ,$177.23 ,$222.74 ,$211.80 ,$317.70 ,$78.77 ,$317.70 ,$317.70 ,$78.77 ,$229.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101498,80354,HC FENTANYL -90,301,1 ,$46.56 ,$30.26 ,$20.21 ,$46.56 ,$34.69 ,$30.50 , N/A ,$24.54 , N/A ,$29.38 ,$29.38 ,$29.38 ,$29.38 ,$41.90 ,$34.92 , N/A ,$40.97 , N/A ,$34.92 ,$34.92 ,$39.58 ,$39.58 , N/A ,$39.58 , N/A ,$36.78 ,$36.78 ,$36.78 ,$41.90 , N/A ,$41.90 , N/A ,$46.56 ,$30.50 , N/A ,$20.21 , N/A , N/A ,$41.90 , N/A ,$29.38 ,$27.94 ,$41.90 , N/A ,$41.90 ,$41.90 , N/A ,$30.26 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101500,82943,HC GLUCAGON-90,301,1 ,$77.20 ,$50.18 ,$14.29 ,$77.20 ,$57.51 ,$50.57 ,$14.29 ,$40.68 ,$14.29 ,$48.71 ,$48.71 ,$48.71 ,$48.71 ,$69.48 ,$57.90 ,$14.29 ,$67.94 ,$14.29 ,$57.90 ,$57.90 ,$65.62 ,$65.62 ,$14.29 ,$65.62 ,$14.29 ,$60.99 ,$60.99 ,$60.99 ,$69.48 ,$35.73 ,$69.48 ,$14.29 ,$77.20 ,$50.57 ,$14.29 ,$33.50 , N/A ,$15.00 ,$69.48 ,$32.15 ,$48.71 ,$46.32 ,$69.48 ,$14.29 ,$69.48 ,$69.48 ,$14.29 ,$50.18 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101509,82330,HC CALCIUM IONIZED STAT -90,301,1 ,$22.00 ,$14.30 ,$9.55 ,$30.78 ,$16.39 ,$14.41 ,$13.68 ,$11.59 ,$13.68 ,$13.88 ,$13.88 ,$13.88 ,$13.88 ,$19.80 ,$16.50 ,$13.68 ,$19.36 ,$13.68 ,$16.50 ,$16.50 ,$18.70 ,$18.70 ,$13.68 ,$18.70 ,$13.68 ,$17.38 ,$17.38 ,$17.38 ,$19.80 ,$22.00 ,$19.80 ,$13.68 ,$22.00 ,$14.41 ,$13.68 ,$9.55 , N/A ,$14.36 ,$19.80 ,$30.78 ,$13.88 ,$13.20 ,$19.80 ,$13.68 ,$19.80 ,$19.80 ,$13.68 ,$14.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101511,80345,HC BARBITURATE -90,301,1 ,$228.86 ,$148.76 ,$99.33 ,$228.86 ,$170.50 ,$149.90 , N/A ,$120.61 , N/A ,$144.41 ,$144.41 ,$144.41 ,$144.41 ,$205.97 ,$171.65 , N/A ,$201.40 , N/A ,$171.65 ,$171.65 ,$194.53 ,$194.53 , N/A ,$194.53 , N/A ,$180.80 ,$180.80 ,$180.80 ,$205.97 , N/A ,$205.97 , N/A ,$228.86 ,$149.90 , N/A ,$99.33 , N/A , N/A ,$205.97 , N/A ,$144.41 ,$137.32 ,$205.97 , N/A ,$205.97 ,$205.97 , N/A ,$148.76 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101512,80324,HC AMPHETAMINE 1-2 -90,301,1 ,$228.86 ,$148.76 ,$99.33 ,$228.86 ,$170.50 ,$149.90 , N/A ,$120.61 , N/A ,$144.41 ,$144.41 ,$144.41 ,$144.41 ,$205.97 ,$171.65 , N/A ,$201.40 , N/A ,$171.65 ,$171.65 ,$194.53 ,$194.53 , N/A ,$194.53 , N/A ,$180.80 ,$180.80 ,$180.80 ,$205.97 , N/A ,$205.97 , N/A ,$228.86 ,$149.90 , N/A ,$99.33 , N/A , N/A ,$205.97 , N/A ,$144.41 ,$137.32 ,$205.97 , N/A ,$205.97 ,$205.97 , N/A ,$148.76 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101513,80365,HC OXYCODONE -90,301,1 ,$251.84 ,$163.70 ,$109.30 ,$251.84 ,$187.62 ,$164.96 , N/A ,$132.72 , N/A ,$158.91 ,$158.91 ,$158.91 ,$158.91 ,$226.66 ,$188.88 , N/A ,$221.62 , N/A ,$188.88 ,$188.88 ,$214.06 ,$214.06 , N/A ,$214.06 , N/A ,$198.95 ,$198.95 ,$198.95 ,$226.66 , N/A ,$226.66 , N/A ,$251.84 ,$164.96 , N/A ,$109.30 , N/A , N/A ,$226.66 , N/A ,$158.91 ,$151.10 ,$226.66 , N/A ,$226.66 ,$226.66 , N/A ,$163.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101520,80356,HC HEROIN METABOLITE-90,301,1 ,$228.86 ,$148.76 ,$99.33 ,$228.86 ,$170.50 ,$149.90 , N/A ,$120.61 , N/A ,$144.41 ,$144.41 ,$144.41 ,$144.41 ,$205.97 ,$171.65 , N/A ,$201.40 , N/A ,$171.65 ,$171.65 ,$194.53 ,$194.53 , N/A ,$194.53 , N/A ,$180.80 ,$180.80 ,$180.80 ,$205.97 , N/A ,$205.97 , N/A ,$228.86 ,$149.90 , N/A ,$99.33 , N/A , N/A ,$205.97 , N/A ,$144.41 ,$137.32 ,$205.97 , N/A ,$205.97 ,$205.97 , N/A ,$148.76 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101529,82725,HC FATTY ACIDS NONESTERIFIED-90,301,1 ,$21.00 ,$13.65 ,$9.11 ,$42.23 ,$15.65 ,$13.76 ,$18.77 ,$11.07 ,$18.77 ,$13.25 ,$13.25 ,$13.25 ,$13.25 ,$18.90 ,$15.75 ,$18.77 ,$18.48 ,$18.77 ,$15.75 ,$15.75 ,$17.85 ,$17.85 ,$18.77 ,$17.85 ,$18.77 ,$16.59 ,$16.59 ,$16.59 ,$18.90 ,$21.00 ,$18.90 ,$18.77 ,$21.00 ,$13.76 ,$18.77 ,$9.11 , N/A ,$19.71 ,$18.90 ,$42.23 ,$13.25 ,$12.60 ,$18.90 ,$18.77 ,$18.90 ,$18.90 ,$18.77 ,$13.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101534,80377,HC PANEL HYPOGLYCEMIC QL-90,301,1 ,$314.70 ,$204.56 ,$136.58 ,$314.70 ,$234.45 ,$206.13 , N/A ,$165.85 , N/A ,$198.58 ,$198.58 ,$198.58 ,$198.58 ,$283.23 ,$236.03 , N/A ,$276.94 , N/A ,$236.03 ,$236.03 ,$267.50 ,$267.50 , N/A ,$267.50 , N/A ,$248.61 ,$248.61 ,$248.61 ,$283.23 , N/A ,$283.23 , N/A ,$314.70 ,$206.13 , N/A ,$136.58 , N/A , N/A ,$283.23 , N/A ,$198.58 ,$188.82 ,$283.23 , N/A ,$283.23 ,$283.23 , N/A ,$204.56 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101542,80047,HC BASIC METABOLIC PANEL IONIZED CALCIUM,301,1 ,$177.00 ,$115.05 ,$13.73 ,$177.00 ,$131.87 ,$115.94 ,$13.73 ,$93.28 ,$13.73 ,$111.69 ,$111.69 ,$111.69 ,$111.69 ,$159.30 ,$132.75 ,$13.73 ,$155.76 ,$13.73 ,$132.75 ,$132.75 ,$150.45 ,$150.45 ,$13.73 ,$150.45 ,$13.73 ,$139.83 ,$139.83 ,$139.83 ,$159.30 ,$34.33 ,$159.30 ,$13.73 ,$177.00 ,$115.94 ,$13.73 ,$76.82 , N/A ,$14.42 ,$159.30 ,$30.89 ,$111.69 ,$106.20 ,$159.30 ,$13.73 ,$159.30 ,$159.30 ,$13.73 ,$115.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101553,80299,HC THERAPEUTIC DRUG OTHER,301,1 ,$93.00 ,$60.45 ,$18.64 ,$93.00 ,$69.29 ,$60.92 ,$18.64 ,$49.01 ,$18.64 ,$58.68 ,$58.68 ,$58.68 ,$58.68 ,$83.70 ,$69.75 ,$18.64 ,$81.84 ,$18.64 ,$69.75 ,$69.75 ,$79.05 ,$79.05 ,$18.64 ,$79.05 ,$18.64 ,$73.47 ,$73.47 ,$73.47 ,$83.70 ,$46.60 ,$83.70 ,$18.64 ,$93.00 ,$60.92 ,$18.64 ,$40.36 , N/A ,$19.57 ,$83.70 ,$41.94 ,$58.68 ,$55.80 ,$83.70 ,$18.64 ,$83.70 ,$83.70 ,$18.64 ,$60.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101554,80306,HC DRUG SCREEN PRESUMPTIVE INSTRMNT ASSIST DIR OPTICAL -90,301,1 ,$100.00 ,$65.00 ,$17.14 ,$100.00 ,$74.50 ,$65.50 ,$17.14 ,$52.70 ,$17.14 ,$63.10 ,$63.10 ,$63.10 ,$63.10 ,$90.00 ,$75.00 ,$17.14 ,$88.00 ,$17.14 ,$75.00 ,$75.00 ,$85.00 ,$85.00 ,$17.14 ,$85.00 ,$17.14 ,$79.00 ,$79.00 ,$79.00 ,$90.00 ,$42.85 ,$90.00 ,$17.14 ,$100.00 ,$65.50 ,$17.14 ,$43.40 , N/A ,$18.00 ,$90.00 ,$38.57 ,$63.10 ,$60.00 ,$90.00 ,$17.14 ,$90.00 ,$90.00 ,$17.14 ,$65.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101555,81479,HC IDH GENE MUTATION ASSAY - 90,301,1 ,$187.00 ,$121.55 ,$81.16 ,$187.00 ,$139.32 ,$122.49 , N/A ,$98.55 , N/A ,$118.00 ,$118.00 ,$118.00 ,$118.00 ,$168.30 ,$140.25 , N/A ,$164.56 , N/A ,$140.25 ,$140.25 ,$158.95 ,$158.95 , N/A ,$158.95 , N/A ,$147.73 ,$147.73 ,$147.73 ,$168.30 , N/A ,$168.30 , N/A ,$187.00 ,$122.49 , N/A ,$81.16 , N/A , N/A ,$168.30 , N/A ,$118.00 ,$112.20 ,$168.30 , N/A ,$168.30 ,$168.30 , N/A ,$121.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101556,82042,HC ALBUMIN OTHER SOURCE,301,1 ,$53.00 ,$34.45 ,$7.78 ,$53.00 ,$39.49 ,$34.72 ,$7.78 ,$27.93 ,$7.78 ,$33.44 ,$33.44 ,$33.44 ,$33.44 ,$47.70 ,$39.75 ,$7.78 ,$46.64 ,$7.78 ,$39.75 ,$39.75 ,$45.05 ,$45.05 ,$7.78 ,$45.05 ,$7.78 ,$41.87 ,$41.87 ,$41.87 ,$47.70 ,$19.45 ,$47.70 ,$7.78 ,$53.00 ,$34.72 ,$7.78 ,$23.00 , N/A ,$8.17 ,$47.70 ,$17.51 ,$33.44 ,$31.80 ,$47.70 ,$7.78 ,$47.70 ,$47.70 ,$7.78 ,$34.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101557,82075,HC ALCOHOL BREATH -90,301,1 ,$71.00 ,$46.15 ,$30.00 ,$71.00 ,$52.90 ,$46.51 ,$30.00 ,$37.42 ,$30.00 ,$44.80 ,$44.80 ,$44.80 ,$44.80 ,$63.90 ,$53.25 ,$30.00 ,$62.48 ,$30.00 ,$53.25 ,$53.25 ,$60.35 ,$60.35 ,$30.00 ,$60.35 ,$30.00 ,$56.09 ,$56.09 ,$56.09 ,$63.90 ,$71.00 ,$63.90 ,$30.00 ,$71.00 ,$46.51 ,$30.00 ,$30.81 , N/A ,$31.50 ,$63.90 ,$67.50 ,$44.80 ,$42.60 ,$63.90 ,$30.00 ,$63.90 ,$63.90 ,$30.00 ,$46.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101560,82172,HC APOLIPOPROTEIN SERUM,301,1 ,$104.00 ,$67.60 ,$21.09 ,$104.00 ,$77.48 ,$68.12 ,$21.09 ,$54.81 ,$21.09 ,$65.62 ,$65.62 ,$65.62 ,$65.62 ,$93.60 ,$78.00 ,$21.09 ,$91.52 ,$21.09 ,$78.00 ,$78.00 ,$88.40 ,$88.40 ,$21.09 ,$88.40 ,$21.09 ,$82.16 ,$82.16 ,$82.16 ,$93.60 ,$52.73 ,$93.60 ,$21.09 ,$104.00 ,$68.12 ,$21.09 ,$45.14 , N/A ,$22.14 ,$93.60 ,$47.45 ,$65.62 ,$62.40 ,$93.60 ,$21.09 ,$93.60 ,$93.60 ,$21.09 ,$67.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101561,82247,HC BILIRUBIN TOTAL,301,1 ,$93.00 ,$60.45 ,$5.02 ,$93.00 ,$69.29 ,$60.92 ,$5.02 ,$49.01 ,$5.02 ,$58.68 ,$58.68 ,$58.68 ,$58.68 ,$83.70 ,$69.75 ,$5.02 ,$81.84 ,$5.02 ,$69.75 ,$69.75 ,$79.05 ,$79.05 ,$5.02 ,$79.05 ,$5.02 ,$73.47 ,$73.47 ,$73.47 ,$83.70 ,$12.55 ,$83.70 ,$5.02 ,$93.00 ,$60.92 ,$5.02 ,$40.36 , N/A ,$5.27 ,$83.70 ,$11.30 ,$58.68 ,$55.80 ,$83.70 ,$5.02 ,$83.70 ,$83.70 ,$5.02 ,$60.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101563,82274,HC OCCULT BLOOD FECAL HGB-QW,301,1 ,$101.00 ,$65.65 ,$15.92 ,$101.00 ,$75.25 ,$66.16 ,$15.92 ,$53.23 ,$15.92 ,$63.73 ,$63.73 ,$63.73 ,$63.73 ,$90.90 ,$75.75 ,$15.92 ,$88.88 ,$15.92 ,$75.75 ,$75.75 ,$85.85 ,$85.85 ,$15.92 ,$85.85 ,$15.92 ,$79.79 ,$79.79 ,$79.79 ,$90.90 ,$39.80 ,$90.90 ,$15.92 ,$101.00 ,$66.16 ,$15.92 ,$43.83 , N/A ,$16.72 ,$90.90 ,$35.82 ,$63.73 ,$60.60 ,$90.90 ,$15.92 ,$90.90 ,$90.90 ,$15.92 ,$65.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101570,82465,HC CHOLESTEROL,301,1 ,$55.00 ,$35.75 ,$4.35 ,$55.00 ,$40.98 ,$36.03 ,$4.35 ,$28.99 ,$4.35 ,$34.71 ,$34.71 ,$34.71 ,$34.71 ,$49.50 ,$41.25 ,$4.35 ,$48.40 ,$4.35 ,$41.25 ,$41.25 ,$46.75 ,$46.75 ,$4.35 ,$46.75 ,$4.35 ,$43.45 ,$43.45 ,$43.45 ,$49.50 ,$10.88 ,$49.50 ,$4.35 ,$55.00 ,$36.03 ,$4.35 ,$23.87 , N/A ,$4.57 ,$49.50 ,$9.79 ,$34.71 ,$33.00 ,$49.50 ,$4.35 ,$49.50 ,$49.50 ,$4.35 ,$35.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101572,82570,HC CREATININE OTH SOURCE,301,1 ,$113.00 ,$73.45 ,$5.18 ,$113.00 ,$84.19 ,$74.02 ,$5.18 ,$59.55 ,$5.18 ,$71.30 ,$71.30 ,$71.30 ,$71.30 ,$101.70 ,$84.75 ,$5.18 ,$99.44 ,$5.18 ,$84.75 ,$84.75 ,$96.05 ,$96.05 ,$5.18 ,$96.05 ,$5.18 ,$89.27 ,$89.27 ,$89.27 ,$101.70 ,$12.95 ,$101.70 ,$5.18 ,$113.00 ,$74.02 ,$5.18 ,$49.04 , N/A ,$5.44 ,$101.70 ,$11.66 ,$71.30 ,$67.80 ,$101.70 ,$5.18 ,$101.70 ,$101.70 ,$5.18 ,$73.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101580,82785,HC GAMMAGLOBULIN IGE,301,1 ,$152.00 ,$98.80 ,$16.46 ,$152.00 ,$113.24 ,$99.56 ,$16.46 ,$80.10 ,$16.46 ,$95.91 ,$95.91 ,$95.91 ,$95.91 ,$136.80 ,$114.00 ,$16.46 ,$133.76 ,$16.46 ,$114.00 ,$114.00 ,$129.20 ,$129.20 ,$16.46 ,$129.20 ,$16.46 ,$120.08 ,$120.08 ,$120.08 ,$136.80 ,$41.15 ,$136.80 ,$16.46 ,$152.00 ,$99.56 ,$16.46 ,$65.97 , N/A ,$17.28 ,$136.80 ,$37.04 ,$95.91 ,$91.20 ,$136.80 ,$16.46 ,$136.80 ,$136.80 ,$16.46 ,$98.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101583,82960,HC G6PD SCREEN -90,301,1 ,$87.00 ,$56.55 ,$6.05 ,$87.00 ,$64.82 ,$56.99 ,$6.05 ,$45.85 ,$6.05 ,$54.90 ,$54.90 ,$54.90 ,$54.90 ,$78.30 ,$65.25 ,$6.05 ,$76.56 ,$6.05 ,$65.25 ,$65.25 ,$73.95 ,$73.95 ,$6.05 ,$73.95 ,$6.05 ,$68.73 ,$68.73 ,$68.73 ,$78.30 ,$15.13 ,$78.30 ,$6.05 ,$87.00 ,$56.99 ,$6.05 ,$37.76 , N/A ,$6.35 ,$78.30 ,$13.61 ,$54.90 ,$52.20 ,$78.30 ,$6.05 ,$78.30 ,$78.30 ,$6.05 ,$56.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101589,83036,HC GLYCOSYLATED HGB -90,301,1 ,$84.00 ,$54.60 ,$9.71 ,$84.00 ,$62.58 ,$55.02 ,$9.71 ,$44.27 ,$9.71 ,$53.00 ,$53.00 ,$53.00 ,$53.00 ,$75.60 ,$63.00 ,$9.71 ,$73.92 ,$9.71 ,$63.00 ,$63.00 ,$71.40 ,$71.40 ,$9.71 ,$71.40 ,$9.71 ,$66.36 ,$66.36 ,$66.36 ,$75.60 ,$24.28 ,$75.60 ,$9.71 ,$84.00 ,$55.02 ,$9.71 ,$36.46 , N/A ,$10.20 ,$75.60 ,$21.85 ,$53.00 ,$50.40 ,$75.60 ,$9.71 ,$75.60 ,$75.60 ,$9.71 ,$54.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101591,83090,HC HOMOCYSTEINE,301,1 ,$156.00 ,$101.40 ,$17.92 ,$156.00 ,$116.22 ,$102.18 ,$17.92 ,$82.21 ,$17.92 ,$98.44 ,$98.44 ,$98.44 ,$98.44 ,$140.40 ,$117.00 ,$17.92 ,$137.28 ,$17.92 ,$117.00 ,$117.00 ,$132.60 ,$132.60 ,$17.92 ,$132.60 ,$17.92 ,$123.24 ,$123.24 ,$123.24 ,$140.40 ,$44.80 ,$140.40 ,$17.92 ,$156.00 ,$102.18 ,$17.92 ,$67.70 , N/A ,$18.82 ,$140.40 ,$40.32 ,$98.44 ,$93.60 ,$140.40 ,$17.92 ,$140.40 ,$140.40 ,$17.92 ,$101.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101595,83690,HC LIPASE,301,1 ,$85.00 ,$55.25 ,$6.89 ,$85.00 ,$63.33 ,$55.68 ,$6.89 ,$44.80 ,$6.89 ,$53.64 ,$53.64 ,$53.64 ,$53.64 ,$76.50 ,$63.75 ,$6.89 ,$74.80 ,$6.89 ,$63.75 ,$63.75 ,$72.25 ,$72.25 ,$6.89 ,$72.25 ,$6.89 ,$67.15 ,$67.15 ,$67.15 ,$76.50 ,$17.23 ,$76.50 ,$6.89 ,$85.00 ,$55.68 ,$6.89 ,$36.89 , N/A ,$7.23 ,$76.50 ,$15.50 ,$53.64 ,$51.00 ,$76.50 ,$6.89 ,$76.50 ,$76.50 ,$6.89 ,$55.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101602,84105,HC PHOSPHORUS UR,301,1 ,$82.00 ,$53.30 ,$5.78 ,$82.00 ,$61.09 ,$53.71 ,$5.78 ,$43.21 ,$5.78 ,$51.74 ,$51.74 ,$51.74 ,$51.74 ,$73.80 ,$61.50 ,$5.78 ,$72.16 ,$5.78 ,$61.50 ,$61.50 ,$69.70 ,$69.70 ,$5.78 ,$69.70 ,$5.78 ,$64.78 ,$64.78 ,$64.78 ,$73.80 ,$14.45 ,$73.80 ,$5.78 ,$82.00 ,$53.71 ,$5.78 ,$35.59 , N/A ,$6.07 ,$73.80 ,$13.01 ,$51.74 ,$49.20 ,$73.80 ,$5.78 ,$73.80 ,$73.80 ,$5.78 ,$53.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101609,84153,HC PSA TOTAL,301,1 ,$266.00 ,$172.90 ,$18.39 ,$266.00 ,$198.17 ,$174.23 ,$18.39 ,$140.18 ,$18.39 ,$167.85 ,$167.85 ,$167.85 ,$167.85 ,$239.40 ,$199.50 ,$18.39 ,$234.08 ,$18.39 ,$199.50 ,$199.50 ,$226.10 ,$226.10 ,$18.39 ,$226.10 ,$18.39 ,$210.14 ,$210.14 ,$210.14 ,$239.40 ,$45.98 ,$239.40 ,$18.39 ,$266.00 ,$174.23 ,$18.39 ,$115.44 , N/A ,$19.31 ,$239.40 ,$41.38 ,$167.85 ,$159.60 ,$239.40 ,$18.39 ,$239.40 ,$239.40 ,$18.39 ,$172.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101610,84154,HC PSA FREE,301,1 ,$219.00 ,$142.35 ,$18.39 ,$219.00 ,$163.16 ,$143.45 ,$18.39 ,$115.41 ,$18.39 ,$138.19 ,$138.19 ,$138.19 ,$138.19 ,$197.10 ,$164.25 ,$18.39 ,$192.72 ,$18.39 ,$164.25 ,$164.25 ,$186.15 ,$186.15 ,$18.39 ,$186.15 ,$18.39 ,$173.01 ,$173.01 ,$173.01 ,$197.10 ,$45.98 ,$197.10 ,$18.39 ,$219.00 ,$143.45 ,$18.39 ,$95.05 , N/A ,$19.31 ,$197.10 ,$41.38 ,$138.19 ,$131.40 ,$197.10 ,$18.39 ,$197.10 ,$197.10 ,$18.39 ,$142.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101611,84155,HC PROTEIN TOTAL,301,1 ,$50.00 ,$32.50 ,$3.67 ,$50.00 ,$37.25 ,$32.75 ,$3.67 ,$26.35 ,$3.67 ,$31.55 ,$31.55 ,$31.55 ,$31.55 ,$45.00 ,$37.50 ,$3.67 ,$44.00 ,$3.67 ,$37.50 ,$37.50 ,$42.50 ,$42.50 ,$3.67 ,$42.50 ,$3.67 ,$39.50 ,$39.50 ,$39.50 ,$45.00 ,$9.18 ,$45.00 ,$3.67 ,$50.00 ,$32.75 ,$3.67 ,$21.70 , N/A ,$3.85 ,$45.00 ,$8.26 ,$31.55 ,$30.00 ,$45.00 ,$3.67 ,$45.00 ,$45.00 ,$3.67 ,$32.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101612,84156,HC PROTEIN TOTAL URINE,301,1 ,$91.00 ,$59.15 ,$3.67 ,$91.00 ,$67.80 ,$59.61 ,$3.67 ,$47.96 ,$3.67 ,$57.42 ,$57.42 ,$57.42 ,$57.42 ,$81.90 ,$68.25 ,$3.67 ,$80.08 ,$3.67 ,$68.25 ,$68.25 ,$77.35 ,$77.35 ,$3.67 ,$77.35 ,$3.67 ,$71.89 ,$71.89 ,$71.89 ,$81.90 ,$9.18 ,$81.90 ,$3.67 ,$91.00 ,$59.61 ,$3.67 ,$39.49 , N/A ,$3.85 ,$81.90 ,$8.26 ,$57.42 ,$54.60 ,$81.90 ,$3.67 ,$81.90 ,$81.90 ,$3.67 ,$59.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101614,84165,HC PROTEIN ELECTROPHORESIS,301,1 ,$142.00 ,$92.30 ,$10.74 ,$142.00 ,$105.79 ,$93.01 ,$10.74 ,$74.83 ,$10.74 ,$89.60 ,$89.60 ,$89.60 ,$89.60 ,$127.80 ,$106.50 ,$10.74 ,$124.96 ,$10.74 ,$106.50 ,$106.50 ,$120.70 ,$120.70 ,$10.74 ,$120.70 ,$10.74 ,$112.18 ,$112.18 ,$112.18 ,$127.80 ,$26.85 ,$127.80 ,$10.74 ,$142.00 ,$93.01 ,$10.74 ,$61.63 , N/A ,$11.28 ,$127.80 ,$24.17 ,$89.60 ,$85.20 ,$127.80 ,$10.74 ,$127.80 ,$127.80 ,$10.74 ,$92.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101615,84166,HC PROTEIN EP OTH FLUID,301,1 ,$111.00 ,$72.15 ,$17.83 ,$111.00 ,$82.70 ,$72.71 ,$17.83 ,$58.50 ,$17.83 ,$70.04 ,$70.04 ,$70.04 ,$70.04 ,$99.90 ,$83.25 ,$17.83 ,$97.68 ,$17.83 ,$83.25 ,$83.25 ,$94.35 ,$94.35 ,$17.83 ,$94.35 ,$17.83 ,$87.69 ,$87.69 ,$87.69 ,$99.90 ,$44.58 ,$99.90 ,$17.83 ,$111.00 ,$72.71 ,$17.83 ,$48.17 , N/A ,$18.72 ,$99.90 ,$40.12 ,$70.04 ,$66.60 ,$99.90 ,$17.83 ,$99.90 ,$99.90 ,$17.83 ,$72.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101616,84270,HC SEX HORMONE BIND GLOB,301,1 ,$64.00 ,$41.60 ,$21.73 ,$64.00 ,$47.68 ,$41.92 ,$21.73 ,$33.73 ,$21.73 ,$40.38 ,$40.38 ,$40.38 ,$40.38 ,$57.60 ,$48.00 ,$21.73 ,$56.32 ,$21.73 ,$48.00 ,$48.00 ,$54.40 ,$54.40 ,$21.73 ,$54.40 ,$21.73 ,$50.56 ,$50.56 ,$50.56 ,$57.60 ,$54.33 ,$57.60 ,$21.73 ,$64.00 ,$41.92 ,$21.73 ,$27.78 , N/A ,$22.82 ,$57.60 ,$48.89 ,$40.38 ,$38.40 ,$57.60 ,$21.73 ,$57.60 ,$57.60 ,$21.73 ,$41.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101623,84478,HC TRIGLYCERIDES,301,1 ,$65.00 ,$42.25 ,$5.74 ,$65.00 ,$48.43 ,$42.58 ,$5.74 ,$34.26 ,$5.74 ,$41.02 ,$41.02 ,$41.02 ,$41.02 ,$58.50 ,$48.75 ,$5.74 ,$57.20 ,$5.74 ,$48.75 ,$48.75 ,$55.25 ,$55.25 ,$5.74 ,$55.25 ,$5.74 ,$51.35 ,$51.35 ,$51.35 ,$58.50 ,$14.35 ,$58.50 ,$5.74 ,$65.00 ,$42.58 ,$5.74 ,$28.21 , N/A ,$6.03 ,$58.50 ,$12.92 ,$41.02 ,$39.00 ,$58.50 ,$5.74 ,$58.50 ,$58.50 ,$5.74 ,$42.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101627,84540,HC UREA URINE,301,1 ,$95.00 ,$61.75 ,$5.56 ,$95.00 ,$70.78 ,$62.23 ,$5.56 ,$50.07 ,$5.56 ,$59.95 ,$59.95 ,$59.95 ,$59.95 ,$85.50 ,$71.25 ,$5.56 ,$83.60 ,$5.56 ,$71.25 ,$71.25 ,$80.75 ,$80.75 ,$5.56 ,$80.75 ,$5.56 ,$75.05 ,$75.05 ,$75.05 ,$85.50 ,$13.90 ,$85.50 ,$5.56 ,$95.00 ,$62.23 ,$5.56 ,$41.23 , N/A ,$5.84 ,$85.50 ,$12.51 ,$59.95 ,$57.00 ,$85.50 ,$5.56 ,$85.50 ,$85.50 ,$5.56 ,$61.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101628,84560,HC URIC ACID OTH SRC,301,1 ,$59.00 ,$38.35 ,$5.08 ,$59.00 ,$43.96 ,$38.65 ,$5.08 ,$31.09 ,$5.08 ,$37.23 ,$37.23 ,$37.23 ,$37.23 ,$53.10 ,$44.25 ,$5.08 ,$51.92 ,$5.08 ,$44.25 ,$44.25 ,$50.15 ,$50.15 ,$5.08 ,$50.15 ,$5.08 ,$46.61 ,$46.61 ,$46.61 ,$53.10 ,$12.70 ,$53.10 ,$5.08 ,$59.00 ,$38.65 ,$5.08 ,$25.61 , N/A ,$5.33 ,$53.10 ,$11.43 ,$37.23 ,$35.40 ,$53.10 ,$5.08 ,$53.10 ,$53.10 ,$5.08 ,$38.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101631,G0328,HC OCCULT BLOOD FECAL SCREEN,301,1 ,$77.00 ,$50.05 ,$18.05 ,$77.00 ,$57.37 ,$50.44 ,$18.05 ,$40.58 ,$18.05 ,$48.59 ,$48.59 ,$48.59 ,$48.59 ,$69.30 ,$57.75 ,$18.05 ,$67.76 ,$18.05 ,$57.75 ,$57.75 ,$65.45 ,$65.45 ,$18.05 ,$65.45 ,$18.05 ,$60.83 ,$60.83 ,$60.83 ,$69.30 ,$45.13 ,$69.30 ,$18.05 ,$77.00 ,$50.44 ,$18.05 ,$33.42 , N/A ,$18.95 ,$69.30 ,$40.61 ,$48.59 ,$46.20 ,$69.30 ,$18.05 ,$69.30 ,$69.30 ,$18.05 ,$50.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101632,G0328,HC OCCULT BLOOD FECAL SCRN - AMB-QW,301,1 ,$77.00 ,$50.05 ,$18.05 ,$77.00 ,$57.37 ,$50.44 ,$18.05 ,$40.58 ,$18.05 ,$48.59 ,$48.59 ,$48.59 ,$48.59 ,$69.30 ,$57.75 ,$18.05 ,$67.76 ,$18.05 ,$57.75 ,$57.75 ,$65.45 ,$65.45 ,$18.05 ,$65.45 ,$18.05 ,$60.83 ,$60.83 ,$60.83 ,$69.30 ,$45.13 ,$69.30 ,$18.05 ,$77.00 ,$50.44 ,$18.05 ,$33.42 , N/A ,$18.95 ,$69.30 ,$40.61 ,$48.59 ,$46.20 ,$69.30 ,$18.05 ,$69.30 ,$69.30 ,$18.05 ,$50.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101636,83735,HC MAGNESIUM,301,1 ,$59.00 ,$38.35 ,$6.70 ,$59.00 ,$43.96 ,$38.65 ,$6.70 ,$31.09 ,$6.70 ,$37.23 ,$37.23 ,$37.23 ,$37.23 ,$53.10 ,$44.25 ,$6.70 ,$51.92 ,$6.70 ,$44.25 ,$44.25 ,$50.15 ,$50.15 ,$6.70 ,$50.15 ,$6.70 ,$46.61 ,$46.61 ,$46.61 ,$53.10 ,$16.75 ,$53.10 ,$6.70 ,$59.00 ,$38.65 ,$6.70 ,$25.61 , N/A ,$7.04 ,$53.10 ,$15.08 ,$37.23 ,$35.40 ,$53.10 ,$6.70 ,$53.10 ,$53.10 ,$6.70 ,$38.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101642,84999,HC OSMOLALITY FECAL-90,301,1 ,$624.00 ,$405.60 ,$270.82 ,$624.00 ,$464.88 ,$408.72 , N/A ,$328.85 , N/A ,$393.74 ,$393.74 ,$393.74 ,$393.74 ,$561.60 ,$468.00 , N/A ,$549.12 , N/A ,$468.00 ,$468.00 ,$530.40 ,$530.40 , N/A ,$530.40 , N/A ,$492.96 ,$492.96 ,$492.96 ,$561.60 , N/A ,$561.60 , N/A ,$624.00 ,$408.72 , N/A ,$270.82 , N/A , N/A ,$561.60 , N/A ,$393.74 ,$374.40 ,$561.60 , N/A ,$561.60 ,$561.60 , N/A ,$405.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101651,84150,HC PROSTAGLANDIN-90,301,1 ,$665.00 ,$432.25 ,$41.77 ,$665.00 ,$495.43 ,$435.58 ,$41.77 ,$350.46 ,$41.77 ,$419.62 ,$419.62 ,$419.62 ,$419.62 ,$598.50 ,$498.75 ,$41.77 ,$585.20 ,$41.77 ,$498.75 ,$498.75 ,$565.25 ,$565.25 ,$41.77 ,$565.25 ,$41.77 ,$525.35 ,$525.35 ,$525.35 ,$598.50 ,$104.43 ,$598.50 ,$41.77 ,$665.00 ,$435.58 ,$41.77 ,$288.61 , N/A ,$43.86 ,$598.50 ,$93.98 ,$419.62 ,$399.00 ,$598.50 ,$41.77 ,$598.50 ,$598.50 ,$41.77 ,$432.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101671,80299,HC VORICONAZOLE-90,301,1 ,$200.00 ,$130.00 ,$18.64 ,$200.00 ,$149.00 ,$131.00 ,$18.64 ,$105.40 ,$18.64 ,$126.20 ,$126.20 ,$126.20 ,$126.20 ,$180.00 ,$150.00 ,$18.64 ,$176.00 ,$18.64 ,$150.00 ,$150.00 ,$170.00 ,$170.00 ,$18.64 ,$170.00 ,$18.64 ,$158.00 ,$158.00 ,$158.00 ,$180.00 ,$46.60 ,$180.00 ,$18.64 ,$200.00 ,$131.00 ,$18.64 ,$86.80 , N/A ,$19.57 ,$180.00 ,$41.94 ,$126.20 ,$120.00 ,$180.00 ,$18.64 ,$180.00 ,$180.00 ,$18.64 ,$130.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101675,83050,HC METHEMOGLOBIN-90,301,1 ,$15.00 ,$9.75 ,$6.51 ,$18.45 ,$11.18 ,$9.83 ,$8.20 ,$7.91 ,$8.20 ,$9.47 ,$9.47 ,$9.47 ,$9.47 ,$13.50 ,$11.25 ,$8.20 ,$13.20 ,$8.20 ,$11.25 ,$11.25 ,$12.75 ,$12.75 ,$8.20 ,$12.75 ,$8.20 ,$11.85 ,$11.85 ,$11.85 ,$13.50 ,$15.00 ,$13.50 ,$8.20 ,$15.00 ,$9.83 ,$8.20 ,$6.51 , N/A ,$8.61 ,$13.50 ,$18.45 ,$9.47 ,$9.00 ,$13.50 ,$8.20 ,$13.50 ,$13.50 ,$8.20 ,$9.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101676,82375,HC CARBON MONOXIDE-90,301,1 ,$18.00 ,$11.70 ,$7.81 ,$27.72 ,$13.41 ,$11.79 ,$12.32 ,$9.49 ,$12.32 ,$11.36 ,$11.36 ,$11.36 ,$11.36 ,$16.20 ,$13.50 ,$12.32 ,$15.84 ,$12.32 ,$13.50 ,$13.50 ,$15.30 ,$15.30 ,$12.32 ,$15.30 ,$12.32 ,$14.22 ,$14.22 ,$14.22 ,$16.20 ,$18.00 ,$16.20 ,$12.32 ,$18.00 ,$11.79 ,$12.32 ,$7.81 , N/A ,$12.94 ,$16.20 ,$27.72 ,$11.36 ,$10.80 ,$16.20 ,$12.32 ,$16.20 ,$16.20 ,$12.32 ,$11.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101678,83516,HC FLUOR AB SCR AQUAPORIN 4-90,301,1 ,$880.00 ,$572.00 ,$11.53 ,$880.00 ,$655.60 ,$576.40 ,$11.53 ,$463.76 ,$11.53 ,$555.28 ,$555.28 ,$555.28 ,$555.28 ,$792.00 ,$660.00 ,$11.53 ,$774.40 ,$11.53 ,$660.00 ,$660.00 ,$748.00 ,$748.00 ,$11.53 ,$748.00 ,$11.53 ,$695.20 ,$695.20 ,$695.20 ,$792.00 ,$28.83 ,$792.00 ,$11.53 ,$880.00 ,$576.40 ,$11.53 ,$381.92 , N/A ,$12.11 ,$792.00 ,$25.94 ,$555.28 ,$528.00 ,$792.00 ,$11.53 ,$792.00 ,$792.00 ,$11.53 ,$572.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101682,82963,HC GLUCOSIDASE BETA ASSAY-90,301,1 ,$767.80 ,$499.07 ,$21.48 ,$767.80 ,$572.01 ,$502.91 ,$21.48 ,$404.63 ,$21.48 ,$484.48 ,$484.48 ,$484.48 ,$484.48 ,$691.02 ,$575.85 ,$21.48 ,$675.66 ,$21.48 ,$575.85 ,$575.85 ,$652.63 ,$652.63 ,$21.48 ,$652.63 ,$21.48 ,$606.56 ,$606.56 ,$606.56 ,$691.02 ,$53.70 ,$691.02 ,$21.48 ,$767.80 ,$502.91 ,$21.48 ,$333.23 , N/A ,$22.55 ,$691.02 ,$48.33 ,$484.48 ,$460.68 ,$691.02 ,$21.48 ,$691.02 ,$691.02 ,$21.48 ,$499.07 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101685,80235,HC LACOSAMIDE -90,301,1 ,$134.00 ,$87.10 ,$27.11 ,$134.00 ,$99.83 ,$87.77 ,$27.11 ,$70.62 ,$27.11 ,$84.55 ,$84.55 ,$84.55 ,$84.55 ,$120.60 ,$100.50 ,$27.11 ,$117.92 ,$27.11 ,$100.50 ,$100.50 ,$113.90 ,$113.90 ,$27.11 ,$113.90 ,$27.11 ,$105.86 ,$105.86 ,$105.86 ,$120.60 ,$67.78 ,$120.60 ,$27.11 ,$134.00 ,$87.77 ,$27.11 ,$58.16 , N/A ,$28.47 ,$120.60 ,$61.00 ,$84.55 ,$80.40 ,$120.60 ,$27.11 ,$120.60 ,$120.60 ,$27.11 ,$87.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101686,83721,HC CHOLESTEROL LDL -90,301,1 ,$11.00 ,$7.15 ,$4.77 ,$23.63 ,$8.20 ,$7.21 ,$10.50 ,$5.80 ,$10.50 ,$6.94 ,$6.94 ,$6.94 ,$6.94 ,$9.90 ,$8.25 ,$10.50 ,$9.68 ,$10.50 ,$8.25 ,$8.25 ,$9.35 ,$9.35 ,$10.50 ,$9.35 ,$10.50 ,$8.69 ,$8.69 ,$8.69 ,$9.90 ,$11.00 ,$9.90 ,$10.50 ,$11.00 ,$7.21 ,$10.50 ,$4.77 , N/A ,$11.00 ,$9.90 ,$23.63 ,$6.94 ,$6.60 ,$9.90 ,$10.50 ,$9.90 ,$9.90 ,$10.50 ,$7.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101705,80145,HC DRUG ASSAY ADALIMUMAB -90,301,1 ,$115.71 ,$75.21 ,$38.57 ,$115.71 ,$86.20 ,$75.79 ,$38.57 ,$60.98 ,$38.57 ,$73.01 ,$73.01 ,$73.01 ,$73.01 ,$104.14 ,$86.78 ,$38.57 ,$101.82 ,$38.57 ,$86.78 ,$86.78 ,$98.35 ,$98.35 ,$38.57 ,$98.35 ,$38.57 ,$91.41 ,$91.41 ,$91.41 ,$104.14 ,$96.43 ,$104.14 ,$38.57 ,$115.71 ,$75.79 ,$38.57 ,$50.22 , N/A ,$40.50 ,$104.14 ,$86.78 ,$73.01 ,$69.43 ,$104.14 ,$38.57 ,$104.14 ,$104.14 ,$38.57 ,$75.21 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101706,80230,HC DRUG ASSAY INFLIXIMAB-90,301,1 ,$367.00 ,$238.55 ,$38.57 ,$367.00 ,$273.42 ,$240.39 ,$38.57 ,$193.41 ,$38.57 ,$231.58 ,$231.58 ,$231.58 ,$231.58 ,$330.30 ,$275.25 ,$38.57 ,$322.96 ,$38.57 ,$275.25 ,$275.25 ,$311.95 ,$311.95 ,$38.57 ,$311.95 ,$38.57 ,$289.93 ,$289.93 ,$289.93 ,$330.30 ,$96.43 ,$330.30 ,$38.57 ,$367.00 ,$240.39 ,$38.57 ,$159.28 , N/A ,$40.50 ,$330.30 ,$86.78 ,$231.58 ,$220.20 ,$330.30 ,$38.57 ,$330.30 ,$330.30 ,$38.57 ,$238.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101710,83864,HC MUCOPOLYSACCHARIDE QUANT - 90,301,1 ,$248.00 ,$161.20 ,$28.50 ,$248.00 ,$184.76 ,$162.44 ,$28.50 ,$130.70 ,$28.50 ,$156.49 ,$156.49 ,$156.49 ,$156.49 ,$223.20 ,$186.00 ,$28.50 ,$218.24 ,$28.50 ,$186.00 ,$186.00 ,$210.80 ,$210.80 ,$28.50 ,$210.80 ,$28.50 ,$195.92 ,$195.92 ,$195.92 ,$223.20 ,$71.25 ,$223.20 ,$28.50 ,$248.00 ,$162.44 ,$28.50 ,$107.63 , N/A ,$29.93 ,$223.20 ,$64.13 ,$156.49 ,$148.80 ,$223.20 ,$28.50 ,$223.20 ,$223.20 ,$28.50 ,$161.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101711,84377,HC OLIGOSACCHARIDE SCREEN URINE - 90,301,1 ,$92.00 ,$59.80 ,$5.50 ,$92.00 ,$68.54 ,$60.26 ,$5.50 ,$48.48 ,$5.50 ,$58.05 ,$58.05 ,$58.05 ,$58.05 ,$82.80 ,$69.00 ,$5.50 ,$80.96 ,$5.50 ,$69.00 ,$69.00 ,$78.20 ,$78.20 ,$5.50 ,$78.20 ,$5.50 ,$72.68 ,$72.68 ,$72.68 ,$82.80 ,$13.75 ,$82.80 ,$5.50 ,$92.00 ,$60.26 ,$5.50 ,$39.93 , N/A ,$5.78 ,$82.80 ,$12.38 ,$58.05 ,$55.20 ,$82.80 ,$5.50 ,$82.80 ,$82.80 ,$5.50 ,$59.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101712,84445,HC ASSAY OF TSI GLOBULINS,301,1 ,"$1,226.60 ",$797.29 ,$50.86 ,"$1,226.60 ",$913.82 ,$803.42 ,$50.86 ,$646.42 ,$50.86 ,$773.98 ,$773.98 ,$773.98 ,$773.98 ,"$1,103.94 ",$919.95 ,$50.86 ,"$1,079.41 ",$50.86 ,$919.95 ,$919.95 ,"$1,042.61 ","$1,042.61 ",$50.86 ,"$1,042.61 ",$50.86 ,$969.01 ,$969.01 ,$969.01 ,"$1,103.94 ",$127.15 ,"$1,103.94 ",$50.86 ,"$1,226.60 ",$803.42 ,$50.86 ,$532.34 , N/A ,$53.40 ,"$1,103.94 ",$114.44 ,$773.98 ,$735.96 ,"$1,103.94 ",$50.86 ,"$1,103.94 ","$1,103.94 ",$50.86 ,$797.29 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101720,80307,HC CORD BLOOD DRUG SCREEN,301,1 ,$325.00 ,$211.25 ,$62.14 ,$325.00 ,$242.13 ,$212.88 ,$62.14 ,$171.28 ,$62.14 ,$205.08 ,$205.08 ,$205.08 ,$205.08 ,$292.50 ,$243.75 ,$62.14 ,$286.00 ,$62.14 ,$243.75 ,$243.75 ,$276.25 ,$276.25 ,$62.14 ,$276.25 ,$62.14 ,$256.75 ,$256.75 ,$256.75 ,$292.50 ,$155.35 ,$292.50 ,$62.14 ,$325.00 ,$212.88 ,$62.14 ,$141.05 , N/A ,$65.25 ,$292.50 ,$139.82 ,$205.08 ,$195.00 ,$292.50 ,$62.14 ,$292.50 ,$292.50 ,$62.14 ,$211.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101722,82542,HC COL CHROMOTOGRAPHY QUAL/QUAN-90,301,1 ,$401.64 ,$261.07 ,$24.09 ,$401.64 ,$299.22 ,$263.07 ,$24.09 ,$211.66 ,$24.09 ,$253.43 ,$253.43 ,$253.43 ,$253.43 ,$361.48 ,$301.23 ,$24.09 ,$353.44 ,$24.09 ,$301.23 ,$301.23 ,$341.39 ,$341.39 ,$24.09 ,$341.39 ,$24.09 ,$317.30 ,$317.30 ,$317.30 ,$361.48 ,$60.23 ,$361.48 ,$24.09 ,$401.64 ,$263.07 ,$24.09 ,$174.31 , N/A ,$25.29 ,$361.48 ,$54.20 ,$253.43 ,$240.98 ,$361.48 ,$24.09 ,$361.48 ,$361.48 ,$24.09 ,$261.07 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101723,82397,HC ANTIMULLERIAN ASSAY-90,301,1 ,$347.80 ,$226.07 ,$14.12 ,$347.80 ,$259.11 ,$227.81 ,$14.12 ,$183.29 ,$14.12 ,$219.46 ,$219.46 ,$219.46 ,$219.46 ,$313.02 ,$260.85 ,$14.12 ,$306.06 ,$14.12 ,$260.85 ,$260.85 ,$295.63 ,$295.63 ,$14.12 ,$295.63 ,$14.12 ,$274.76 ,$274.76 ,$274.76 ,$313.02 ,$35.30 ,$313.02 ,$14.12 ,$347.80 ,$227.81 ,$14.12 ,$150.95 , N/A ,$14.83 ,$313.02 ,$31.77 ,$219.46 ,$208.68 ,$313.02 ,$14.12 ,$313.02 ,$313.02 ,$14.12 ,$226.07 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30101725,80354,HC FENTANYL URINE - 90,301,1 ,$216.00 ,$140.40 ,$93.74 ,$216.00 ,$160.92 ,$141.48 , N/A ,$113.83 , N/A ,$136.30 ,$136.30 ,$136.30 ,$136.30 ,$194.40 ,$162.00 , N/A ,$190.08 , N/A ,$162.00 ,$162.00 ,$183.60 ,$183.60 , N/A ,$183.60 , N/A ,$170.64 ,$170.64 ,$170.64 ,$194.40 , N/A ,$194.40 , N/A ,$216.00 ,$141.48 , N/A ,$93.74 , N/A , N/A ,$194.40 , N/A ,$136.30 ,$129.60 ,$194.40 , N/A ,$194.40 ,$194.40 , N/A ,$140.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200163,86308,HC HETEROPHILE SCR MONO,302,1 ,$171.00 ,$111.15 ,$5.18 ,$171.00 ,$127.40 ,$112.01 ,$5.18 ,$90.12 ,$5.18 ,$107.90 ,$107.90 ,$107.90 ,$107.90 ,$153.90 ,$128.25 ,$5.18 ,$150.48 ,$5.18 ,$128.25 ,$128.25 ,$145.35 ,$145.35 ,$5.18 ,$145.35 ,$5.18 ,$135.09 ,$135.09 ,$135.09 ,$153.90 ,$12.95 ,$153.90 ,$5.18 ,$171.00 ,$112.01 ,$5.18 ,$74.21 , N/A ,$5.44 ,$153.90 ,$11.66 ,$107.90 ,$102.60 ,$153.90 ,$5.18 ,$153.90 ,$153.90 ,$5.18 ,$111.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200191,86403,HC PARTICLE AGG SCREEN,302,1 ,$157.00 ,$102.05 ,$11.54 ,$157.00 ,$116.97 ,$102.84 ,$11.54 ,$82.74 ,$11.54 ,$99.07 ,$99.07 ,$99.07 ,$99.07 ,$141.30 ,$117.75 ,$11.54 ,$138.16 ,$11.54 ,$117.75 ,$117.75 ,$133.45 ,$133.45 ,$11.54 ,$133.45 ,$11.54 ,$124.03 ,$124.03 ,$124.03 ,$141.30 ,$28.85 ,$141.30 ,$11.54 ,$157.00 ,$102.84 ,$11.54 ,$68.14 , N/A ,$12.12 ,$141.30 ,$25.97 ,$99.07 ,$94.20 ,$141.30 ,$11.54 ,$141.30 ,$141.30 ,$11.54 ,$102.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200201,86592,HC SYPHILIS VDRL RPR QL,302,1 ,$103.00 ,$66.95 ,$4.27 ,$103.00 ,$76.74 ,$67.47 ,$4.27 ,$54.28 ,$4.27 ,$64.99 ,$64.99 ,$64.99 ,$64.99 ,$92.70 ,$77.25 ,$4.27 ,$90.64 ,$4.27 ,$77.25 ,$77.25 ,$87.55 ,$87.55 ,$4.27 ,$87.55 ,$4.27 ,$81.37 ,$81.37 ,$81.37 ,$92.70 ,$10.68 ,$92.70 ,$4.27 ,$103.00 ,$67.47 ,$4.27 ,$44.70 , N/A ,$4.48 ,$92.70 ,$9.61 ,$64.99 ,$61.80 ,$92.70 ,$4.27 ,$92.70 ,$92.70 ,$4.27 ,$66.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200288,86762,HC RUBELLA AB,302,1 ,$122.00 ,$79.30 ,$14.39 ,$122.00 ,$90.89 ,$79.91 ,$14.39 ,$64.29 ,$14.39 ,$76.98 ,$76.98 ,$76.98 ,$76.98 ,$109.80 ,$91.50 ,$14.39 ,$107.36 ,$14.39 ,$91.50 ,$91.50 ,$103.70 ,$103.70 ,$14.39 ,$103.70 ,$14.39 ,$96.38 ,$96.38 ,$96.38 ,$109.80 ,$35.98 ,$109.80 ,$14.39 ,$122.00 ,$79.91 ,$14.39 ,$52.95 , N/A ,$15.11 ,$109.80 ,$32.38 ,$76.98 ,$73.20 ,$109.80 ,$14.39 ,$109.80 ,$109.80 ,$14.39 ,$79.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200506,86060,HC ASO,302,1 ,$199.00 ,$129.35 ,$7.30 ,$199.00 ,$148.26 ,$130.35 ,$7.30 ,$104.87 ,$7.30 ,$125.57 ,$125.57 ,$125.57 ,$125.57 ,$179.10 ,$149.25 ,$7.30 ,$175.12 ,$7.30 ,$149.25 ,$149.25 ,$169.15 ,$169.15 ,$7.30 ,$169.15 ,$7.30 ,$157.21 ,$157.21 ,$157.21 ,$179.10 ,$18.25 ,$179.10 ,$7.30 ,$199.00 ,$130.35 ,$7.30 ,$86.37 , N/A ,$7.67 ,$179.10 ,$16.43 ,$125.57 ,$119.40 ,$179.10 ,$7.30 ,$179.10 ,$179.10 ,$7.30 ,$129.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200507,86141,HC C-REACTIVE PROTEIN (HS),302,1 ,$130.00 ,$84.50 ,$12.95 ,$130.00 ,$96.85 ,$85.15 ,$12.95 ,$68.51 ,$12.95 ,$82.03 ,$82.03 ,$82.03 ,$82.03 ,$117.00 ,$97.50 ,$12.95 ,$114.40 ,$12.95 ,$97.50 ,$97.50 ,$110.50 ,$110.50 ,$12.95 ,$110.50 ,$12.95 ,$102.70 ,$102.70 ,$102.70 ,$117.00 ,$32.38 ,$117.00 ,$12.95 ,$130.00 ,$85.15 ,$12.95 ,$56.42 , N/A ,$13.60 ,$117.00 ,$29.14 ,$82.03 ,$78.00 ,$117.00 ,$12.95 ,$117.00 ,$117.00 ,$12.95 ,$84.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200523,86431,HC RHEUMATOID FACTOR QN,302,1 ,$188.00 ,$122.20 ,$5.67 ,$188.00 ,$140.06 ,$123.14 ,$5.67 ,$99.08 ,$5.67 ,$118.63 ,$118.63 ,$118.63 ,$118.63 ,$169.20 ,$141.00 ,$5.67 ,$165.44 ,$5.67 ,$141.00 ,$141.00 ,$159.80 ,$159.80 ,$5.67 ,$159.80 ,$5.67 ,$148.52 ,$148.52 ,$148.52 ,$169.20 ,$14.18 ,$169.20 ,$5.67 ,$188.00 ,$123.14 ,$5.67 ,$81.59 , N/A ,$5.95 ,$169.20 ,$12.76 ,$118.63 ,$112.80 ,$169.20 ,$5.67 ,$169.20 ,$169.20 ,$5.67 ,$122.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200542,86703,HC HIV 1 HIV 2 AB SGL ASSAY,302,1 ,$246.00 ,$159.90 ,$13.71 ,$246.00 ,$183.27 ,$161.13 ,$13.71 ,$129.64 ,$13.71 ,$155.23 ,$155.23 ,$155.23 ,$155.23 ,$221.40 ,$184.50 ,$13.71 ,$216.48 ,$13.71 ,$184.50 ,$184.50 ,$209.10 ,$209.10 ,$13.71 ,$209.10 ,$13.71 ,$194.34 ,$194.34 ,$194.34 ,$221.40 ,$34.28 ,$221.40 ,$13.71 ,$246.00 ,$161.13 ,$13.71 ,$106.76 , N/A ,$14.40 ,$221.40 ,$30.85 ,$155.23 ,$147.60 ,$221.40 ,$13.71 ,$221.40 ,$221.40 ,$13.71 ,$159.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200544,86705,HC HEP B CORE IGM,302,1 ,$86.00 ,$55.90 ,$11.77 ,$86.00 ,$64.07 ,$56.33 ,$11.77 ,$45.32 ,$11.77 ,$54.27 ,$54.27 ,$54.27 ,$54.27 ,$77.40 ,$64.50 ,$11.77 ,$75.68 ,$11.77 ,$64.50 ,$64.50 ,$73.10 ,$73.10 ,$11.77 ,$73.10 ,$11.77 ,$67.94 ,$67.94 ,$67.94 ,$77.40 ,$29.43 ,$77.40 ,$11.77 ,$86.00 ,$56.33 ,$11.77 ,$37.32 , N/A ,$12.36 ,$77.40 ,$26.48 ,$54.27 ,$51.60 ,$77.40 ,$11.77 ,$77.40 ,$77.40 ,$11.77 ,$55.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200545,86706,HC HEP B SURFACE AB,302,1 ,$216.00 ,$140.40 ,$10.74 ,$216.00 ,$160.92 ,$141.48 ,$10.74 ,$113.83 ,$10.74 ,$136.30 ,$136.30 ,$136.30 ,$136.30 ,$194.40 ,$162.00 ,$10.74 ,$190.08 ,$10.74 ,$162.00 ,$162.00 ,$183.60 ,$183.60 ,$10.74 ,$183.60 ,$10.74 ,$170.64 ,$170.64 ,$170.64 ,$194.40 ,$26.85 ,$194.40 ,$10.74 ,$216.00 ,$141.48 ,$10.74 ,$93.74 , N/A ,$11.28 ,$194.40 ,$24.17 ,$136.30 ,$129.60 ,$194.40 ,$10.74 ,$194.40 ,$194.40 ,$10.74 ,$140.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200548,86709,HC HEP A AB IGM,302,1 ,$166.00 ,$107.90 ,$11.26 ,$166.00 ,$123.67 ,$108.73 ,$11.26 ,$87.48 ,$11.26 ,$104.75 ,$104.75 ,$104.75 ,$104.75 ,$149.40 ,$124.50 ,$11.26 ,$146.08 ,$11.26 ,$124.50 ,$124.50 ,$141.10 ,$141.10 ,$11.26 ,$141.10 ,$11.26 ,$131.14 ,$131.14 ,$131.14 ,$149.40 ,$28.15 ,$149.40 ,$11.26 ,$166.00 ,$108.73 ,$11.26 ,$72.04 , N/A ,$11.82 ,$149.40 ,$25.34 ,$104.75 ,$99.60 ,$149.40 ,$11.26 ,$149.40 ,$149.40 ,$11.26 ,$107.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200559,86850,HC AB SCREEN,302,1 ,$86.00 ,$55.90 ,$37.32 ,$106.27 ,$64.07 ,$56.33 ,$47.23 ,$45.32 ,$47.23 ,$54.27 ,$54.27 ,$54.27 ,$54.27 ,$77.40 ,$64.50 ,$47.23 ,$75.68 ,$47.23 ,$64.50 ,$64.50 ,$73.10 ,$73.10 ,$47.23 ,$73.10 ,$47.23 ,$67.94 ,$67.94 ,$67.94 ,$77.40 ,$86.00 ,$77.40 ,$47.23 ,$86.00 ,$56.33 ,$47.23 ,$37.32 , N/A ,$49.59 ,$77.40 ,$106.27 ,$54.27 ,$51.60 ,$77.40 ,$47.23 ,$77.40 ,$77.40 ,$47.23 ,$55.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200561,86870,HC RBC AB ID PANEL,302,1 ,$283.00 ,$183.95 ,$122.82 ,$622.03 ,$210.84 ,$185.37 ,$276.46 ,$149.14 ,$276.46 ,$178.57 ,$178.57 ,$178.57 ,$178.57 ,$254.70 ,$212.25 ,$276.46 ,$249.04 ,$276.46 ,$212.25 ,$212.25 ,$240.55 ,$240.55 ,$276.46 ,$240.55 ,$276.46 ,$223.57 ,$223.57 ,$223.57 ,$254.70 ,$283.00 ,$254.70 ,$276.46 ,$283.00 ,$185.37 ,$276.46 ,$122.82 , N/A ,$283.00 ,$254.70 ,$622.03 ,$178.57 ,$169.80 ,$254.70 ,$276.46 ,$254.70 ,$254.70 ,$276.46 ,$183.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200562,86880,HC COOMBS DIRECT,302,1 ,$80.00 ,$52.00 ,$34.72 ,$118.87 ,$59.60 ,$52.40 ,$52.83 ,$42.16 ,$52.83 ,$50.48 ,$50.48 ,$50.48 ,$50.48 ,$72.00 ,$60.00 ,$52.83 ,$70.40 ,$52.83 ,$60.00 ,$60.00 ,$68.00 ,$68.00 ,$52.83 ,$68.00 ,$52.83 ,$63.20 ,$63.20 ,$63.20 ,$72.00 ,$80.00 ,$72.00 ,$52.83 ,$80.00 ,$52.40 ,$52.83 ,$34.72 , N/A ,$55.47 ,$72.00 ,$118.87 ,$50.48 ,$48.00 ,$72.00 ,$52.83 ,$72.00 ,$72.00 ,$52.83 ,$52.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200563,86885,HC INDIRECT COOMBS,302,1 ,$67.00 ,$43.55 ,$29.08 ,$318.55 ,$49.92 ,$43.89 ,$67.00 ,$35.31 ,$67.00 ,$42.28 ,$42.28 ,$42.28 ,$42.28 ,$60.30 ,$50.25 ,$67.00 ,$58.96 ,$67.00 ,$50.25 ,$50.25 ,$56.95 ,$56.95 ,$67.00 ,$56.95 ,$67.00 ,$52.93 ,$52.93 ,$52.93 ,$60.30 ,$67.00 ,$60.30 ,$67.00 ,$67.00 ,$43.89 ,$67.00 ,$29.08 , N/A ,$67.00 ,$60.30 ,$318.55 ,$42.28 ,$40.20 ,$60.30 ,$67.00 ,$60.30 ,$60.30 ,$67.00 ,$43.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200565,86900,HC BLOOD TYPING ABO,302,1 ,$44.00 ,$28.60 ,$19.10 ,$239.09 ,$32.78 ,$28.82 ,$44.00 ,$23.19 ,$44.00 ,$27.76 ,$27.76 ,$27.76 ,$27.76 ,$39.60 ,$33.00 ,$44.00 ,$38.72 ,$44.00 ,$33.00 ,$33.00 ,$37.40 ,$37.40 ,$44.00 ,$37.40 ,$44.00 ,$34.76 ,$34.76 ,$34.76 ,$39.60 ,$44.00 ,$39.60 ,$44.00 ,$44.00 ,$28.82 ,$44.00 ,$19.10 , N/A ,$44.00 ,$39.60 ,$239.09 ,$27.76 ,$26.40 ,$39.60 ,$44.00 ,$39.60 ,$39.60 ,$44.00 ,$28.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200566,86901,HC BLOOD TYPING RH,302,1 ,$45.00 ,$29.25 ,$19.53 ,$72.27 ,$33.53 ,$29.48 ,$32.12 ,$23.72 ,$32.12 ,$28.40 ,$28.40 ,$28.40 ,$28.40 ,$40.50 ,$33.75 ,$32.12 ,$39.60 ,$32.12 ,$33.75 ,$33.75 ,$38.25 ,$38.25 ,$32.12 ,$38.25 ,$32.12 ,$35.55 ,$35.55 ,$35.55 ,$40.50 ,$45.00 ,$40.50 ,$32.12 ,$45.00 ,$29.48 ,$32.12 ,$19.53 , N/A ,$33.73 ,$40.50 ,$72.27 ,$28.40 ,$27.00 ,$40.50 ,$32.12 ,$40.50 ,$40.50 ,$32.12 ,$29.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200567,86902,HC RBC AG SCR RGT SERUM,302,1 ,$111.00 ,$72.15 ,$48.17 ,$622.03 ,$82.70 ,$72.71 ,$111.00 ,$58.50 ,$111.00 ,$70.04 ,$70.04 ,$70.04 ,$70.04 ,$99.90 ,$83.25 ,$111.00 ,$97.68 ,$111.00 ,$83.25 ,$83.25 ,$94.35 ,$94.35 ,$111.00 ,$94.35 ,$111.00 ,$87.69 ,$87.69 ,$87.69 ,$99.90 ,$111.00 ,$99.90 ,$111.00 ,$111.00 ,$72.71 ,$111.00 ,$48.17 , N/A ,$111.00 ,$99.90 ,$622.03 ,$70.04 ,$66.60 ,$99.90 ,$111.00 ,$99.90 ,$99.90 ,$111.00 ,$72.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200568,86905,HC RBC ANTIGEN OTHER THAN ABO OR RH(D) EACH,302,1 ,$71.00 ,$46.15 ,$30.81 ,$622.03 ,$52.90 ,$46.51 ,$71.00 ,$37.42 ,$71.00 ,$44.80 ,$44.80 ,$44.80 ,$44.80 ,$63.90 ,$53.25 ,$71.00 ,$62.48 ,$71.00 ,$53.25 ,$53.25 ,$60.35 ,$60.35 ,$71.00 ,$60.35 ,$71.00 ,$56.09 ,$56.09 ,$56.09 ,$63.90 ,$71.00 ,$63.90 ,$71.00 ,$71.00 ,$46.51 ,$71.00 ,$30.81 , N/A ,$71.00 ,$63.90 ,$622.03 ,$44.80 ,$42.60 ,$63.90 ,$71.00 ,$63.90 ,$63.90 ,$71.00 ,$46.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200569,86920,HC CROSSMATCH IMMEDIATE SPIN,302,1 ,$111.00 ,$72.15 ,$48.17 ,$318.55 ,$82.70 ,$72.71 ,$111.00 ,$58.50 ,$111.00 ,$70.04 ,$70.04 ,$70.04 ,$70.04 ,$99.90 ,$83.25 ,$111.00 ,$97.68 ,$111.00 ,$83.25 ,$83.25 ,$94.35 ,$94.35 ,$111.00 ,$94.35 ,$111.00 ,$87.69 ,$87.69 ,$87.69 ,$99.90 ,$111.00 ,$99.90 ,$111.00 ,$111.00 ,$72.71 ,$111.00 ,$48.17 , N/A ,$111.00 ,$99.90 ,$318.55 ,$70.04 ,$66.60 ,$99.90 ,$111.00 ,$99.90 ,$99.90 ,$111.00 ,$72.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200570,86921,HC CROSSMATCH INCUBATION,302,1 ,$57.00 ,$37.05 ,$24.74 ,$318.55 ,$42.47 ,$37.34 ,$57.00 ,$30.04 ,$57.00 ,$35.97 ,$35.97 ,$35.97 ,$35.97 ,$51.30 ,$42.75 ,$57.00 ,$50.16 ,$57.00 ,$42.75 ,$42.75 ,$48.45 ,$48.45 ,$57.00 ,$48.45 ,$57.00 ,$45.03 ,$45.03 ,$45.03 ,$51.30 ,$57.00 ,$51.30 ,$57.00 ,$57.00 ,$37.34 ,$57.00 ,$24.74 , N/A ,$57.00 ,$51.30 ,$318.55 ,$35.97 ,$34.20 ,$51.30 ,$57.00 ,$51.30 ,$51.30 ,$57.00 ,$37.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200571,86922,HC CROSSMATCH AHG,302,1 ,$103.00 ,$66.95 ,$44.70 ,$318.55 ,$76.74 ,$67.47 ,$103.00 ,$54.28 ,$103.00 ,$64.99 ,$64.99 ,$64.99 ,$64.99 ,$92.70 ,$77.25 ,$103.00 ,$90.64 ,$103.00 ,$77.25 ,$77.25 ,$87.55 ,$87.55 ,$103.00 ,$87.55 ,$103.00 ,$81.37 ,$81.37 ,$81.37 ,$92.70 ,$103.00 ,$92.70 ,$103.00 ,$103.00 ,$67.47 ,$103.00 ,$44.70 , N/A ,$103.00 ,$92.70 ,$318.55 ,$64.99 ,$61.80 ,$92.70 ,$103.00 ,$92.70 ,$92.70 ,$103.00 ,$66.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200843,86000,HC AGGLUTININS FEBRILE EA AG-90,302,1 ,$87.00 ,$56.55 ,$6.98 ,$87.00 ,$64.82 ,$56.99 ,$6.98 ,$45.85 ,$6.98 ,$54.90 ,$54.90 ,$54.90 ,$54.90 ,$78.30 ,$65.25 ,$6.98 ,$76.56 ,$6.98 ,$65.25 ,$65.25 ,$73.95 ,$73.95 ,$6.98 ,$73.95 ,$6.98 ,$68.73 ,$68.73 ,$68.73 ,$78.30 ,$17.45 ,$78.30 ,$6.98 ,$87.00 ,$56.99 ,$6.98 ,$37.76 , N/A ,$7.33 ,$78.30 ,$15.71 ,$54.90 ,$52.20 ,$78.30 ,$6.98 ,$78.30 ,$78.30 ,$6.98 ,$56.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200845,86003,HC RAST ALLERGEN IGE QN SQ EA-90,302,1 ,$24.00 ,$15.60 ,$5.22 ,$24.00 ,$17.88 ,$15.72 ,$5.22 ,$12.65 ,$5.22 ,$15.14 ,$15.14 ,$15.14 ,$15.14 ,$21.60 ,$18.00 ,$5.22 ,$21.12 ,$5.22 ,$18.00 ,$18.00 ,$20.40 ,$20.40 ,$5.22 ,$20.40 ,$5.22 ,$18.96 ,$18.96 ,$18.96 ,$21.60 ,$13.05 ,$21.60 ,$5.22 ,$24.00 ,$15.72 ,$5.22 ,$10.42 , N/A ,$5.48 ,$21.60 ,$11.75 ,$15.14 ,$14.40 ,$21.60 ,$5.22 ,$21.60 ,$21.60 ,$5.22 ,$15.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200847,86021,HC LEUKO AB ID-90,302,1 ,$93.00 ,$60.45 ,$15.05 ,$93.00 ,$69.29 ,$60.92 ,$15.05 ,$49.01 ,$15.05 ,$58.68 ,$58.68 ,$58.68 ,$58.68 ,$83.70 ,$69.75 ,$15.05 ,$81.84 ,$15.05 ,$69.75 ,$69.75 ,$79.05 ,$79.05 ,$15.05 ,$79.05 ,$15.05 ,$73.47 ,$73.47 ,$73.47 ,$83.70 ,$37.63 ,$83.70 ,$15.05 ,$93.00 ,$60.92 ,$15.05 ,$40.36 , N/A ,$15.80 ,$83.70 ,$33.86 ,$58.68 ,$55.80 ,$83.70 ,$15.05 ,$83.70 ,$83.70 ,$15.05 ,$60.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200851,86022,HC PLATELET AB ID-90,302,1 ,$503.00 ,$326.95 ,$18.37 ,$503.00 ,$374.74 ,$329.47 ,$18.37 ,$265.08 ,$18.37 ,$317.39 ,$317.39 ,$317.39 ,$317.39 ,$452.70 ,$377.25 ,$18.37 ,$442.64 ,$18.37 ,$377.25 ,$377.25 ,$427.55 ,$427.55 ,$18.37 ,$427.55 ,$18.37 ,$397.37 ,$397.37 ,$397.37 ,$452.70 ,$45.93 ,$452.70 ,$18.37 ,$503.00 ,$329.47 ,$18.37 ,$218.30 , N/A ,$19.29 ,$452.70 ,$41.33 ,$317.39 ,$301.80 ,$452.70 ,$18.37 ,$452.70 ,$452.70 ,$18.37 ,$326.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200852,86022,HC PLATE AB SEROTONIN RELEASE-90,302,1 ,$113.00 ,$73.45 ,$18.37 ,$113.00 ,$84.19 ,$74.02 ,$18.37 ,$59.55 ,$18.37 ,$71.30 ,$71.30 ,$71.30 ,$71.30 ,$101.70 ,$84.75 ,$18.37 ,$99.44 ,$18.37 ,$84.75 ,$84.75 ,$96.05 ,$96.05 ,$18.37 ,$96.05 ,$18.37 ,$89.27 ,$89.27 ,$89.27 ,$101.70 ,$45.93 ,$101.70 ,$18.37 ,$113.00 ,$74.02 ,$18.37 ,$49.04 , N/A ,$19.29 ,$101.70 ,$41.33 ,$71.30 ,$67.80 ,$101.70 ,$18.37 ,$101.70 ,$101.70 ,$18.37 ,$73.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200859,86039,HC ANA TITER-90,302,1 ,$207.00 ,$134.55 ,$11.16 ,$207.00 ,$154.22 ,$135.59 ,$11.16 ,$109.09 ,$11.16 ,$130.62 ,$130.62 ,$130.62 ,$130.62 ,$186.30 ,$155.25 ,$11.16 ,$182.16 ,$11.16 ,$155.25 ,$155.25 ,$175.95 ,$175.95 ,$11.16 ,$175.95 ,$11.16 ,$163.53 ,$163.53 ,$163.53 ,$186.30 ,$27.90 ,$186.30 ,$11.16 ,$207.00 ,$135.59 ,$11.16 ,$89.84 , N/A ,$11.72 ,$186.30 ,$25.11 ,$130.62 ,$124.20 ,$186.30 ,$11.16 ,$186.30 ,$186.30 ,$11.16 ,$134.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200861,86140,HC C-REACTIVE PROTEIN-90,302,1 ,$155.00 ,$100.75 ,$5.18 ,$155.00 ,$115.48 ,$101.53 ,$5.18 ,$81.69 ,$5.18 ,$97.81 ,$97.81 ,$97.81 ,$97.81 ,$139.50 ,$116.25 ,$5.18 ,$136.40 ,$5.18 ,$116.25 ,$116.25 ,$131.75 ,$131.75 ,$5.18 ,$131.75 ,$5.18 ,$122.45 ,$122.45 ,$122.45 ,$139.50 ,$12.95 ,$139.50 ,$5.18 ,$155.00 ,$101.53 ,$5.18 ,$67.27 , N/A ,$5.44 ,$139.50 ,$11.66 ,$97.81 ,$93.00 ,$139.50 ,$5.18 ,$139.50 ,$139.50 ,$5.18 ,$100.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200862,86140,HC C-REACTIVE PROTEIN,302,1 ,$155.00 ,$100.75 ,$5.18 ,$155.00 ,$115.48 ,$101.53 ,$5.18 ,$81.69 ,$5.18 ,$97.81 ,$97.81 ,$97.81 ,$97.81 ,$139.50 ,$116.25 ,$5.18 ,$136.40 ,$5.18 ,$116.25 ,$116.25 ,$131.75 ,$131.75 ,$5.18 ,$131.75 ,$5.18 ,$122.45 ,$122.45 ,$122.45 ,$139.50 ,$12.95 ,$139.50 ,$5.18 ,$155.00 ,$101.53 ,$5.18 ,$67.27 , N/A ,$5.44 ,$139.50 ,$11.66 ,$97.81 ,$93.00 ,$139.50 ,$5.18 ,$139.50 ,$139.50 ,$5.18 ,$100.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200864,86146,HC BETA 2 GLYCO AB-90,302,1 ,$157.00 ,$102.05 ,$25.45 ,$157.00 ,$116.97 ,$102.84 ,$25.45 ,$82.74 ,$25.45 ,$99.07 ,$99.07 ,$99.07 ,$99.07 ,$141.30 ,$117.75 ,$25.45 ,$138.16 ,$25.45 ,$117.75 ,$117.75 ,$133.45 ,$133.45 ,$25.45 ,$133.45 ,$25.45 ,$124.03 ,$124.03 ,$124.03 ,$141.30 ,$63.63 ,$141.30 ,$25.45 ,$157.00 ,$102.84 ,$25.45 ,$68.14 , N/A ,$26.72 ,$141.30 ,$57.26 ,$99.07 ,$94.20 ,$141.30 ,$25.45 ,$141.30 ,$141.30 ,$25.45 ,$102.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200865,86147,HC CARDIOLIPIN AB EA-90,302,1 ,$197.00 ,$128.05 ,$25.45 ,$197.00 ,$146.77 ,$129.04 ,$25.45 ,$103.82 ,$25.45 ,$124.31 ,$124.31 ,$124.31 ,$124.31 ,$177.30 ,$147.75 ,$25.45 ,$173.36 ,$25.45 ,$147.75 ,$147.75 ,$167.45 ,$167.45 ,$25.45 ,$167.45 ,$25.45 ,$155.63 ,$155.63 ,$155.63 ,$177.30 ,$63.63 ,$177.30 ,$25.45 ,$197.00 ,$129.04 ,$25.45 ,$85.50 , N/A ,$26.72 ,$177.30 ,$57.26 ,$124.31 ,$118.20 ,$177.30 ,$25.45 ,$177.30 ,$177.30 ,$25.45 ,$128.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200866,86148,HC ANTI-PHOSPHATIDYLSERINE AB-90,302,1 ,$60.00 ,$39.00 ,$16.07 ,$60.00 ,$44.70 ,$39.30 ,$16.07 ,$31.62 ,$16.07 ,$37.86 ,$37.86 ,$37.86 ,$37.86 ,$54.00 ,$45.00 ,$16.07 ,$52.80 ,$16.07 ,$45.00 ,$45.00 ,$51.00 ,$51.00 ,$16.07 ,$51.00 ,$16.07 ,$47.40 ,$47.40 ,$47.40 ,$54.00 ,$40.18 ,$54.00 ,$16.07 ,$60.00 ,$39.30 ,$16.07 ,$26.04 , N/A ,$16.87 ,$54.00 ,$36.16 ,$37.86 ,$36.00 ,$54.00 ,$16.07 ,$54.00 ,$54.00 ,$16.07 ,$39.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200868,86157,HC COLD AGGLUTININ TITER-90,302,1 ,$142.00 ,$92.30 ,$8.06 ,$142.00 ,$105.79 ,$93.01 ,$8.06 ,$74.83 ,$8.06 ,$89.60 ,$89.60 ,$89.60 ,$89.60 ,$127.80 ,$106.50 ,$8.06 ,$124.96 ,$8.06 ,$106.50 ,$106.50 ,$120.70 ,$120.70 ,$8.06 ,$120.70 ,$8.06 ,$112.18 ,$112.18 ,$112.18 ,$127.80 ,$20.15 ,$127.80 ,$8.06 ,$142.00 ,$93.01 ,$8.06 ,$61.63 , N/A ,$8.46 ,$127.80 ,$18.14 ,$89.60 ,$85.20 ,$127.80 ,$8.06 ,$127.80 ,$127.80 ,$8.06 ,$92.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200869,86160,HC COMPLEMENT AG EA-90,302,1 ,$74.00 ,$48.10 ,$12.00 ,$74.00 ,$55.13 ,$48.47 ,$12.00 ,$39.00 ,$12.00 ,$46.69 ,$46.69 ,$46.69 ,$46.69 ,$66.60 ,$55.50 ,$12.00 ,$65.12 ,$12.00 ,$55.50 ,$55.50 ,$62.90 ,$62.90 ,$12.00 ,$62.90 ,$12.00 ,$58.46 ,$58.46 ,$58.46 ,$66.60 ,$30.00 ,$66.60 ,$12.00 ,$74.00 ,$48.47 ,$12.00 ,$32.12 , N/A ,$12.60 ,$66.60 ,$27.00 ,$46.69 ,$44.40 ,$66.60 ,$12.00 ,$66.60 ,$66.60 ,$12.00 ,$48.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200871,86162,HC COMPLEMENT TOTAL-90,302,1 ,$152.00 ,$98.80 ,$20.32 ,$152.00 ,$113.24 ,$99.56 ,$20.32 ,$80.10 ,$20.32 ,$95.91 ,$95.91 ,$95.91 ,$95.91 ,$136.80 ,$114.00 ,$20.32 ,$133.76 ,$20.32 ,$114.00 ,$114.00 ,$129.20 ,$129.20 ,$20.32 ,$129.20 ,$20.32 ,$120.08 ,$120.08 ,$120.08 ,$136.80 ,$50.80 ,$136.80 ,$20.32 ,$152.00 ,$99.56 ,$20.32 ,$65.97 , N/A ,$21.34 ,$136.80 ,$45.72 ,$95.91 ,$91.20 ,$136.80 ,$20.32 ,$136.80 ,$136.80 ,$20.32 ,$98.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200873,86200,HC CCP AB-90,302,1 ,$254.00 ,$165.10 ,$12.95 ,$254.00 ,$189.23 ,$166.37 ,$12.95 ,$133.86 ,$12.95 ,$160.27 ,$160.27 ,$160.27 ,$160.27 ,$228.60 ,$190.50 ,$12.95 ,$223.52 ,$12.95 ,$190.50 ,$190.50 ,$215.90 ,$215.90 ,$12.95 ,$215.90 ,$12.95 ,$200.66 ,$200.66 ,$200.66 ,$228.60 ,$32.38 ,$228.60 ,$12.95 ,$254.00 ,$166.37 ,$12.95 ,$110.24 , N/A ,$13.60 ,$228.60 ,$29.14 ,$160.27 ,$152.40 ,$228.60 ,$12.95 ,$228.60 ,$228.60 ,$12.95 ,$165.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200877,86235,HC ENA AB-90,302,1 ,$134.00 ,$87.10 ,$17.93 ,$134.00 ,$99.83 ,$87.77 ,$17.93 ,$70.62 ,$17.93 ,$84.55 ,$84.55 ,$84.55 ,$84.55 ,$120.60 ,$100.50 ,$17.93 ,$117.92 ,$17.93 ,$100.50 ,$100.50 ,$113.90 ,$113.90 ,$17.93 ,$113.90 ,$17.93 ,$105.86 ,$105.86 ,$105.86 ,$120.60 ,$44.83 ,$120.60 ,$17.93 ,$134.00 ,$87.77 ,$17.93 ,$58.16 , N/A ,$18.83 ,$120.60 ,$40.34 ,$84.55 ,$80.40 ,$120.60 ,$17.93 ,$120.60 ,$120.60 ,$17.93 ,$87.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200878,86255,HC FLUOR AB SCR-90,302,1 ,$805.00 ,$523.25 ,$12.05 ,$805.00 ,$599.73 ,$527.28 ,$12.05 ,$424.24 ,$12.05 ,$507.96 ,$507.96 ,$507.96 ,$507.96 ,$724.50 ,$603.75 ,$12.05 ,$708.40 ,$12.05 ,$603.75 ,$603.75 ,$684.25 ,$684.25 ,$12.05 ,$684.25 ,$12.05 ,$635.95 ,$635.95 ,$635.95 ,$724.50 ,$30.13 ,$724.50 ,$12.05 ,$805.00 ,$527.28 ,$12.05 ,$349.37 , N/A ,$12.65 ,$724.50 ,$27.11 ,$507.96 ,$483.00 ,$724.50 ,$12.05 ,$724.50 ,$724.50 ,$12.05 ,$523.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200879,86256,HC FLUOR AB TITER-90,302,1 ,$137.00 ,$89.05 ,$12.05 ,$137.00 ,$102.07 ,$89.74 ,$12.05 ,$72.20 ,$12.05 ,$86.45 ,$86.45 ,$86.45 ,$86.45 ,$123.30 ,$102.75 ,$12.05 ,$120.56 ,$12.05 ,$102.75 ,$102.75 ,$116.45 ,$116.45 ,$12.05 ,$116.45 ,$12.05 ,$108.23 ,$108.23 ,$108.23 ,$123.30 ,$30.13 ,$123.30 ,$12.05 ,$137.00 ,$89.74 ,$12.05 ,$59.46 , N/A ,$12.65 ,$123.30 ,$27.11 ,$86.45 ,$82.20 ,$123.30 ,$12.05 ,$123.30 ,$123.30 ,$12.05 ,$89.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200880,86300,HC TUMOR AG CA 15-3 (27.29)-90,302,1 ,$175.00 ,$113.75 ,$20.81 ,$175.00 ,$130.38 ,$114.63 ,$20.81 ,$92.23 ,$20.81 ,$110.43 ,$110.43 ,$110.43 ,$110.43 ,$157.50 ,$131.25 ,$20.81 ,$154.00 ,$20.81 ,$131.25 ,$131.25 ,$148.75 ,$148.75 ,$20.81 ,$148.75 ,$20.81 ,$138.25 ,$138.25 ,$138.25 ,$157.50 ,$52.03 ,$157.50 ,$20.81 ,$175.00 ,$114.63 ,$20.81 ,$75.95 , N/A ,$21.85 ,$157.50 ,$46.82 ,$110.43 ,$105.00 ,$157.50 ,$20.81 ,$157.50 ,$157.50 ,$20.81 ,$113.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200881,86301,HC TUMOR AG CA 19-9 -90,302,1 ,$150.00 ,$97.50 ,$20.81 ,$150.00 ,$111.75 ,$98.25 ,$20.81 ,$79.05 ,$20.81 ,$94.65 ,$94.65 ,$94.65 ,$94.65 ,$135.00 ,$112.50 ,$20.81 ,$132.00 ,$20.81 ,$112.50 ,$112.50 ,$127.50 ,$127.50 ,$20.81 ,$127.50 ,$20.81 ,$118.50 ,$118.50 ,$118.50 ,$135.00 ,$52.03 ,$135.00 ,$20.81 ,$150.00 ,$98.25 ,$20.81 ,$65.10 , N/A ,$21.85 ,$135.00 ,$46.82 ,$94.65 ,$90.00 ,$135.00 ,$20.81 ,$135.00 ,$135.00 ,$20.81 ,$97.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200882,86304,HC TUMOR AG CA 125 -90,302,1 ,$184.00 ,$119.60 ,$20.81 ,$184.00 ,$137.08 ,$120.52 ,$20.81 ,$96.97 ,$20.81 ,$116.10 ,$116.10 ,$116.10 ,$116.10 ,$165.60 ,$138.00 ,$20.81 ,$161.92 ,$20.81 ,$138.00 ,$138.00 ,$156.40 ,$156.40 ,$20.81 ,$156.40 ,$20.81 ,$145.36 ,$145.36 ,$145.36 ,$165.60 ,$52.03 ,$165.60 ,$20.81 ,$184.00 ,$120.52 ,$20.81 ,$79.86 , N/A ,$21.85 ,$165.60 ,$46.82 ,$116.10 ,$110.40 ,$165.60 ,$20.81 ,$165.60 ,$165.60 ,$20.81 ,$119.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200883,86305,HC HE4 OVARIAN CANCER-90,302,1 ,$149.00 ,$96.85 ,$20.81 ,$149.00 ,$111.01 ,$97.60 ,$20.81 ,$78.52 ,$20.81 ,$94.02 ,$94.02 ,$94.02 ,$94.02 ,$134.10 ,$111.75 ,$20.81 ,$131.12 ,$20.81 ,$111.75 ,$111.75 ,$126.65 ,$126.65 ,$20.81 ,$126.65 ,$20.81 ,$117.71 ,$117.71 ,$117.71 ,$134.10 ,$52.03 ,$134.10 ,$20.81 ,$149.00 ,$97.60 ,$20.81 ,$64.67 , N/A ,$21.85 ,$134.10 ,$46.82 ,$94.02 ,$89.40 ,$134.10 ,$20.81 ,$134.10 ,$134.10 ,$20.81 ,$96.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200887,86635,HC COCCIDIOIDES AB-90,302,1 ,$131.10 ,$85.22 ,$11.47 ,$131.10 ,$97.67 ,$85.87 ,$11.47 ,$69.09 ,$11.47 ,$82.72 ,$82.72 ,$82.72 ,$82.72 ,$117.99 ,$98.33 ,$11.47 ,$115.37 ,$11.47 ,$98.33 ,$98.33 ,$111.44 ,$111.44 ,$11.47 ,$111.44 ,$11.47 ,$103.57 ,$103.57 ,$103.57 ,$117.99 ,$28.68 ,$117.99 ,$11.47 ,$131.10 ,$85.87 ,$11.47 ,$56.90 , N/A ,$12.04 ,$117.99 ,$25.81 ,$82.72 ,$78.66 ,$117.99 ,$11.47 ,$117.99 ,$117.99 ,$11.47 ,$85.22 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200888,86638,HC Q FEVER AB-90,302,1 ,$100.00 ,$65.00 ,$12.12 ,$100.00 ,$74.50 ,$65.50 ,$12.12 ,$52.70 ,$12.12 ,$63.10 ,$63.10 ,$63.10 ,$63.10 ,$90.00 ,$75.00 ,$12.12 ,$88.00 ,$12.12 ,$75.00 ,$75.00 ,$85.00 ,$85.00 ,$12.12 ,$85.00 ,$12.12 ,$79.00 ,$79.00 ,$79.00 ,$90.00 ,$30.30 ,$90.00 ,$12.12 ,$100.00 ,$65.50 ,$12.12 ,$43.40 , N/A ,$12.73 ,$90.00 ,$27.27 ,$63.10 ,$60.00 ,$90.00 ,$12.12 ,$90.00 ,$90.00 ,$12.12 ,$65.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200890,86644,HC CMV AB-90,302,1 ,$89.00 ,$57.85 ,$14.39 ,$89.00 ,$66.31 ,$58.30 ,$14.39 ,$46.90 ,$14.39 ,$56.16 ,$56.16 ,$56.16 ,$56.16 ,$80.10 ,$66.75 ,$14.39 ,$78.32 ,$14.39 ,$66.75 ,$66.75 ,$75.65 ,$75.65 ,$14.39 ,$75.65 ,$14.39 ,$70.31 ,$70.31 ,$70.31 ,$80.10 ,$35.98 ,$80.10 ,$14.39 ,$89.00 ,$58.30 ,$14.39 ,$38.63 , N/A ,$15.11 ,$80.10 ,$32.38 ,$56.16 ,$53.40 ,$80.10 ,$14.39 ,$80.10 ,$80.10 ,$14.39 ,$57.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200891,86645,HC CMV AB IGM-90,302,1 ,$104.00 ,$67.60 ,$16.85 ,$104.00 ,$77.48 ,$68.12 ,$16.85 ,$54.81 ,$16.85 ,$65.62 ,$65.62 ,$65.62 ,$65.62 ,$93.60 ,$78.00 ,$16.85 ,$91.52 ,$16.85 ,$78.00 ,$78.00 ,$88.40 ,$88.40 ,$16.85 ,$88.40 ,$16.85 ,$82.16 ,$82.16 ,$82.16 ,$93.60 ,$42.13 ,$93.60 ,$16.85 ,$104.00 ,$68.12 ,$16.85 ,$45.14 , N/A ,$17.69 ,$93.60 ,$37.91 ,$65.62 ,$62.40 ,$93.60 ,$16.85 ,$93.60 ,$93.60 ,$16.85 ,$67.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200892,86648,HC DIPTHERIA-90,302,1 ,$175.00 ,$113.75 ,$15.21 ,$175.00 ,$130.38 ,$114.63 ,$15.21 ,$92.23 ,$15.21 ,$110.43 ,$110.43 ,$110.43 ,$110.43 ,$157.50 ,$131.25 ,$15.21 ,$154.00 ,$15.21 ,$131.25 ,$131.25 ,$148.75 ,$148.75 ,$15.21 ,$148.75 ,$15.21 ,$138.25 ,$138.25 ,$138.25 ,$157.50 ,$38.03 ,$157.50 ,$15.21 ,$175.00 ,$114.63 ,$15.21 ,$75.95 , N/A ,$15.97 ,$157.50 ,$34.22 ,$110.43 ,$105.00 ,$157.50 ,$15.21 ,$157.50 ,$157.50 ,$15.21 ,$113.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200899,86664,HC EBV NUCLEAR AG-90,302,1 ,$134.00 ,$87.10 ,$15.29 ,$134.00 ,$99.83 ,$87.77 ,$15.29 ,$70.62 ,$15.29 ,$84.55 ,$84.55 ,$84.55 ,$84.55 ,$120.60 ,$100.50 ,$15.29 ,$117.92 ,$15.29 ,$100.50 ,$100.50 ,$113.90 ,$113.90 ,$15.29 ,$113.90 ,$15.29 ,$105.86 ,$105.86 ,$105.86 ,$120.60 ,$38.23 ,$120.60 ,$15.29 ,$134.00 ,$87.77 ,$15.29 ,$58.16 , N/A ,$16.05 ,$120.60 ,$34.40 ,$84.55 ,$80.40 ,$120.60 ,$15.29 ,$120.60 ,$120.60 ,$15.29 ,$87.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200900,86665,HC EBV VIRAL CAP-90,302,1 ,$163.00 ,$105.95 ,$18.14 ,$163.00 ,$121.44 ,$106.77 ,$18.14 ,$85.90 ,$18.14 ,$102.85 ,$102.85 ,$102.85 ,$102.85 ,$146.70 ,$122.25 ,$18.14 ,$143.44 ,$18.14 ,$122.25 ,$122.25 ,$138.55 ,$138.55 ,$18.14 ,$138.55 ,$18.14 ,$128.77 ,$128.77 ,$128.77 ,$146.70 ,$45.35 ,$146.70 ,$18.14 ,$163.00 ,$106.77 ,$18.14 ,$70.74 , N/A ,$19.05 ,$146.70 ,$40.82 ,$102.85 ,$97.80 ,$146.70 ,$18.14 ,$146.70 ,$146.70 ,$18.14 ,$105.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200901,86666,HC EHRLICHIA AB-90,302,1 ,$88.00 ,$57.20 ,$10.18 ,$88.00 ,$65.56 ,$57.64 ,$10.18 ,$46.38 ,$10.18 ,$55.53 ,$55.53 ,$55.53 ,$55.53 ,$79.20 ,$66.00 ,$10.18 ,$77.44 ,$10.18 ,$66.00 ,$66.00 ,$74.80 ,$74.80 ,$10.18 ,$74.80 ,$10.18 ,$69.52 ,$69.52 ,$69.52 ,$79.20 ,$25.45 ,$79.20 ,$10.18 ,$88.00 ,$57.64 ,$10.18 ,$38.19 , N/A ,$10.69 ,$79.20 ,$22.91 ,$55.53 ,$52.80 ,$79.20 ,$10.18 ,$79.20 ,$79.20 ,$10.18 ,$57.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200906,86682,HC HELMINTH ANTIBODY-90,302,1 ,$108.00 ,$70.20 ,$13.01 ,$108.00 ,$80.46 ,$70.74 ,$13.01 ,$56.92 ,$13.01 ,$68.15 ,$68.15 ,$68.15 ,$68.15 ,$97.20 ,$81.00 ,$13.01 ,$95.04 ,$13.01 ,$81.00 ,$81.00 ,$91.80 ,$91.80 ,$13.01 ,$91.80 ,$13.01 ,$85.32 ,$85.32 ,$85.32 ,$97.20 ,$32.53 ,$97.20 ,$13.01 ,$108.00 ,$70.74 ,$13.01 ,$46.87 , N/A ,$13.66 ,$97.20 ,$29.27 ,$68.15 ,$64.80 ,$97.20 ,$13.01 ,$97.20 ,$97.20 ,$13.01 ,$70.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200907,86684,HC HAEMOPHILUS INFLUENZA AB-90,302,1 ,$190.00 ,$123.50 ,$15.84 ,$190.00 ,$141.55 ,$124.45 ,$15.84 ,$100.13 ,$15.84 ,$119.89 ,$119.89 ,$119.89 ,$119.89 ,$171.00 ,$142.50 ,$15.84 ,$167.20 ,$15.84 ,$142.50 ,$142.50 ,$161.50 ,$161.50 ,$15.84 ,$161.50 ,$15.84 ,$150.10 ,$150.10 ,$150.10 ,$171.00 ,$39.60 ,$171.00 ,$15.84 ,$190.00 ,$124.45 ,$15.84 ,$82.46 , N/A ,$16.63 ,$171.00 ,$35.64 ,$119.89 ,$114.00 ,$171.00 ,$15.84 ,$171.00 ,$171.00 ,$15.84 ,$123.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200912,86695,HC HERPES SIMPLEX AB I-90,302,1 ,$94.00 ,$61.10 ,$13.19 ,$94.00 ,$70.03 ,$61.57 ,$13.19 ,$49.54 ,$13.19 ,$59.31 ,$59.31 ,$59.31 ,$59.31 ,$84.60 ,$70.50 ,$13.19 ,$82.72 ,$13.19 ,$70.50 ,$70.50 ,$79.90 ,$79.90 ,$13.19 ,$79.90 ,$13.19 ,$74.26 ,$74.26 ,$74.26 ,$84.60 ,$32.98 ,$84.60 ,$13.19 ,$94.00 ,$61.57 ,$13.19 ,$40.80 , N/A ,$13.85 ,$84.60 ,$29.68 ,$59.31 ,$56.40 ,$84.60 ,$13.19 ,$84.60 ,$84.60 ,$13.19 ,$61.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200913,86696,HC HERPES SIMPLEX AB II-90,302,1 ,$138.00 ,$89.70 ,$19.35 ,$138.00 ,$102.81 ,$90.39 ,$19.35 ,$72.73 ,$19.35 ,$87.08 ,$87.08 ,$87.08 ,$87.08 ,$124.20 ,$103.50 ,$19.35 ,$121.44 ,$19.35 ,$103.50 ,$103.50 ,$117.30 ,$117.30 ,$19.35 ,$117.30 ,$19.35 ,$109.02 ,$109.02 ,$109.02 ,$124.20 ,$48.38 ,$124.20 ,$19.35 ,$138.00 ,$90.39 ,$19.35 ,$59.89 , N/A ,$20.32 ,$124.20 ,$43.54 ,$87.08 ,$82.80 ,$124.20 ,$19.35 ,$124.20 ,$124.20 ,$19.35 ,$89.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200914,86698,HC HISTOPLASMA AB-90,302,1 ,$77.00 ,$50.05 ,$13.79 ,$77.00 ,$57.37 ,$50.44 ,$13.79 ,$40.58 ,$13.79 ,$48.59 ,$48.59 ,$48.59 ,$48.59 ,$69.30 ,$57.75 ,$13.79 ,$67.76 ,$13.79 ,$57.75 ,$57.75 ,$65.45 ,$65.45 ,$13.79 ,$65.45 ,$13.79 ,$60.83 ,$60.83 ,$60.83 ,$69.30 ,$34.48 ,$69.30 ,$13.79 ,$77.00 ,$50.44 ,$13.79 ,$33.42 , N/A ,$14.48 ,$69.30 ,$31.03 ,$48.59 ,$46.20 ,$69.30 ,$13.79 ,$69.30 ,$69.30 ,$13.79 ,$50.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200915,86701,HC HIV-1 AB-90,302,1 ,$165.00 ,$107.25 ,$8.89 ,$165.00 ,$122.93 ,$108.08 ,$8.89 ,$86.96 ,$8.89 ,$104.12 ,$104.12 ,$104.12 ,$104.12 ,$148.50 ,$123.75 ,$8.89 ,$145.20 ,$8.89 ,$123.75 ,$123.75 ,$140.25 ,$140.25 ,$8.89 ,$140.25 ,$8.89 ,$130.35 ,$130.35 ,$130.35 ,$148.50 ,$22.23 ,$148.50 ,$8.89 ,$165.00 ,$108.08 ,$8.89 ,$71.61 , N/A ,$9.33 ,$148.50 ,$20.00 ,$104.12 ,$99.00 ,$148.50 ,$8.89 ,$148.50 ,$148.50 ,$8.89 ,$107.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200918,86702,HC HIV-2 AB-90,302,1 ,$165.00 ,$107.25 ,$13.52 ,$165.00 ,$122.93 ,$108.08 ,$13.52 ,$86.96 ,$13.52 ,$104.12 ,$104.12 ,$104.12 ,$104.12 ,$148.50 ,$123.75 ,$13.52 ,$145.20 ,$13.52 ,$123.75 ,$123.75 ,$140.25 ,$140.25 ,$13.52 ,$140.25 ,$13.52 ,$130.35 ,$130.35 ,$130.35 ,$148.50 ,$33.80 ,$148.50 ,$13.52 ,$165.00 ,$108.08 ,$13.52 ,$71.61 , N/A ,$14.20 ,$148.50 ,$30.42 ,$104.12 ,$99.00 ,$148.50 ,$13.52 ,$148.50 ,$148.50 ,$13.52 ,$107.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200919,86704,HC HEP CORE AB-90,302,1 ,$84.00 ,$54.60 ,$12.05 ,$84.00 ,$62.58 ,$55.02 ,$12.05 ,$44.27 ,$12.05 ,$53.00 ,$53.00 ,$53.00 ,$53.00 ,$75.60 ,$63.00 ,$12.05 ,$73.92 ,$12.05 ,$63.00 ,$63.00 ,$71.40 ,$71.40 ,$12.05 ,$71.40 ,$12.05 ,$66.36 ,$66.36 ,$66.36 ,$75.60 ,$30.13 ,$75.60 ,$12.05 ,$84.00 ,$55.02 ,$12.05 ,$36.46 , N/A ,$12.65 ,$75.60 ,$27.11 ,$53.00 ,$50.40 ,$75.60 ,$12.05 ,$75.60 ,$75.60 ,$12.05 ,$54.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200923,86707,HC HEP B E AB-90,302,1 ,$71.00 ,$46.15 ,$11.57 ,$71.00 ,$52.90 ,$46.51 ,$11.57 ,$37.42 ,$11.57 ,$44.80 ,$44.80 ,$44.80 ,$44.80 ,$63.90 ,$53.25 ,$11.57 ,$62.48 ,$11.57 ,$53.25 ,$53.25 ,$60.35 ,$60.35 ,$11.57 ,$60.35 ,$11.57 ,$56.09 ,$56.09 ,$56.09 ,$63.90 ,$28.93 ,$63.90 ,$11.57 ,$71.00 ,$46.51 ,$11.57 ,$30.81 , N/A ,$12.15 ,$63.90 ,$26.03 ,$44.80 ,$42.60 ,$63.90 ,$11.57 ,$63.90 ,$63.90 ,$11.57 ,$46.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200924,86708,HC HEP A AB TOTAL-90,302,1 ,$76.00 ,$49.40 ,$12.39 ,$76.00 ,$56.62 ,$49.78 ,$12.39 ,$40.05 ,$12.39 ,$47.96 ,$47.96 ,$47.96 ,$47.96 ,$68.40 ,$57.00 ,$12.39 ,$66.88 ,$12.39 ,$57.00 ,$57.00 ,$64.60 ,$64.60 ,$12.39 ,$64.60 ,$12.39 ,$60.04 ,$60.04 ,$60.04 ,$68.40 ,$30.98 ,$68.40 ,$12.39 ,$76.00 ,$49.78 ,$12.39 ,$32.98 , N/A ,$13.01 ,$68.40 ,$27.88 ,$47.96 ,$45.60 ,$68.40 ,$12.39 ,$68.40 ,$68.40 ,$12.39 ,$49.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200926,86710,HC INFLUENZA AB-90,302,1 ,$84.00 ,$54.60 ,$13.55 ,$84.00 ,$62.58 ,$55.02 ,$13.55 ,$44.27 ,$13.55 ,$53.00 ,$53.00 ,$53.00 ,$53.00 ,$75.60 ,$63.00 ,$13.55 ,$73.92 ,$13.55 ,$63.00 ,$63.00 ,$71.40 ,$71.40 ,$13.55 ,$71.40 ,$13.55 ,$66.36 ,$66.36 ,$66.36 ,$75.60 ,$33.88 ,$75.60 ,$13.55 ,$84.00 ,$55.02 ,$13.55 ,$36.46 , N/A ,$14.23 ,$75.60 ,$30.49 ,$53.00 ,$50.40 ,$75.60 ,$13.55 ,$75.60 ,$75.60 ,$13.55 ,$54.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200932,86738,HC MYCOPLASMA AB-90,302,1 ,$181.00 ,$117.65 ,$13.24 ,$181.00 ,$134.85 ,$118.56 ,$13.24 ,$95.39 ,$13.24 ,$114.21 ,$114.21 ,$114.21 ,$114.21 ,$162.90 ,$135.75 ,$13.24 ,$159.28 ,$13.24 ,$135.75 ,$135.75 ,$153.85 ,$153.85 ,$13.24 ,$153.85 ,$13.24 ,$142.99 ,$142.99 ,$142.99 ,$162.90 ,$33.10 ,$162.90 ,$13.24 ,$181.00 ,$118.56 ,$13.24 ,$78.55 , N/A ,$13.90 ,$162.90 ,$29.79 ,$114.21 ,$108.60 ,$162.90 ,$13.24 ,$162.90 ,$162.90 ,$13.24 ,$117.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200933,86738,HC MYCOPLASMA AB IFA-90,302,1 ,$181.00 ,$117.65 ,$13.24 ,$181.00 ,$134.85 ,$118.56 ,$13.24 ,$95.39 ,$13.24 ,$114.21 ,$114.21 ,$114.21 ,$114.21 ,$162.90 ,$135.75 ,$13.24 ,$159.28 ,$13.24 ,$135.75 ,$135.75 ,$153.85 ,$153.85 ,$13.24 ,$153.85 ,$13.24 ,$142.99 ,$142.99 ,$142.99 ,$162.90 ,$33.10 ,$162.90 ,$13.24 ,$181.00 ,$118.56 ,$13.24 ,$78.55 , N/A ,$13.90 ,$162.90 ,$29.79 ,$114.21 ,$108.60 ,$162.90 ,$13.24 ,$162.90 ,$162.90 ,$13.24 ,$117.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200935,86747,HC PARVOVIRUS AB-90,302,1 ,$161.00 ,$104.65 ,$15.03 ,$161.00 ,$119.95 ,$105.46 ,$15.03 ,$84.85 ,$15.03 ,$101.59 ,$101.59 ,$101.59 ,$101.59 ,$144.90 ,$120.75 ,$15.03 ,$141.68 ,$15.03 ,$120.75 ,$120.75 ,$136.85 ,$136.85 ,$15.03 ,$136.85 ,$15.03 ,$127.19 ,$127.19 ,$127.19 ,$144.90 ,$37.58 ,$144.90 ,$15.03 ,$161.00 ,$105.46 ,$15.03 ,$69.87 , N/A ,$15.78 ,$144.90 ,$33.82 ,$101.59 ,$96.60 ,$144.90 ,$15.03 ,$144.90 ,$144.90 ,$15.03 ,$104.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200939,86757,HC RICKETTSIA AB-90,302,1 ,$69.00 ,$44.85 ,$19.35 ,$69.00 ,$51.41 ,$45.20 ,$19.35 ,$36.36 ,$19.35 ,$43.54 ,$43.54 ,$43.54 ,$43.54 ,$62.10 ,$51.75 ,$19.35 ,$60.72 ,$19.35 ,$51.75 ,$51.75 ,$58.65 ,$58.65 ,$19.35 ,$58.65 ,$19.35 ,$54.51 ,$54.51 ,$54.51 ,$62.10 ,$48.38 ,$62.10 ,$19.35 ,$69.00 ,$45.20 ,$19.35 ,$29.95 , N/A ,$20.32 ,$62.10 ,$43.54 ,$43.54 ,$41.40 ,$62.10 ,$19.35 ,$62.10 ,$62.10 ,$19.35 ,$44.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200941,86765,HC RUBEOLA AB-90,302,1 ,$80.00 ,$52.00 ,$12.88 ,$80.00 ,$59.60 ,$52.40 ,$12.88 ,$42.16 ,$12.88 ,$50.48 ,$50.48 ,$50.48 ,$50.48 ,$72.00 ,$60.00 ,$12.88 ,$70.40 ,$12.88 ,$60.00 ,$60.00 ,$68.00 ,$68.00 ,$12.88 ,$68.00 ,$12.88 ,$63.20 ,$63.20 ,$63.20 ,$72.00 ,$32.20 ,$72.00 ,$12.88 ,$80.00 ,$52.40 ,$12.88 ,$34.72 , N/A ,$13.52 ,$72.00 ,$28.98 ,$50.48 ,$48.00 ,$72.00 ,$12.88 ,$72.00 ,$72.00 ,$12.88 ,$52.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200943,86774,HC TETANUS AB-90,302,1 ,$91.00 ,$59.15 ,$14.80 ,$91.00 ,$67.80 ,$59.61 ,$14.80 ,$47.96 ,$14.80 ,$57.42 ,$57.42 ,$57.42 ,$57.42 ,$81.90 ,$68.25 ,$14.80 ,$80.08 ,$14.80 ,$68.25 ,$68.25 ,$77.35 ,$77.35 ,$14.80 ,$77.35 ,$14.80 ,$71.89 ,$71.89 ,$71.89 ,$81.90 ,$37.00 ,$81.90 ,$14.80 ,$91.00 ,$59.61 ,$14.80 ,$39.49 , N/A ,$15.54 ,$81.90 ,$33.30 ,$57.42 ,$54.60 ,$81.90 ,$14.80 ,$81.90 ,$81.90 ,$14.80 ,$59.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200944,86777,HC TOXOPLASMA AB-90,302,1 ,$89.00 ,$57.85 ,$14.39 ,$89.00 ,$66.31 ,$58.30 ,$14.39 ,$46.90 ,$14.39 ,$56.16 ,$56.16 ,$56.16 ,$56.16 ,$80.10 ,$66.75 ,$14.39 ,$78.32 ,$14.39 ,$66.75 ,$66.75 ,$75.65 ,$75.65 ,$14.39 ,$75.65 ,$14.39 ,$70.31 ,$70.31 ,$70.31 ,$80.10 ,$35.98 ,$80.10 ,$14.39 ,$89.00 ,$58.30 ,$14.39 ,$38.63 , N/A ,$15.11 ,$80.10 ,$32.38 ,$56.16 ,$53.40 ,$80.10 ,$14.39 ,$80.10 ,$80.10 ,$14.39 ,$57.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200945,86778,HC TOXOPLASMA AB IGM-90,302,1 ,$89.00 ,$57.85 ,$14.41 ,$89.00 ,$66.31 ,$58.30 ,$14.41 ,$46.90 ,$14.41 ,$56.16 ,$56.16 ,$56.16 ,$56.16 ,$80.10 ,$66.75 ,$14.41 ,$78.32 ,$14.41 ,$66.75 ,$66.75 ,$75.65 ,$75.65 ,$14.41 ,$75.65 ,$14.41 ,$70.31 ,$70.31 ,$70.31 ,$80.10 ,$36.03 ,$80.10 ,$14.41 ,$89.00 ,$58.30 ,$14.41 ,$38.63 , N/A ,$15.13 ,$80.10 ,$32.42 ,$56.16 ,$53.40 ,$80.10 ,$14.41 ,$80.10 ,$80.10 ,$14.41 ,$57.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200946,86780,HC TREPONEMA P AB CONFIRM-90,302,1 ,$24.00 ,$15.60 ,$10.42 ,$29.79 ,$17.88 ,$15.72 ,$13.24 ,$12.65 ,$13.24 ,$15.14 ,$15.14 ,$15.14 ,$15.14 ,$21.60 ,$18.00 ,$13.24 ,$21.12 ,$13.24 ,$18.00 ,$18.00 ,$20.40 ,$20.40 ,$13.24 ,$20.40 ,$13.24 ,$18.96 ,$18.96 ,$18.96 ,$21.60 ,$24.00 ,$21.60 ,$13.24 ,$24.00 ,$15.72 ,$13.24 ,$10.42 , N/A ,$13.90 ,$21.60 ,$29.79 ,$15.14 ,$14.40 ,$21.60 ,$13.24 ,$21.60 ,$21.60 ,$13.24 ,$15.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200948,86787,HC VARICELLA ZOSTER AB-90,302,1 ,$80.00 ,$52.00 ,$12.88 ,$80.00 ,$59.60 ,$52.40 ,$12.88 ,$42.16 ,$12.88 ,$50.48 ,$50.48 ,$50.48 ,$50.48 ,$72.00 ,$60.00 ,$12.88 ,$70.40 ,$12.88 ,$60.00 ,$60.00 ,$68.00 ,$68.00 ,$12.88 ,$68.00 ,$12.88 ,$63.20 ,$63.20 ,$63.20 ,$72.00 ,$32.20 ,$72.00 ,$12.88 ,$80.00 ,$52.40 ,$12.88 ,$34.72 , N/A ,$13.52 ,$72.00 ,$28.98 ,$50.48 ,$48.00 ,$72.00 ,$12.88 ,$72.00 ,$72.00 ,$12.88 ,$52.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200949,86788,HC WEST NILE VIRUS AB IGM-90,302,1 ,$217.00 ,$141.05 ,$16.85 ,$217.00 ,$161.67 ,$142.14 ,$16.85 ,$114.36 ,$16.85 ,$136.93 ,$136.93 ,$136.93 ,$136.93 ,$195.30 ,$162.75 ,$16.85 ,$190.96 ,$16.85 ,$162.75 ,$162.75 ,$184.45 ,$184.45 ,$16.85 ,$184.45 ,$16.85 ,$171.43 ,$171.43 ,$171.43 ,$195.30 ,$42.13 ,$195.30 ,$16.85 ,$217.00 ,$142.14 ,$16.85 ,$94.18 , N/A ,$17.69 ,$195.30 ,$37.91 ,$136.93 ,$130.20 ,$195.30 ,$16.85 ,$195.30 ,$195.30 ,$16.85 ,$141.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200950,86789,HC WEST NILE AB-90,302,1 ,$217.00 ,$141.05 ,$14.39 ,$217.00 ,$161.67 ,$142.14 ,$14.39 ,$114.36 ,$14.39 ,$136.93 ,$136.93 ,$136.93 ,$136.93 ,$195.30 ,$162.75 ,$14.39 ,$190.96 ,$14.39 ,$162.75 ,$162.75 ,$184.45 ,$184.45 ,$14.39 ,$184.45 ,$14.39 ,$171.43 ,$171.43 ,$171.43 ,$195.30 ,$35.98 ,$195.30 ,$14.39 ,$217.00 ,$142.14 ,$14.39 ,$94.18 , N/A ,$15.11 ,$195.30 ,$32.38 ,$136.93 ,$130.20 ,$195.30 ,$14.39 ,$195.30 ,$195.30 ,$14.39 ,$141.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200951,86790,HC VIRUS AB NOT SPECIFIED-90,302,1 ,$85.32 ,$55.46 ,$12.88 ,$85.32 ,$63.56 ,$55.88 ,$12.88 ,$44.96 ,$12.88 ,$53.84 ,$53.84 ,$53.84 ,$53.84 ,$76.79 ,$63.99 ,$12.88 ,$75.08 ,$12.88 ,$63.99 ,$63.99 ,$72.52 ,$72.52 ,$12.88 ,$72.52 ,$12.88 ,$67.40 ,$67.40 ,$67.40 ,$76.79 ,$32.20 ,$76.79 ,$12.88 ,$85.32 ,$55.88 ,$12.88 ,$37.03 , N/A ,$13.52 ,$76.79 ,$28.98 ,$53.84 ,$51.19 ,$76.79 ,$12.88 ,$76.79 ,$76.79 ,$12.88 ,$55.46 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200953,86800,HC THYROGLOBULIN AB-90,302,1 ,$98.00 ,$63.70 ,$15.91 ,$98.00 ,$73.01 ,$64.19 ,$15.91 ,$51.65 ,$15.91 ,$61.84 ,$61.84 ,$61.84 ,$61.84 ,$88.20 ,$73.50 ,$15.91 ,$86.24 ,$15.91 ,$73.50 ,$73.50 ,$83.30 ,$83.30 ,$15.91 ,$83.30 ,$15.91 ,$77.42 ,$77.42 ,$77.42 ,$88.20 ,$39.78 ,$88.20 ,$15.91 ,$98.00 ,$64.19 ,$15.91 ,$42.53 , N/A ,$16.71 ,$88.20 ,$35.80 ,$61.84 ,$58.80 ,$88.20 ,$15.91 ,$88.20 ,$88.20 ,$15.91 ,$63.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200954,86803,HC HEP C AB-90,302,1 ,$10.00 ,$6.50 ,$4.34 ,$22.50 ,$7.45 ,$6.55 ,$10.00 ,$5.27 ,$10.00 ,$6.31 ,$6.31 ,$6.31 ,$6.31 ,$9.00 ,$7.50 ,$10.00 ,$8.80 ,$10.00 ,$7.50 ,$7.50 ,$8.50 ,$8.50 ,$10.00 ,$8.50 ,$10.00 ,$7.90 ,$7.90 ,$7.90 ,$9.00 ,$10.00 ,$9.00 ,$10.00 ,$10.00 ,$6.55 ,$10.00 ,$4.34 , N/A ,$10.00 ,$9.00 ,$22.50 ,$6.31 ,$6.00 ,$9.00 ,$10.00 ,$9.00 ,$9.00 ,$10.00 ,$6.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200955,86803,HC HEP C AB,302,1 ,$214.00 ,$139.10 ,$14.27 ,$214.00 ,$159.43 ,$140.17 ,$14.27 ,$112.78 ,$14.27 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$14.27 ,$188.32 ,$14.27 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$14.27 ,$181.90 ,$14.27 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$35.68 ,$192.60 ,$14.27 ,$214.00 ,$140.17 ,$14.27 ,$92.88 , N/A ,$14.98 ,$192.60 ,$32.11 ,$135.03 ,$128.40 ,$192.60 ,$14.27 ,$192.60 ,$192.60 ,$14.27 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200960,86812,HC HLA TYPING SINGLE A/B/C-90,302,1 ,$312.00 ,$202.80 ,$25.81 ,$312.00 ,$232.44 ,$204.36 ,$25.81 ,$164.42 ,$25.81 ,$196.87 ,$196.87 ,$196.87 ,$196.87 ,$280.80 ,$234.00 ,$25.81 ,$274.56 ,$25.81 ,$234.00 ,$234.00 ,$265.20 ,$265.20 ,$25.81 ,$265.20 ,$25.81 ,$246.48 ,$246.48 ,$246.48 ,$280.80 ,$64.53 ,$280.80 ,$25.81 ,$312.00 ,$204.36 ,$25.81 ,$135.41 , N/A ,$27.10 ,$280.80 ,$58.07 ,$196.87 ,$187.20 ,$280.80 ,$25.81 ,$280.80 ,$280.80 ,$25.81 ,$202.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200964,86850,HC AB SCREEN-90,302,1 ,$100.00 ,$65.00 ,$43.40 ,$106.27 ,$74.50 ,$65.50 ,$47.23 ,$52.70 ,$47.23 ,$63.10 ,$63.10 ,$63.10 ,$63.10 ,$90.00 ,$75.00 ,$47.23 ,$88.00 ,$47.23 ,$75.00 ,$75.00 ,$85.00 ,$85.00 ,$47.23 ,$85.00 ,$47.23 ,$79.00 ,$79.00 ,$79.00 ,$90.00 ,$100.00 ,$90.00 ,$47.23 ,$100.00 ,$65.50 ,$47.23 ,$43.40 , N/A ,$49.59 ,$90.00 ,$106.27 ,$63.10 ,$60.00 ,$90.00 ,$47.23 ,$90.00 ,$90.00 ,$47.23 ,$65.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200971,86860,HC ELUTION-90,302,1 ,$225.00 ,$146.25 ,$97.65 ,$318.55 ,$167.63 ,$147.38 ,$141.58 ,$118.58 ,$141.58 ,$141.98 ,$141.98 ,$141.98 ,$141.98 ,$202.50 ,$168.75 ,$141.58 ,$198.00 ,$141.58 ,$168.75 ,$168.75 ,$191.25 ,$191.25 ,$141.58 ,$191.25 ,$141.58 ,$177.75 ,$177.75 ,$177.75 ,$202.50 ,$225.00 ,$202.50 ,$141.58 ,$225.00 ,$147.38 ,$141.58 ,$97.65 , N/A ,$148.66 ,$202.50 ,$318.55 ,$141.98 ,$135.00 ,$202.50 ,$141.58 ,$202.50 ,$202.50 ,$141.58 ,$146.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200972,86870,HC RBC AB ID PANEL-90,302,1 ,$175.00 ,$113.75 ,$75.95 ,$622.03 ,$130.38 ,$114.63 ,$175.00 ,$92.23 ,$175.00 ,$110.43 ,$110.43 ,$110.43 ,$110.43 ,$157.50 ,$131.25 ,$175.00 ,$154.00 ,$175.00 ,$131.25 ,$131.25 ,$148.75 ,$148.75 ,$175.00 ,$148.75 ,$175.00 ,$138.25 ,$138.25 ,$138.25 ,$157.50 ,$175.00 ,$157.50 ,$175.00 ,$175.00 ,$114.63 ,$175.00 ,$75.95 , N/A ,$175.00 ,$157.50 ,$622.03 ,$110.43 ,$105.00 ,$157.50 ,$175.00 ,$157.50 ,$157.50 ,$175.00 ,$113.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200973,86870,HC RBC AB ID PANEL SERUM-90,302,1 ,$50.00 ,$32.50 ,$21.70 ,$622.03 ,$37.25 ,$32.75 ,$50.00 ,$26.35 ,$50.00 ,$31.55 ,$31.55 ,$31.55 ,$31.55 ,$45.00 ,$37.50 ,$50.00 ,$44.00 ,$50.00 ,$37.50 ,$37.50 ,$42.50 ,$42.50 ,$50.00 ,$42.50 ,$50.00 ,$39.50 ,$39.50 ,$39.50 ,$45.00 ,$50.00 ,$45.00 ,$50.00 ,$50.00 ,$32.75 ,$50.00 ,$21.70 , N/A ,$50.00 ,$45.00 ,$622.03 ,$31.55 ,$30.00 ,$45.00 ,$50.00 ,$45.00 ,$45.00 ,$50.00 ,$32.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200975,86880,HC COOMBS DIRECT-90,302,1 ,$75.00 ,$48.75 ,$32.55 ,$118.87 ,$55.88 ,$49.13 ,$52.83 ,$39.53 ,$52.83 ,$47.33 ,$47.33 ,$47.33 ,$47.33 ,$67.50 ,$56.25 ,$52.83 ,$66.00 ,$52.83 ,$56.25 ,$56.25 ,$63.75 ,$63.75 ,$52.83 ,$63.75 ,$52.83 ,$59.25 ,$59.25 ,$59.25 ,$67.50 ,$75.00 ,$67.50 ,$52.83 ,$75.00 ,$49.13 ,$52.83 ,$32.55 , N/A ,$55.47 ,$67.50 ,$118.87 ,$47.33 ,$45.00 ,$67.50 ,$52.83 ,$67.50 ,$67.50 ,$52.83 ,$48.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200980,86900,HC BLOOD TYPING ABO-90,302,1 ,$38.00 ,$24.70 ,$16.49 ,$239.09 ,$28.31 ,$24.89 ,$38.00 ,$20.03 ,$38.00 ,$23.98 ,$23.98 ,$23.98 ,$23.98 ,$34.20 ,$28.50 ,$38.00 ,$33.44 ,$38.00 ,$28.50 ,$28.50 ,$32.30 ,$32.30 ,$38.00 ,$32.30 ,$38.00 ,$30.02 ,$30.02 ,$30.02 ,$34.20 ,$38.00 ,$34.20 ,$38.00 ,$38.00 ,$24.89 ,$38.00 ,$16.49 , N/A ,$38.00 ,$34.20 ,$239.09 ,$23.98 ,$22.80 ,$34.20 ,$38.00 ,$34.20 ,$34.20 ,$38.00 ,$24.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200982,86901,HC BLOOD TYPING RH-90,302,1 ,$38.00 ,$24.70 ,$16.49 ,$72.27 ,$28.31 ,$24.89 ,$32.12 ,$20.03 ,$32.12 ,$23.98 ,$23.98 ,$23.98 ,$23.98 ,$34.20 ,$28.50 ,$32.12 ,$33.44 ,$32.12 ,$28.50 ,$28.50 ,$32.30 ,$32.30 ,$32.12 ,$32.30 ,$32.12 ,$30.02 ,$30.02 ,$30.02 ,$34.20 ,$38.00 ,$34.20 ,$32.12 ,$38.00 ,$24.89 ,$32.12 ,$16.49 , N/A ,$33.73 ,$34.20 ,$72.27 ,$23.98 ,$22.80 ,$34.20 ,$32.12 ,$34.20 ,$34.20 ,$32.12 ,$24.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200984,86902,HC RBC AG SCR RGT SERUM T1-90,302,1 ,$100.00 ,$65.00 ,$43.40 ,$622.03 ,$74.50 ,$65.50 ,$100.00 ,$52.70 ,$100.00 ,$63.10 ,$63.10 ,$63.10 ,$63.10 ,$90.00 ,$75.00 ,$100.00 ,$88.00 ,$100.00 ,$75.00 ,$75.00 ,$85.00 ,$85.00 ,$100.00 ,$85.00 ,$100.00 ,$79.00 ,$79.00 ,$79.00 ,$90.00 ,$100.00 ,$90.00 ,$100.00 ,$100.00 ,$65.50 ,$100.00 ,$43.40 , N/A ,$100.00 ,$90.00 ,$622.03 ,$63.10 ,$60.00 ,$90.00 ,$100.00 ,$90.00 ,$90.00 ,$100.00 ,$65.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200985,86902,HC RBC AG SCR RGT SERUM T2-90,302,1 ,$175.00 ,$113.75 ,$75.95 ,$622.03 ,$130.38 ,$114.63 ,$175.00 ,$92.23 ,$175.00 ,$110.43 ,$110.43 ,$110.43 ,$110.43 ,$157.50 ,$131.25 ,$175.00 ,$154.00 ,$175.00 ,$131.25 ,$131.25 ,$148.75 ,$148.75 ,$175.00 ,$148.75 ,$175.00 ,$138.25 ,$138.25 ,$138.25 ,$157.50 ,$175.00 ,$157.50 ,$175.00 ,$175.00 ,$114.63 ,$175.00 ,$75.95 , N/A ,$175.00 ,$157.50 ,$622.03 ,$110.43 ,$105.00 ,$157.50 ,$175.00 ,$157.50 ,$157.50 ,$175.00 ,$113.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200986,86902,HC RBC AG SCR RGT SERUM T3-90,302,1 ,$225.00 ,$146.25 ,$97.65 ,$622.03 ,$167.63 ,$147.38 ,$225.00 ,$118.58 ,$225.00 ,$141.98 ,$141.98 ,$141.98 ,$141.98 ,$202.50 ,$168.75 ,$225.00 ,$198.00 ,$225.00 ,$168.75 ,$168.75 ,$191.25 ,$191.25 ,$225.00 ,$191.25 ,$225.00 ,$177.75 ,$177.75 ,$177.75 ,$202.50 ,$225.00 ,$202.50 ,$225.00 ,$225.00 ,$147.38 ,$225.00 ,$97.65 , N/A ,$225.00 ,$202.50 ,$622.03 ,$141.98 ,$135.00 ,$202.50 ,$225.00 ,$202.50 ,$202.50 ,$225.00 ,$146.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200987,86902,HC RBC AG SCR RGT SERUM T4-90,302,1 ,$275.00 ,$178.75 ,$119.35 ,$622.03 ,$204.88 ,$180.13 ,$275.00 ,$144.93 ,$275.00 ,$173.53 ,$173.53 ,$173.53 ,$173.53 ,$247.50 ,$206.25 ,$275.00 ,$242.00 ,$275.00 ,$206.25 ,$206.25 ,$233.75 ,$233.75 ,$275.00 ,$233.75 ,$275.00 ,$217.25 ,$217.25 ,$217.25 ,$247.50 ,$275.00 ,$247.50 ,$275.00 ,$275.00 ,$180.13 ,$275.00 ,$119.35 , N/A ,$275.00 ,$247.50 ,$622.03 ,$173.53 ,$165.00 ,$247.50 ,$275.00 ,$247.50 ,$247.50 ,$275.00 ,$178.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200988,86902,HC RBC AG SCR RGT SERUM ANTISERA-90,302,1 ,$375.00 ,$243.75 ,$162.75 ,$622.03 ,$279.38 ,$245.63 ,$276.46 ,$197.63 ,$276.46 ,$236.63 ,$236.63 ,$236.63 ,$236.63 ,$337.50 ,$281.25 ,$276.46 ,$330.00 ,$276.46 ,$281.25 ,$281.25 ,$318.75 ,$318.75 ,$276.46 ,$318.75 ,$276.46 ,$296.25 ,$296.25 ,$296.25 ,$337.50 ,$375.00 ,$337.50 ,$276.46 ,$375.00 ,$245.63 ,$276.46 ,$162.75 , N/A ,$290.28 ,$337.50 ,$622.03 ,$236.63 ,$225.00 ,$337.50 ,$276.46 ,$337.50 ,$337.50 ,$276.46 ,$243.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200992,86905,HC RBC AG TYPING NON ABO/RH T1-90,302,1 ,$100.00 ,$65.00 ,$43.40 ,$622.03 ,$74.50 ,$65.50 ,$100.00 ,$52.70 ,$100.00 ,$63.10 ,$63.10 ,$63.10 ,$63.10 ,$90.00 ,$75.00 ,$100.00 ,$88.00 ,$100.00 ,$75.00 ,$75.00 ,$85.00 ,$85.00 ,$100.00 ,$85.00 ,$100.00 ,$79.00 ,$79.00 ,$79.00 ,$90.00 ,$100.00 ,$90.00 ,$100.00 ,$100.00 ,$65.50 ,$100.00 ,$43.40 , N/A ,$100.00 ,$90.00 ,$622.03 ,$63.10 ,$60.00 ,$90.00 ,$100.00 ,$90.00 ,$90.00 ,$100.00 ,$65.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200993,86905,HC RBC AG TYPING NON ABO/RH T2-90,302,1 ,$175.00 ,$113.75 ,$75.95 ,$622.03 ,$130.38 ,$114.63 ,$175.00 ,$92.23 ,$175.00 ,$110.43 ,$110.43 ,$110.43 ,$110.43 ,$157.50 ,$131.25 ,$175.00 ,$154.00 ,$175.00 ,$131.25 ,$131.25 ,$148.75 ,$148.75 ,$175.00 ,$148.75 ,$175.00 ,$138.25 ,$138.25 ,$138.25 ,$157.50 ,$175.00 ,$157.50 ,$175.00 ,$175.00 ,$114.63 ,$175.00 ,$75.95 , N/A ,$175.00 ,$157.50 ,$622.03 ,$110.43 ,$105.00 ,$157.50 ,$175.00 ,$157.50 ,$157.50 ,$175.00 ,$113.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200994,86905,HC RBC AG TYPING NON ABO/RH T3-90,302,1 ,$225.00 ,$146.25 ,$97.65 ,$622.03 ,$167.63 ,$147.38 ,$225.00 ,$118.58 ,$225.00 ,$141.98 ,$141.98 ,$141.98 ,$141.98 ,$202.50 ,$168.75 ,$225.00 ,$198.00 ,$225.00 ,$168.75 ,$168.75 ,$191.25 ,$191.25 ,$225.00 ,$191.25 ,$225.00 ,$177.75 ,$177.75 ,$177.75 ,$202.50 ,$225.00 ,$202.50 ,$225.00 ,$225.00 ,$147.38 ,$225.00 ,$97.65 , N/A ,$225.00 ,$202.50 ,$622.03 ,$141.98 ,$135.00 ,$202.50 ,$225.00 ,$202.50 ,$202.50 ,$225.00 ,$146.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200995,86905,HC RBC AG TYPING NON ABO/RH T4-90,302,1 ,$275.00 ,$178.75 ,$119.35 ,$622.03 ,$204.88 ,$180.13 ,$275.00 ,$144.93 ,$275.00 ,$173.53 ,$173.53 ,$173.53 ,$173.53 ,$247.50 ,$206.25 ,$275.00 ,$242.00 ,$275.00 ,$206.25 ,$206.25 ,$233.75 ,$233.75 ,$275.00 ,$233.75 ,$275.00 ,$217.25 ,$217.25 ,$217.25 ,$247.50 ,$275.00 ,$247.50 ,$275.00 ,$275.00 ,$180.13 ,$275.00 ,$119.35 , N/A ,$275.00 ,$247.50 ,$622.03 ,$173.53 ,$165.00 ,$247.50 ,$275.00 ,$247.50 ,$247.50 ,$275.00 ,$178.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30200996,86905,HC RBC AG TYP NABO/RH ANTISERA-90,302,1 ,$375.00 ,$243.75 ,$162.75 ,$622.03 ,$279.38 ,$245.63 ,$276.46 ,$197.63 ,$276.46 ,$236.63 ,$236.63 ,$236.63 ,$236.63 ,$337.50 ,$281.25 ,$276.46 ,$330.00 ,$276.46 ,$281.25 ,$281.25 ,$318.75 ,$318.75 ,$276.46 ,$318.75 ,$276.46 ,$296.25 ,$296.25 ,$296.25 ,$337.50 ,$375.00 ,$337.50 ,$276.46 ,$375.00 ,$245.63 ,$276.46 ,$162.75 , N/A ,$290.28 ,$337.50 ,$622.03 ,$236.63 ,$225.00 ,$337.50 ,$276.46 ,$337.50 ,$337.50 ,$276.46 ,$243.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201002,86970,HC RBC PRETREAT CHEM-90,302,1 ,$138.00 ,$89.70 ,$32.12 ,$138.00 ,$102.81 ,$90.39 ,$32.12 ,$72.73 ,$32.12 ,$87.08 ,$87.08 ,$87.08 ,$87.08 ,$124.20 ,$103.50 ,$32.12 ,$121.44 ,$32.12 ,$103.50 ,$103.50 ,$117.30 ,$117.30 ,$32.12 ,$117.30 ,$32.12 ,$109.02 ,$109.02 ,$109.02 ,$124.20 ,$80.30 ,$124.20 ,$32.12 ,$138.00 ,$90.39 ,$32.12 ,$59.89 , N/A ,$33.73 ,$124.20 ,$72.27 ,$87.08 ,$82.80 ,$124.20 ,$32.12 ,$124.20 ,$124.20 ,$32.12 ,$89.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201004,86971,HC RBC PRETREAT ENZYME-90,302,1 ,$50.00 ,$32.50 ,$21.70 ,$622.03 ,$37.25 ,$32.75 ,$50.00 ,$26.35 ,$50.00 ,$31.55 ,$31.55 ,$31.55 ,$31.55 ,$45.00 ,$37.50 ,$50.00 ,$44.00 ,$50.00 ,$37.50 ,$37.50 ,$42.50 ,$42.50 ,$50.00 ,$42.50 ,$50.00 ,$39.50 ,$39.50 ,$39.50 ,$45.00 ,$50.00 ,$45.00 ,$50.00 ,$50.00 ,$32.75 ,$50.00 ,$21.70 , N/A ,$50.00 ,$45.00 ,$622.03 ,$31.55 ,$30.00 ,$45.00 ,$50.00 ,$45.00 ,$45.00 ,$50.00 ,$32.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201006,86972,HC RBC PRETREAT DENSITY SEP-90,302,1 ,$113.00 ,$73.45 ,$49.04 ,$318.55 ,$84.19 ,$74.02 ,$113.00 ,$59.55 ,$113.00 ,$71.30 ,$71.30 ,$71.30 ,$71.30 ,$101.70 ,$84.75 ,$113.00 ,$99.44 ,$113.00 ,$84.75 ,$84.75 ,$96.05 ,$96.05 ,$113.00 ,$96.05 ,$113.00 ,$89.27 ,$89.27 ,$89.27 ,$101.70 ,$113.00 ,$101.70 ,$113.00 ,$113.00 ,$74.02 ,$113.00 ,$49.04 , N/A ,$113.00 ,$101.70 ,$318.55 ,$71.30 ,$67.80 ,$101.70 ,$113.00 ,$101.70 ,$101.70 ,$113.00 ,$73.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201018,86978,HC RBC PRETREAT ABSOR AUTO,302,1 ,$138.00 ,$89.70 ,$32.12 ,$138.00 ,$102.81 ,$90.39 ,$32.12 ,$72.73 ,$32.12 ,$87.08 ,$87.08 ,$87.08 ,$87.08 ,$124.20 ,$103.50 ,$32.12 ,$121.44 ,$32.12 ,$103.50 ,$103.50 ,$117.30 ,$117.30 ,$32.12 ,$117.30 ,$32.12 ,$109.02 ,$109.02 ,$109.02 ,$124.20 ,$80.30 ,$124.20 ,$32.12 ,$138.00 ,$90.39 ,$32.12 ,$59.89 , N/A ,$33.73 ,$124.20 ,$72.27 ,$87.08 ,$82.80 ,$124.20 ,$32.12 ,$124.20 ,$124.20 ,$32.12 ,$89.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201021,86999,HC ANTIGEN HISTORICL NEG EA UN-90,302,1 ,$63.00 ,$40.95 ,$23.42 ,$63.00 ,$46.94 ,$41.27 ,$23.42 ,$33.20 ,$23.42 ,$39.75 ,$39.75 ,$39.75 ,$39.75 ,$56.70 ,$47.25 ,$23.42 ,$55.44 ,$23.42 ,$47.25 ,$47.25 ,$53.55 ,$53.55 ,$23.42 ,$53.55 ,$23.42 ,$49.77 ,$49.77 ,$49.77 ,$56.70 ,$58.54 ,$56.70 ,$23.42 ,$63.00 ,$41.27 ,$23.42 ,$27.34 , N/A ,$24.59 ,$56.70 ,$52.69 ,$39.75 ,$37.80 ,$56.70 ,$23.42 ,$56.70 ,$56.70 ,$23.42 ,$40.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201022,87801,HC INFECT MLT ORG AMP-90,302,1 ,$450.00 ,$292.50 ,$70.20 ,$450.00 ,$335.25 ,$294.75 ,$70.20 ,$237.15 ,$70.20 ,$283.95 ,$283.95 ,$283.95 ,$283.95 ,$405.00 ,$337.50 ,$70.20 ,$396.00 ,$70.20 ,$337.50 ,$337.50 ,$382.50 ,$382.50 ,$70.20 ,$382.50 ,$70.20 ,$355.50 ,$355.50 ,$355.50 ,$405.00 ,$175.50 ,$405.00 ,$70.20 ,$450.00 ,$294.75 ,$70.20 ,$195.30 , N/A ,$73.71 ,$405.00 ,$157.95 ,$283.95 ,$270.00 ,$405.00 ,$70.20 ,$405.00 ,$405.00 ,$70.20 ,$292.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201025,86316,HC TUMOR AG OTHER AG QN-90,302,1 ,$129.00 ,$83.85 ,$20.81 ,$129.00 ,$96.11 ,$84.50 ,$20.81 ,$67.98 ,$20.81 ,$81.40 ,$81.40 ,$81.40 ,$81.40 ,$116.10 ,$96.75 ,$20.81 ,$113.52 ,$20.81 ,$96.75 ,$96.75 ,$109.65 ,$109.65 ,$20.81 ,$109.65 ,$20.81 ,$101.91 ,$101.91 ,$101.91 ,$116.10 ,$52.03 ,$116.10 ,$20.81 ,$129.00 ,$84.50 ,$20.81 ,$55.99 , N/A ,$21.85 ,$116.10 ,$46.82 ,$81.40 ,$77.40 ,$116.10 ,$20.81 ,$116.10 ,$116.10 ,$20.81 ,$83.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201026,86317,HC INFECTIOUS AB QN-90,302,1 ,$17.85 ,$11.60 ,$7.75 ,$33.73 ,$13.30 ,$11.69 ,$14.99 ,$9.41 ,$14.99 ,$11.26 ,$11.26 ,$11.26 ,$11.26 ,$16.07 ,$13.39 ,$14.99 ,$15.71 ,$14.99 ,$13.39 ,$13.39 ,$15.17 ,$15.17 ,$14.99 ,$15.17 ,$14.99 ,$14.10 ,$14.10 ,$14.10 ,$16.07 ,$17.85 ,$16.07 ,$14.99 ,$17.85 ,$11.69 ,$14.99 ,$7.75 , N/A ,$15.74 ,$16.07 ,$33.73 ,$11.26 ,$10.71 ,$16.07 ,$14.99 ,$16.07 ,$16.07 ,$14.99 ,$11.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201028,86329,HC IMMUNODIFFUSION NOS-90,302,1 ,$100.00 ,$65.00 ,$14.05 ,$100.00 ,$74.50 ,$65.50 ,$14.05 ,$52.70 ,$14.05 ,$63.10 ,$63.10 ,$63.10 ,$63.10 ,$90.00 ,$75.00 ,$14.05 ,$88.00 ,$14.05 ,$75.00 ,$75.00 ,$85.00 ,$85.00 ,$14.05 ,$85.00 ,$14.05 ,$79.00 ,$79.00 ,$79.00 ,$90.00 ,$35.13 ,$90.00 ,$14.05 ,$100.00 ,$65.50 ,$14.05 ,$43.40 , N/A ,$14.75 ,$90.00 ,$31.61 ,$63.10 ,$60.00 ,$90.00 ,$14.05 ,$90.00 ,$90.00 ,$14.05 ,$65.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201031,86334,HC IMMUNOFIX ELECTRO SERUM -90,302,1 ,$215.00 ,$139.75 ,$22.34 ,$215.00 ,$160.18 ,$140.83 ,$22.34 ,$113.31 ,$22.34 ,$135.67 ,$135.67 ,$135.67 ,$135.67 ,$193.50 ,$161.25 ,$22.34 ,$189.20 ,$22.34 ,$161.25 ,$161.25 ,$182.75 ,$182.75 ,$22.34 ,$182.75 ,$22.34 ,$169.85 ,$169.85 ,$169.85 ,$193.50 ,$55.85 ,$193.50 ,$22.34 ,$215.00 ,$140.83 ,$22.34 ,$93.31 , N/A ,$23.46 ,$193.50 ,$50.27 ,$135.67 ,$129.00 ,$193.50 ,$22.34 ,$193.50 ,$193.50 ,$22.34 ,$139.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201032,86335,HC IMMUNOFIX ELECTRO OTH-90,302,1 ,$197.00 ,$128.05 ,$29.35 ,$197.00 ,$146.77 ,$129.04 ,$29.35 ,$103.82 ,$29.35 ,$124.31 ,$124.31 ,$124.31 ,$124.31 ,$177.30 ,$147.75 ,$29.35 ,$173.36 ,$29.35 ,$147.75 ,$147.75 ,$167.45 ,$167.45 ,$29.35 ,$167.45 ,$29.35 ,$155.63 ,$155.63 ,$155.63 ,$177.30 ,$73.38 ,$177.30 ,$29.35 ,$197.00 ,$129.04 ,$29.35 ,$85.50 , N/A ,$30.82 ,$177.30 ,$66.04 ,$124.31 ,$118.20 ,$177.30 ,$29.35 ,$177.30 ,$177.30 ,$29.35 ,$128.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201033,86336,HC INHIBIN A-90,302,1 ,$116.00 ,$75.40 ,$15.59 ,$116.00 ,$86.42 ,$75.98 ,$15.59 ,$61.13 ,$15.59 ,$73.20 ,$73.20 ,$73.20 ,$73.20 ,$104.40 ,$87.00 ,$15.59 ,$102.08 ,$15.59 ,$87.00 ,$87.00 ,$98.60 ,$98.60 ,$15.59 ,$98.60 ,$15.59 ,$91.64 ,$91.64 ,$91.64 ,$104.40 ,$38.98 ,$104.40 ,$15.59 ,$116.00 ,$75.98 ,$15.59 ,$50.34 , N/A ,$16.37 ,$104.40 ,$35.08 ,$73.20 ,$69.60 ,$104.40 ,$15.59 ,$104.40 ,$104.40 ,$15.59 ,$75.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201034,86337,HC INSULIN AB-90,302,1 ,$207.00 ,$134.55 ,$21.41 ,$207.00 ,$154.22 ,$135.59 ,$21.41 ,$109.09 ,$21.41 ,$130.62 ,$130.62 ,$130.62 ,$130.62 ,$186.30 ,$155.25 ,$21.41 ,$182.16 ,$21.41 ,$155.25 ,$155.25 ,$175.95 ,$175.95 ,$21.41 ,$175.95 ,$21.41 ,$163.53 ,$163.53 ,$163.53 ,$186.30 ,$53.53 ,$186.30 ,$21.41 ,$207.00 ,$135.59 ,$21.41 ,$89.84 , N/A ,$22.48 ,$186.30 ,$48.17 ,$130.62 ,$124.20 ,$186.30 ,$21.41 ,$186.30 ,$186.30 ,$21.41 ,$134.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201035,86340,HC INTRINSIC FACTOR AB-90,302,1 ,$93.00 ,$60.45 ,$15.08 ,$93.00 ,$69.29 ,$60.92 ,$15.08 ,$49.01 ,$15.08 ,$58.68 ,$58.68 ,$58.68 ,$58.68 ,$83.70 ,$69.75 ,$15.08 ,$81.84 ,$15.08 ,$69.75 ,$69.75 ,$79.05 ,$79.05 ,$15.08 ,$79.05 ,$15.08 ,$73.47 ,$73.47 ,$73.47 ,$83.70 ,$37.70 ,$83.70 ,$15.08 ,$93.00 ,$60.92 ,$15.08 ,$40.36 , N/A ,$15.83 ,$83.70 ,$33.93 ,$58.68 ,$55.80 ,$83.70 ,$15.08 ,$83.70 ,$83.70 ,$15.08 ,$60.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201036,86341,HC ISLET CELL AB-90,302,1 ,$122.00 ,$79.30 ,$23.57 ,$122.00 ,$90.89 ,$79.91 ,$23.57 ,$64.29 ,$23.57 ,$76.98 ,$76.98 ,$76.98 ,$76.98 ,$109.80 ,$91.50 ,$23.57 ,$107.36 ,$23.57 ,$91.50 ,$91.50 ,$103.70 ,$103.70 ,$23.57 ,$103.70 ,$23.57 ,$96.38 ,$96.38 ,$96.38 ,$109.80 ,$58.93 ,$109.80 ,$23.57 ,$122.00 ,$79.91 ,$23.57 ,$52.95 , N/A ,$24.75 ,$109.80 ,$53.03 ,$76.98 ,$73.20 ,$109.80 ,$23.57 ,$109.80 ,$109.80 ,$23.57 ,$79.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201040,86355,HC B CELLS TOTAL COUNT-90,302,1 ,$145.00 ,$94.25 ,$37.73 ,$145.00 ,$108.03 ,$94.98 ,$37.73 ,$76.42 ,$37.73 ,$91.50 ,$91.50 ,$91.50 ,$91.50 ,$130.50 ,$108.75 ,$37.73 ,$127.60 ,$37.73 ,$108.75 ,$108.75 ,$123.25 ,$123.25 ,$37.73 ,$123.25 ,$37.73 ,$114.55 ,$114.55 ,$114.55 ,$130.50 ,$94.33 ,$130.50 ,$37.73 ,$145.00 ,$94.98 ,$37.73 ,$62.93 , N/A ,$39.62 ,$130.50 ,$84.89 ,$91.50 ,$87.00 ,$130.50 ,$37.73 ,$130.50 ,$130.50 ,$37.73 ,$94.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201041,86356,HC MOL ANTIGEN QN EA-90,302,1 ,$270.00 ,$175.50 ,$26.78 ,$270.00 ,$201.15 ,$176.85 ,$26.78 ,$142.29 ,$26.78 ,$170.37 ,$170.37 ,$170.37 ,$170.37 ,$243.00 ,$202.50 ,$26.78 ,$237.60 ,$26.78 ,$202.50 ,$202.50 ,$229.50 ,$229.50 ,$26.78 ,$229.50 ,$26.78 ,$213.30 ,$213.30 ,$213.30 ,$243.00 ,$66.95 ,$243.00 ,$26.78 ,$270.00 ,$176.85 ,$26.78 ,$117.18 , N/A ,$28.12 ,$243.00 ,$60.26 ,$170.37 ,$162.00 ,$243.00 ,$26.78 ,$243.00 ,$243.00 ,$26.78 ,$175.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201043,86359,HC T CELLS TOTAL COUNT-90,302,1 ,$145.00 ,$94.25 ,$37.73 ,$145.00 ,$108.03 ,$94.98 ,$37.73 ,$76.42 ,$37.73 ,$91.50 ,$91.50 ,$91.50 ,$91.50 ,$130.50 ,$108.75 ,$37.73 ,$127.60 ,$37.73 ,$108.75 ,$108.75 ,$123.25 ,$123.25 ,$37.73 ,$123.25 ,$37.73 ,$114.55 ,$114.55 ,$114.55 ,$130.50 ,$94.33 ,$130.50 ,$37.73 ,$145.00 ,$94.98 ,$37.73 ,$62.93 , N/A ,$39.62 ,$130.50 ,$84.89 ,$91.50 ,$87.00 ,$130.50 ,$37.73 ,$130.50 ,$130.50 ,$37.73 ,$94.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201045,86360,HC ABS T CELLS CD4 CD8 RATIO-90,302,1 ,$200.00 ,$130.00 ,$46.98 ,$200.00 ,$149.00 ,$131.00 ,$46.98 ,$105.40 ,$46.98 ,$126.20 ,$126.20 ,$126.20 ,$126.20 ,$180.00 ,$150.00 ,$46.98 ,$176.00 ,$46.98 ,$150.00 ,$150.00 ,$170.00 ,$170.00 ,$46.98 ,$170.00 ,$46.98 ,$158.00 ,$158.00 ,$158.00 ,$180.00 ,$117.45 ,$180.00 ,$46.98 ,$200.00 ,$131.00 ,$46.98 ,$86.80 , N/A ,$49.33 ,$180.00 ,$105.71 ,$126.20 ,$120.00 ,$180.00 ,$46.98 ,$180.00 ,$180.00 ,$46.98 ,$130.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201046,86361,HC T CELLS CD4 COUNT-90,302,1 ,$31.00 ,$20.15 ,$13.45 ,$60.26 ,$23.10 ,$20.31 ,$26.78 ,$16.34 ,$26.78 ,$19.56 ,$19.56 ,$19.56 ,$19.56 ,$27.90 ,$23.25 ,$26.78 ,$27.28 ,$26.78 ,$23.25 ,$23.25 ,$26.35 ,$26.35 ,$26.78 ,$26.35 ,$26.78 ,$24.49 ,$24.49 ,$24.49 ,$27.90 ,$31.00 ,$27.90 ,$26.78 ,$31.00 ,$20.31 ,$26.78 ,$13.45 , N/A ,$28.12 ,$27.90 ,$60.26 ,$19.56 ,$18.60 ,$27.90 ,$26.78 ,$27.90 ,$27.90 ,$26.78 ,$20.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201047,86376,HC MICROSOMAL AB-90,302,1 ,$90.00 ,$58.50 ,$14.55 ,$90.00 ,$67.05 ,$58.95 ,$14.55 ,$47.43 ,$14.55 ,$56.79 ,$56.79 ,$56.79 ,$56.79 ,$81.00 ,$67.50 ,$14.55 ,$79.20 ,$14.55 ,$67.50 ,$67.50 ,$76.50 ,$76.50 ,$14.55 ,$76.50 ,$14.55 ,$71.10 ,$71.10 ,$71.10 ,$81.00 ,$36.38 ,$81.00 ,$14.55 ,$90.00 ,$58.95 ,$14.55 ,$39.06 , N/A ,$15.28 ,$81.00 ,$32.74 ,$56.79 ,$54.00 ,$81.00 ,$14.55 ,$81.00 ,$81.00 ,$14.55 ,$58.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201049,86403,HC PARTICLE AGG SCREEN-90,302,1 ,$22.00 ,$14.30 ,$9.55 ,$25.97 ,$16.39 ,$14.41 ,$11.54 ,$11.59 ,$11.54 ,$13.88 ,$13.88 ,$13.88 ,$13.88 ,$19.80 ,$16.50 ,$11.54 ,$19.36 ,$11.54 ,$16.50 ,$16.50 ,$18.70 ,$18.70 ,$11.54 ,$18.70 ,$11.54 ,$17.38 ,$17.38 ,$17.38 ,$19.80 ,$22.00 ,$19.80 ,$11.54 ,$22.00 ,$14.41 ,$11.54 ,$9.55 , N/A ,$12.12 ,$19.80 ,$25.97 ,$13.88 ,$13.20 ,$19.80 ,$11.54 ,$19.80 ,$19.80 ,$11.54 ,$14.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201052,86431,HC RHEUMATOID FACTOR QN-90,302,1 ,$188.00 ,$122.20 ,$5.67 ,$188.00 ,$140.06 ,$123.14 ,$5.67 ,$99.08 ,$5.67 ,$118.63 ,$118.63 ,$118.63 ,$118.63 ,$169.20 ,$141.00 ,$5.67 ,$165.44 ,$5.67 ,$141.00 ,$141.00 ,$159.80 ,$159.80 ,$5.67 ,$159.80 ,$5.67 ,$148.52 ,$148.52 ,$148.52 ,$169.20 ,$14.18 ,$169.20 ,$5.67 ,$188.00 ,$123.14 ,$5.67 ,$81.59 , N/A ,$5.95 ,$169.20 ,$12.76 ,$118.63 ,$112.80 ,$169.20 ,$5.67 ,$169.20 ,$169.20 ,$5.67 ,$122.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201053,86480,HC TB QUANTIFERON GOLD-90,302,1 ,$68.00 ,$44.20 ,$29.51 ,$139.46 ,$50.66 ,$44.54 ,$61.98 ,$35.84 ,$61.98 ,$42.91 ,$42.91 ,$42.91 ,$42.91 ,$61.20 ,$51.00 ,$61.98 ,$59.84 ,$61.98 ,$51.00 ,$51.00 ,$57.80 ,$57.80 ,$61.98 ,$57.80 ,$61.98 ,$53.72 ,$53.72 ,$53.72 ,$61.20 ,$68.00 ,$61.20 ,$61.98 ,$68.00 ,$44.54 ,$61.98 ,$29.51 , N/A ,$65.08 ,$61.20 ,$139.46 ,$42.91 ,$40.80 ,$61.20 ,$61.98 ,$61.20 ,$61.20 ,$61.98 ,$44.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201054,86592,HC SYPHILIS VDRL RPR QL-90,302,1 ,$118.00 ,$76.70 ,$4.27 ,$118.00 ,$87.91 ,$77.29 ,$4.27 ,$62.19 ,$4.27 ,$74.46 ,$74.46 ,$74.46 ,$74.46 ,$106.20 ,$88.50 ,$4.27 ,$103.84 ,$4.27 ,$88.50 ,$88.50 ,$100.30 ,$100.30 ,$4.27 ,$100.30 ,$4.27 ,$93.22 ,$93.22 ,$93.22 ,$106.20 ,$10.68 ,$106.20 ,$4.27 ,$118.00 ,$77.29 ,$4.27 ,$51.21 , N/A ,$4.48 ,$106.20 ,$9.61 ,$74.46 ,$70.80 ,$106.20 ,$4.27 ,$106.20 ,$106.20 ,$4.27 ,$76.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201055,86603,HC ADENOVIRUS AB-90,302,1 ,$79.00 ,$51.35 ,$12.87 ,$79.00 ,$58.86 ,$51.75 ,$12.87 ,$41.63 ,$12.87 ,$49.85 ,$49.85 ,$49.85 ,$49.85 ,$71.10 ,$59.25 ,$12.87 ,$69.52 ,$12.87 ,$59.25 ,$59.25 ,$67.15 ,$67.15 ,$12.87 ,$67.15 ,$12.87 ,$62.41 ,$62.41 ,$62.41 ,$71.10 ,$32.18 ,$71.10 ,$12.87 ,$79.00 ,$51.75 ,$12.87 ,$34.29 , N/A ,$13.51 ,$71.10 ,$28.96 ,$49.85 ,$47.40 ,$71.10 ,$12.87 ,$71.10 ,$71.10 ,$12.87 ,$51.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201056,86606,HC ASPERGILLUS AB-90,302,1 ,$182.00 ,$118.30 ,$15.05 ,$182.00 ,$135.59 ,$119.21 ,$15.05 ,$95.91 ,$15.05 ,$114.84 ,$114.84 ,$114.84 ,$114.84 ,$163.80 ,$136.50 ,$15.05 ,$160.16 ,$15.05 ,$136.50 ,$136.50 ,$154.70 ,$154.70 ,$15.05 ,$154.70 ,$15.05 ,$143.78 ,$143.78 ,$143.78 ,$163.80 ,$37.63 ,$163.80 ,$15.05 ,$182.00 ,$119.21 ,$15.05 ,$78.99 , N/A ,$15.80 ,$163.80 ,$33.86 ,$114.84 ,$109.20 ,$163.80 ,$15.05 ,$163.80 ,$163.80 ,$15.05 ,$118.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201058,86611,HC BARTONELLA SCREEN AB-90,302,1 ,$72.00 ,$46.80 ,$10.18 ,$72.00 ,$53.64 ,$47.16 ,$10.18 ,$37.94 ,$10.18 ,$45.43 ,$45.43 ,$45.43 ,$45.43 ,$64.80 ,$54.00 ,$10.18 ,$63.36 ,$10.18 ,$54.00 ,$54.00 ,$61.20 ,$61.20 ,$10.18 ,$61.20 ,$10.18 ,$56.88 ,$56.88 ,$56.88 ,$64.80 ,$25.45 ,$64.80 ,$10.18 ,$72.00 ,$47.16 ,$10.18 ,$31.25 , N/A ,$10.69 ,$64.80 ,$22.91 ,$45.43 ,$43.20 ,$64.80 ,$10.18 ,$64.80 ,$64.80 ,$10.18 ,$46.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201060,86612,HC BLASTOMYCES AB-90,302,1 ,$71.30 ,$46.35 ,$12.90 ,$71.30 ,$53.12 ,$46.70 ,$12.90 ,$37.58 ,$12.90 ,$44.99 ,$44.99 ,$44.99 ,$44.99 ,$64.17 ,$53.48 ,$12.90 ,$62.74 ,$12.90 ,$53.48 ,$53.48 ,$60.61 ,$60.61 ,$12.90 ,$60.61 ,$12.90 ,$56.33 ,$56.33 ,$56.33 ,$64.17 ,$32.25 ,$64.17 ,$12.90 ,$71.30 ,$46.70 ,$12.90 ,$30.94 , N/A ,$13.55 ,$64.17 ,$29.03 ,$44.99 ,$42.78 ,$64.17 ,$12.90 ,$64.17 ,$64.17 ,$12.90 ,$46.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201062,86617,HC LYME DISEASE AB CONFIRM-90,302,1 ,$175.00 ,$113.75 ,$15.49 ,$175.00 ,$130.38 ,$114.63 ,$15.49 ,$92.23 ,$15.49 ,$110.43 ,$110.43 ,$110.43 ,$110.43 ,$157.50 ,$131.25 ,$15.49 ,$154.00 ,$15.49 ,$131.25 ,$131.25 ,$148.75 ,$148.75 ,$15.49 ,$148.75 ,$15.49 ,$138.25 ,$138.25 ,$138.25 ,$157.50 ,$38.73 ,$157.50 ,$15.49 ,$175.00 ,$114.63 ,$15.49 ,$75.95 , N/A ,$16.26 ,$157.50 ,$34.85 ,$110.43 ,$105.00 ,$157.50 ,$15.49 ,$157.50 ,$157.50 ,$15.49 ,$113.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201063,86618,HC LYME AB-90,302,1 ,$153.00 ,$99.45 ,$17.03 ,$153.00 ,$113.99 ,$100.22 ,$17.03 ,$80.63 ,$17.03 ,$96.54 ,$96.54 ,$96.54 ,$96.54 ,$137.70 ,$114.75 ,$17.03 ,$134.64 ,$17.03 ,$114.75 ,$114.75 ,$130.05 ,$130.05 ,$17.03 ,$130.05 ,$17.03 ,$120.87 ,$120.87 ,$120.87 ,$137.70 ,$42.58 ,$137.70 ,$17.03 ,$153.00 ,$100.22 ,$17.03 ,$66.40 , N/A ,$17.88 ,$137.70 ,$38.32 ,$96.54 ,$91.80 ,$137.70 ,$17.03 ,$137.70 ,$137.70 ,$17.03 ,$99.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201066,86628,HC CANDIDA AB-90,302,1 ,$51.00 ,$33.15 ,$12.01 ,$51.00 ,$38.00 ,$33.41 ,$12.01 ,$26.88 ,$12.01 ,$32.18 ,$32.18 ,$32.18 ,$32.18 ,$45.90 ,$38.25 ,$12.01 ,$44.88 ,$12.01 ,$38.25 ,$38.25 ,$43.35 ,$43.35 ,$12.01 ,$43.35 ,$12.01 ,$40.29 ,$40.29 ,$40.29 ,$45.90 ,$30.03 ,$45.90 ,$12.01 ,$51.00 ,$33.41 ,$12.01 ,$22.13 , N/A ,$12.61 ,$45.90 ,$27.02 ,$32.18 ,$30.60 ,$45.90 ,$12.01 ,$45.90 ,$45.90 ,$12.01 ,$33.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201073,86644,HC CMV AB MICROPLATE -90,302,1 ,$86.00 ,$55.90 ,$14.39 ,$86.00 ,$64.07 ,$56.33 ,$14.39 ,$45.32 ,$14.39 ,$54.27 ,$54.27 ,$54.27 ,$54.27 ,$77.40 ,$64.50 ,$14.39 ,$75.68 ,$14.39 ,$64.50 ,$64.50 ,$73.10 ,$73.10 ,$14.39 ,$73.10 ,$14.39 ,$67.94 ,$67.94 ,$67.94 ,$77.40 ,$35.98 ,$77.40 ,$14.39 ,$86.00 ,$56.33 ,$14.39 ,$37.32 , N/A ,$15.11 ,$77.40 ,$32.38 ,$54.27 ,$51.60 ,$77.40 ,$14.39 ,$77.40 ,$77.40 ,$14.39 ,$55.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201074,86695,HC HERPES SIMPLEX AB I W/O TITER-90,302,1 ,$81.00 ,$52.65 ,$13.19 ,$81.00 ,$60.35 ,$53.06 ,$13.19 ,$42.69 ,$13.19 ,$51.11 ,$51.11 ,$51.11 ,$51.11 ,$72.90 ,$60.75 ,$13.19 ,$71.28 ,$13.19 ,$60.75 ,$60.75 ,$68.85 ,$68.85 ,$13.19 ,$68.85 ,$13.19 ,$63.99 ,$63.99 ,$63.99 ,$72.90 ,$32.98 ,$72.90 ,$13.19 ,$81.00 ,$53.06 ,$13.19 ,$35.15 , N/A ,$13.85 ,$72.90 ,$29.68 ,$51.11 ,$48.60 ,$72.90 ,$13.19 ,$72.90 ,$72.90 ,$13.19 ,$52.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201075,86696,HC HERPES SIMPLEX AB II W/O TITER-90,302,1 ,$120.00 ,$78.00 ,$19.35 ,$120.00 ,$89.40 ,$78.60 ,$19.35 ,$63.24 ,$19.35 ,$75.72 ,$75.72 ,$75.72 ,$75.72 ,$108.00 ,$90.00 ,$19.35 ,$105.60 ,$19.35 ,$90.00 ,$90.00 ,$102.00 ,$102.00 ,$19.35 ,$102.00 ,$19.35 ,$94.80 ,$94.80 ,$94.80 ,$108.00 ,$48.38 ,$108.00 ,$19.35 ,$120.00 ,$78.60 ,$19.35 ,$52.08 , N/A ,$20.32 ,$108.00 ,$43.54 ,$75.72 ,$72.00 ,$108.00 ,$19.35 ,$108.00 ,$108.00 ,$19.35 ,$78.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201079,86711,HC AB JOHN CUNNINGHAM VIRUS-90,302,1 ,"$2,291.64 ","$1,489.57 ",$16.89 ,"$2,291.64 ","$1,707.27 ","$1,501.02 ",$16.89 ,"$1,207.69 ",$16.89 ,"$1,446.02 ","$1,446.02 ","$1,446.02 ","$1,446.02 ","$2,062.48 ","$1,718.73 ",$16.89 ,"$2,016.64 ",$16.89 ,"$1,718.73 ","$1,718.73 ","$1,947.89 ","$1,947.89 ",$16.89 ,"$1,947.89 ",$16.89 ,"$1,810.40 ","$1,810.40 ","$1,810.40 ","$2,062.48 ",$42.23 ,"$2,062.48 ",$16.89 ,"$2,291.64 ","$1,501.02 ",$16.89 ,$994.57 , N/A ,$17.73 ,"$2,062.48 ",$38.00 ,"$1,446.02 ","$1,374.98 ","$2,062.48 ",$16.89 ,"$2,062.48 ","$2,062.48 ",$16.89 ,"$1,489.57 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201088,86008,HC ALLERGEN IGE QN/SEMI-QN RECOMB/COMP EA-90,302,1 ,$9.76 ,$6.34 ,$4.24 ,$21.96 ,$7.27 ,$6.39 ,$9.76 ,$5.14 ,$9.76 ,$6.16 ,$6.16 ,$6.16 ,$6.16 ,$8.78 ,$7.32 ,$9.76 ,$8.59 ,$9.76 ,$7.32 ,$7.32 ,$8.30 ,$8.30 ,$9.76 ,$8.30 ,$9.76 ,$7.71 ,$7.71 ,$7.71 ,$8.78 ,$9.76 ,$8.78 ,$9.76 ,$9.76 ,$6.39 ,$9.76 ,$4.24 , N/A ,$9.76 ,$8.78 ,$21.96 ,$6.16 ,$5.86 ,$8.78 ,$9.76 ,$8.78 ,$8.78 ,$9.76 ,$6.34 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201094,86038,HC ANA SCREEN,302,1 ,$180.00 ,$117.00 ,$12.09 ,$180.00 ,$134.10 ,$117.90 ,$12.09 ,$94.86 ,$12.09 ,$113.58 ,$113.58 ,$113.58 ,$113.58 ,$162.00 ,$135.00 ,$12.09 ,$158.40 ,$12.09 ,$135.00 ,$135.00 ,$153.00 ,$153.00 ,$12.09 ,$153.00 ,$12.09 ,$142.20 ,$142.20 ,$142.20 ,$162.00 ,$30.23 ,$162.00 ,$12.09 ,$180.00 ,$117.90 ,$12.09 ,$78.12 , N/A ,$12.69 ,$162.00 ,$27.20 ,$113.58 ,$108.00 ,$162.00 ,$12.09 ,$162.00 ,$162.00 ,$12.09 ,$117.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201098,86225,HC DNA DOUBLE STRAND AB,302,1 ,$218.00 ,$141.70 ,$13.74 ,$218.00 ,$162.41 ,$142.79 ,$13.74 ,$114.89 ,$13.74 ,$137.56 ,$137.56 ,$137.56 ,$137.56 ,$196.20 ,$163.50 ,$13.74 ,$191.84 ,$13.74 ,$163.50 ,$163.50 ,$185.30 ,$185.30 ,$13.74 ,$185.30 ,$13.74 ,$172.22 ,$172.22 ,$172.22 ,$196.20 ,$34.35 ,$196.20 ,$13.74 ,$218.00 ,$142.79 ,$13.74 ,$94.61 , N/A ,$14.43 ,$196.20 ,$30.92 ,$137.56 ,$130.80 ,$196.20 ,$13.74 ,$196.20 ,$196.20 ,$13.74 ,$141.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201099,86235,HC ENA AB,302,1 ,$134.00 ,$87.10 ,$17.93 ,$134.00 ,$99.83 ,$87.77 ,$17.93 ,$70.62 ,$17.93 ,$84.55 ,$84.55 ,$84.55 ,$84.55 ,$120.60 ,$100.50 ,$17.93 ,$117.92 ,$17.93 ,$100.50 ,$100.50 ,$113.90 ,$113.90 ,$17.93 ,$113.90 ,$17.93 ,$105.86 ,$105.86 ,$105.86 ,$120.60 ,$44.83 ,$120.60 ,$17.93 ,$134.00 ,$87.77 ,$17.93 ,$58.16 , N/A ,$18.83 ,$120.60 ,$40.34 ,$84.55 ,$80.40 ,$120.60 ,$17.93 ,$120.60 ,$120.60 ,$17.93 ,$87.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201100,86300,HC TUMOR AG CA 15-3 (27.29),302,1 ,$175.00 ,$113.75 ,$20.81 ,$175.00 ,$130.38 ,$114.63 ,$20.81 ,$92.23 ,$20.81 ,$110.43 ,$110.43 ,$110.43 ,$110.43 ,$157.50 ,$131.25 ,$20.81 ,$154.00 ,$20.81 ,$131.25 ,$131.25 ,$148.75 ,$148.75 ,$20.81 ,$148.75 ,$20.81 ,$138.25 ,$138.25 ,$138.25 ,$157.50 ,$52.03 ,$157.50 ,$20.81 ,$175.00 ,$114.63 ,$20.81 ,$75.95 , N/A ,$21.85 ,$157.50 ,$46.82 ,$110.43 ,$105.00 ,$157.50 ,$20.81 ,$157.50 ,$157.50 ,$20.81 ,$113.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201102,86334,HC IMMUNOFIX ELECTRO SERUM,302,1 ,$215.00 ,$139.75 ,$22.34 ,$215.00 ,$160.18 ,$140.83 ,$22.34 ,$113.31 ,$22.34 ,$135.67 ,$135.67 ,$135.67 ,$135.67 ,$193.50 ,$161.25 ,$22.34 ,$189.20 ,$22.34 ,$161.25 ,$161.25 ,$182.75 ,$182.75 ,$22.34 ,$182.75 ,$22.34 ,$169.85 ,$169.85 ,$169.85 ,$193.50 ,$55.85 ,$193.50 ,$22.34 ,$215.00 ,$140.83 ,$22.34 ,$93.31 , N/A ,$23.46 ,$193.50 ,$50.27 ,$135.67 ,$129.00 ,$193.50 ,$22.34 ,$193.50 ,$193.50 ,$22.34 ,$139.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201103,86335,HC IMMUNOFIX ELECTRO OTH,302,1 ,$215.00 ,$139.75 ,$29.35 ,$215.00 ,$160.18 ,$140.83 ,$29.35 ,$113.31 ,$29.35 ,$135.67 ,$135.67 ,$135.67 ,$135.67 ,$193.50 ,$161.25 ,$29.35 ,$189.20 ,$29.35 ,$161.25 ,$161.25 ,$182.75 ,$182.75 ,$29.35 ,$182.75 ,$29.35 ,$169.85 ,$169.85 ,$169.85 ,$193.50 ,$73.38 ,$193.50 ,$29.35 ,$215.00 ,$140.83 ,$29.35 ,$93.31 , N/A ,$30.82 ,$193.50 ,$66.04 ,$135.67 ,$129.00 ,$193.50 ,$29.35 ,$193.50 ,$193.50 ,$29.35 ,$139.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201106,86376,HC MICROSOMAL AB,302,1 ,$172.00 ,$111.80 ,$14.55 ,$172.00 ,$128.14 ,$112.66 ,$14.55 ,$90.64 ,$14.55 ,$108.53 ,$108.53 ,$108.53 ,$108.53 ,$154.80 ,$129.00 ,$14.55 ,$151.36 ,$14.55 ,$129.00 ,$129.00 ,$146.20 ,$146.20 ,$14.55 ,$146.20 ,$14.55 ,$135.88 ,$135.88 ,$135.88 ,$154.80 ,$36.38 ,$154.80 ,$14.55 ,$172.00 ,$112.66 ,$14.55 ,$74.65 , N/A ,$15.28 ,$154.80 ,$32.74 ,$108.53 ,$103.20 ,$154.80 ,$14.55 ,$154.80 ,$154.80 ,$14.55 ,$111.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201109,86480,HC TB QUANTIFERON GOLD,302,1 ,$270.00 ,$175.50 ,$61.98 ,$270.00 ,$201.15 ,$176.85 ,$61.98 ,$142.29 ,$61.98 ,$170.37 ,$170.37 ,$170.37 ,$170.37 ,$243.00 ,$202.50 ,$61.98 ,$237.60 ,$61.98 ,$202.50 ,$202.50 ,$229.50 ,$229.50 ,$61.98 ,$229.50 ,$61.98 ,$213.30 ,$213.30 ,$213.30 ,$243.00 ,$154.95 ,$243.00 ,$61.98 ,$270.00 ,$176.85 ,$61.98 ,$117.18 , N/A ,$65.08 ,$243.00 ,$139.46 ,$170.37 ,$162.00 ,$243.00 ,$61.98 ,$243.00 ,$243.00 ,$61.98 ,$175.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201112,86606,HC ASPERGILLUS AB,302,1 ,$93.00 ,$60.45 ,$15.05 ,$93.00 ,$69.29 ,$60.92 ,$15.05 ,$49.01 ,$15.05 ,$58.68 ,$58.68 ,$58.68 ,$58.68 ,$83.70 ,$69.75 ,$15.05 ,$81.84 ,$15.05 ,$69.75 ,$69.75 ,$79.05 ,$79.05 ,$15.05 ,$79.05 ,$15.05 ,$73.47 ,$73.47 ,$73.47 ,$83.70 ,$37.63 ,$83.70 ,$15.05 ,$93.00 ,$60.92 ,$15.05 ,$40.36 , N/A ,$15.80 ,$83.70 ,$33.86 ,$58.68 ,$55.80 ,$83.70 ,$15.05 ,$83.70 ,$83.70 ,$15.05 ,$60.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201113,86612,HC BLASTOMYCES AB,302,1 ,$80.00 ,$52.00 ,$12.90 ,$80.00 ,$59.60 ,$52.40 ,$12.90 ,$42.16 ,$12.90 ,$50.48 ,$50.48 ,$50.48 ,$50.48 ,$72.00 ,$60.00 ,$12.90 ,$70.40 ,$12.90 ,$60.00 ,$60.00 ,$68.00 ,$68.00 ,$12.90 ,$68.00 ,$12.90 ,$63.20 ,$63.20 ,$63.20 ,$72.00 ,$32.25 ,$72.00 ,$12.90 ,$80.00 ,$52.40 ,$12.90 ,$34.72 , N/A ,$13.55 ,$72.00 ,$29.03 ,$50.48 ,$48.00 ,$72.00 ,$12.90 ,$72.00 ,$72.00 ,$12.90 ,$52.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201114,86618,HC LYME AB,302,1 ,$133.00 ,$86.45 ,$17.03 ,$133.00 ,$99.09 ,$87.12 ,$17.03 ,$70.09 ,$17.03 ,$83.92 ,$83.92 ,$83.92 ,$83.92 ,$119.70 ,$99.75 ,$17.03 ,$117.04 ,$17.03 ,$99.75 ,$99.75 ,$113.05 ,$113.05 ,$17.03 ,$113.05 ,$17.03 ,$105.07 ,$105.07 ,$105.07 ,$119.70 ,$42.58 ,$119.70 ,$17.03 ,$133.00 ,$87.12 ,$17.03 ,$57.72 , N/A ,$17.88 ,$119.70 ,$38.32 ,$83.92 ,$79.80 ,$119.70 ,$17.03 ,$119.70 ,$119.70 ,$17.03 ,$86.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201115,86635,HC COCCIDIOIDES AB,302,1 ,$71.00 ,$46.15 ,$11.47 ,$71.00 ,$52.90 ,$46.51 ,$11.47 ,$37.42 ,$11.47 ,$44.80 ,$44.80 ,$44.80 ,$44.80 ,$63.90 ,$53.25 ,$11.47 ,$62.48 ,$11.47 ,$53.25 ,$53.25 ,$60.35 ,$60.35 ,$11.47 ,$60.35 ,$11.47 ,$56.09 ,$56.09 ,$56.09 ,$63.90 ,$28.68 ,$63.90 ,$11.47 ,$71.00 ,$46.51 ,$11.47 ,$30.81 , N/A ,$12.04 ,$63.90 ,$25.81 ,$44.80 ,$42.60 ,$63.90 ,$11.47 ,$63.90 ,$63.90 ,$11.47 ,$46.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201117,86644,HC CMV AB,302,1 ,$155.00 ,$100.75 ,$14.39 ,$155.00 ,$115.48 ,$101.53 ,$14.39 ,$81.69 ,$14.39 ,$97.81 ,$97.81 ,$97.81 ,$97.81 ,$139.50 ,$116.25 ,$14.39 ,$136.40 ,$14.39 ,$116.25 ,$116.25 ,$131.75 ,$131.75 ,$14.39 ,$131.75 ,$14.39 ,$122.45 ,$122.45 ,$122.45 ,$139.50 ,$35.98 ,$139.50 ,$14.39 ,$155.00 ,$101.53 ,$14.39 ,$67.27 , N/A ,$15.11 ,$139.50 ,$32.38 ,$97.81 ,$93.00 ,$139.50 ,$14.39 ,$139.50 ,$139.50 ,$14.39 ,$100.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201118,86645,HC CMV AB IGM,302,1 ,$124.00 ,$80.60 ,$16.85 ,$124.00 ,$92.38 ,$81.22 ,$16.85 ,$65.35 ,$16.85 ,$78.24 ,$78.24 ,$78.24 ,$78.24 ,$111.60 ,$93.00 ,$16.85 ,$109.12 ,$16.85 ,$93.00 ,$93.00 ,$105.40 ,$105.40 ,$16.85 ,$105.40 ,$16.85 ,$97.96 ,$97.96 ,$97.96 ,$111.60 ,$42.13 ,$111.60 ,$16.85 ,$124.00 ,$81.22 ,$16.85 ,$53.82 , N/A ,$17.69 ,$111.60 ,$37.91 ,$78.24 ,$74.40 ,$111.60 ,$16.85 ,$111.60 ,$111.60 ,$16.85 ,$80.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201119,86677,HC H PYLORI AB,302,1 ,$90.00 ,$58.50 ,$16.85 ,$90.00 ,$67.05 ,$58.95 ,$16.85 ,$47.43 ,$16.85 ,$56.79 ,$56.79 ,$56.79 ,$56.79 ,$81.00 ,$67.50 ,$16.85 ,$79.20 ,$16.85 ,$67.50 ,$67.50 ,$76.50 ,$76.50 ,$16.85 ,$76.50 ,$16.85 ,$71.10 ,$71.10 ,$71.10 ,$81.00 ,$42.13 ,$81.00 ,$16.85 ,$90.00 ,$58.95 ,$16.85 ,$39.06 , N/A ,$17.69 ,$81.00 ,$37.91 ,$56.79 ,$54.00 ,$81.00 ,$16.85 ,$81.00 ,$81.00 ,$16.85 ,$58.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201122,86705,HC HEP B CORE IGM,302,1 ,$86.00 ,$55.90 ,$11.77 ,$86.00 ,$64.07 ,$56.33 ,$11.77 ,$45.32 ,$11.77 ,$54.27 ,$54.27 ,$54.27 ,$54.27 ,$77.40 ,$64.50 ,$11.77 ,$75.68 ,$11.77 ,$64.50 ,$64.50 ,$73.10 ,$73.10 ,$11.77 ,$73.10 ,$11.77 ,$67.94 ,$67.94 ,$67.94 ,$77.40 ,$29.43 ,$77.40 ,$11.77 ,$86.00 ,$56.33 ,$11.77 ,$37.32 , N/A ,$12.36 ,$77.40 ,$26.48 ,$54.27 ,$51.60 ,$77.40 ,$11.77 ,$77.40 ,$77.40 ,$11.77 ,$55.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201125,86709,HC HEP A AB (HAAB) IGM,302,1 ,$166.00 ,$107.90 ,$11.26 ,$166.00 ,$123.67 ,$108.73 ,$11.26 ,$87.48 ,$11.26 ,$104.75 ,$104.75 ,$104.75 ,$104.75 ,$149.40 ,$124.50 ,$11.26 ,$146.08 ,$11.26 ,$124.50 ,$124.50 ,$141.10 ,$141.10 ,$11.26 ,$141.10 ,$11.26 ,$131.14 ,$131.14 ,$131.14 ,$149.40 ,$28.15 ,$149.40 ,$11.26 ,$166.00 ,$108.73 ,$11.26 ,$72.04 , N/A ,$11.82 ,$149.40 ,$25.34 ,$104.75 ,$99.60 ,$149.40 ,$11.26 ,$149.40 ,$149.40 ,$11.26 ,$107.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201126,86735,HC MUMPS AB,302,1 ,$93.00 ,$60.45 ,$13.05 ,$93.00 ,$69.29 ,$60.92 ,$13.05 ,$49.01 ,$13.05 ,$58.68 ,$58.68 ,$58.68 ,$58.68 ,$83.70 ,$69.75 ,$13.05 ,$81.84 ,$13.05 ,$69.75 ,$69.75 ,$79.05 ,$79.05 ,$13.05 ,$79.05 ,$13.05 ,$73.47 ,$73.47 ,$73.47 ,$83.70 ,$32.63 ,$83.70 ,$13.05 ,$93.00 ,$60.92 ,$13.05 ,$40.36 , N/A ,$13.70 ,$83.70 ,$29.36 ,$58.68 ,$55.80 ,$83.70 ,$13.05 ,$83.70 ,$83.70 ,$13.05 ,$60.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201127,86762,HC RUBELLA AB,302,1 ,$122.00 ,$79.30 ,$14.39 ,$122.00 ,$90.89 ,$79.91 ,$14.39 ,$64.29 ,$14.39 ,$76.98 ,$76.98 ,$76.98 ,$76.98 ,$109.80 ,$91.50 ,$14.39 ,$107.36 ,$14.39 ,$91.50 ,$91.50 ,$103.70 ,$103.70 ,$14.39 ,$103.70 ,$14.39 ,$96.38 ,$96.38 ,$96.38 ,$109.80 ,$35.98 ,$109.80 ,$14.39 ,$122.00 ,$79.91 ,$14.39 ,$52.95 , N/A ,$15.11 ,$109.80 ,$32.38 ,$76.98 ,$73.20 ,$109.80 ,$14.39 ,$109.80 ,$109.80 ,$14.39 ,$79.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201128,86765,HC RUBEOLA AB,302,1 ,$132.00 ,$85.80 ,$12.88 ,$132.00 ,$98.34 ,$86.46 ,$12.88 ,$69.56 ,$12.88 ,$83.29 ,$83.29 ,$83.29 ,$83.29 ,$118.80 ,$99.00 ,$12.88 ,$116.16 ,$12.88 ,$99.00 ,$99.00 ,$112.20 ,$112.20 ,$12.88 ,$112.20 ,$12.88 ,$104.28 ,$104.28 ,$104.28 ,$118.80 ,$32.20 ,$118.80 ,$12.88 ,$132.00 ,$86.46 ,$12.88 ,$57.29 , N/A ,$13.52 ,$118.80 ,$28.98 ,$83.29 ,$79.20 ,$118.80 ,$12.88 ,$118.80 ,$118.80 ,$12.88 ,$85.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201129,86780,HC TREPONEMA P AB CONFIRM,302,1 ,$2.99 ,$1.94 ,$1.30 ,$6.73 ,$2.23 ,$1.96 ,$2.99 ,$1.58 ,$2.99 ,$1.89 ,$1.89 ,$1.89 ,$1.89 ,$2.69 ,$2.24 ,$2.99 ,$2.63 ,$2.99 ,$2.24 ,$2.24 ,$2.54 ,$2.54 ,$2.99 ,$2.54 ,$2.99 ,$2.36 ,$2.36 ,$2.36 ,$2.69 ,$2.99 ,$2.69 ,$2.99 ,$2.99 ,$1.96 ,$2.99 ,$1.30 , N/A ,$2.99 ,$2.69 ,$6.73 ,$1.89 ,$1.79 ,$2.69 ,$2.99 ,$2.69 ,$2.69 ,$2.99 ,$1.94 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201130,86787,HC VARICELLA ZOSTER AB,302,1 ,$159.00 ,$103.35 ,$12.88 ,$159.00 ,$118.46 ,$104.15 ,$12.88 ,$83.79 ,$12.88 ,$100.33 ,$100.33 ,$100.33 ,$100.33 ,$143.10 ,$119.25 ,$12.88 ,$139.92 ,$12.88 ,$119.25 ,$119.25 ,$135.15 ,$135.15 ,$12.88 ,$135.15 ,$12.88 ,$125.61 ,$125.61 ,$125.61 ,$143.10 ,$32.20 ,$143.10 ,$12.88 ,$159.00 ,$104.15 ,$12.88 ,$69.01 , N/A ,$13.52 ,$143.10 ,$28.98 ,$100.33 ,$95.40 ,$143.10 ,$12.88 ,$143.10 ,$143.10 ,$12.88 ,$103.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201131,86800,HC THYROGLOBULIN AB,302,1 ,$196.00 ,$127.40 ,$15.91 ,$196.00 ,$146.02 ,$128.38 ,$15.91 ,$103.29 ,$15.91 ,$123.68 ,$123.68 ,$123.68 ,$123.68 ,$176.40 ,$147.00 ,$15.91 ,$172.48 ,$15.91 ,$147.00 ,$147.00 ,$166.60 ,$166.60 ,$15.91 ,$166.60 ,$15.91 ,$154.84 ,$154.84 ,$154.84 ,$176.40 ,$39.78 ,$176.40 ,$15.91 ,$196.00 ,$128.38 ,$15.91 ,$85.06 , N/A ,$16.71 ,$176.40 ,$35.80 ,$123.68 ,$117.60 ,$176.40 ,$15.91 ,$176.40 ,$176.40 ,$15.91 ,$127.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201142,86039,HC ANA TITER,302,1 ,$180.00 ,$117.00 ,$11.16 ,$180.00 ,$134.10 ,$117.90 ,$11.16 ,$94.86 ,$11.16 ,$113.58 ,$113.58 ,$113.58 ,$113.58 ,$162.00 ,$135.00 ,$11.16 ,$158.40 ,$11.16 ,$135.00 ,$135.00 ,$153.00 ,$153.00 ,$11.16 ,$153.00 ,$11.16 ,$142.20 ,$142.20 ,$142.20 ,$162.00 ,$27.90 ,$162.00 ,$11.16 ,$180.00 ,$117.90 ,$11.16 ,$78.12 , N/A ,$11.72 ,$162.00 ,$25.11 ,$113.58 ,$108.00 ,$162.00 ,$11.16 ,$162.00 ,$162.00 ,$11.16 ,$117.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201144,86160,HC COMPLEMENT AG EA,302,1 ,$192.00 ,$124.80 ,$12.00 ,$192.00 ,$143.04 ,$125.76 ,$12.00 ,$101.18 ,$12.00 ,$121.15 ,$121.15 ,$121.15 ,$121.15 ,$172.80 ,$144.00 ,$12.00 ,$168.96 ,$12.00 ,$144.00 ,$144.00 ,$163.20 ,$163.20 ,$12.00 ,$163.20 ,$12.00 ,$151.68 ,$151.68 ,$151.68 ,$172.80 ,$30.00 ,$172.80 ,$12.00 ,$192.00 ,$125.76 ,$12.00 ,$83.33 , N/A ,$12.60 ,$172.80 ,$27.00 ,$121.15 ,$115.20 ,$172.80 ,$12.00 ,$172.80 ,$172.80 ,$12.00 ,$124.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201146,86780,HC TREPONEMA P AB CONFIRM,302,1 ,$138.00 ,$89.70 ,$13.24 ,$138.00 ,$102.81 ,$90.39 ,$13.24 ,$72.73 ,$13.24 ,$87.08 ,$87.08 ,$87.08 ,$87.08 ,$124.20 ,$103.50 ,$13.24 ,$121.44 ,$13.24 ,$103.50 ,$103.50 ,$117.30 ,$117.30 ,$13.24 ,$117.30 ,$13.24 ,$109.02 ,$109.02 ,$109.02 ,$124.20 ,$33.10 ,$124.20 ,$13.24 ,$138.00 ,$90.39 ,$13.24 ,$59.89 , N/A ,$13.90 ,$124.20 ,$29.79 ,$87.08 ,$82.80 ,$124.20 ,$13.24 ,$124.20 ,$124.20 ,$13.24 ,$89.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30201152,86255,HC FLUOR AB SCR AQUAPORIN-90,302,1 ,$18.00 ,$11.70 ,$7.81 ,$27.11 ,$13.41 ,$11.79 ,$12.05 ,$9.49 ,$12.05 ,$11.36 ,$11.36 ,$11.36 ,$11.36 ,$16.20 ,$13.50 ,$12.05 ,$15.84 ,$12.05 ,$13.50 ,$13.50 ,$15.30 ,$15.30 ,$12.05 ,$15.30 ,$12.05 ,$14.22 ,$14.22 ,$14.22 ,$16.20 ,$18.00 ,$16.20 ,$12.05 ,$18.00 ,$11.79 ,$12.05 ,$7.81 , N/A ,$12.65 ,$16.20 ,$27.11 ,$11.36 ,$10.80 ,$16.20 ,$12.05 ,$16.20 ,$16.20 ,$12.05 ,$11.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500103,85007,HC BLOOD COUNT MAN DIFF WBC,305,1 ,$25.00 ,$16.25 ,$3.80 ,$25.00 ,$18.63 ,$16.38 ,$3.80 ,$13.18 ,$3.80 ,$15.78 ,$15.78 ,$15.78 ,$15.78 ,$22.50 ,$18.75 ,$3.80 ,$22.00 ,$3.80 ,$18.75 ,$18.75 ,$21.25 ,$21.25 ,$3.80 ,$21.25 ,$3.80 ,$19.75 ,$19.75 ,$19.75 ,$22.50 ,$9.50 ,$22.50 ,$3.80 ,$25.00 ,$16.38 ,$3.80 ,$10.85 , N/A ,$3.99 ,$22.50 ,$8.55 ,$15.78 ,$15.00 ,$22.50 ,$3.80 ,$22.50 ,$22.50 ,$3.80 ,$16.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500104,85014,HC HEMATOCRIT,305,1 ,$18.00 ,$11.70 ,$2.37 ,$18.00 ,$13.41 ,$11.79 ,$2.37 ,$9.49 ,$2.37 ,$11.36 ,$11.36 ,$11.36 ,$11.36 ,$16.20 ,$13.50 ,$2.37 ,$15.84 ,$2.37 ,$13.50 ,$13.50 ,$15.30 ,$15.30 ,$2.37 ,$15.30 ,$2.37 ,$14.22 ,$14.22 ,$14.22 ,$16.20 ,$5.93 ,$16.20 ,$2.37 ,$2.37 ,$11.79 ,$2.37 ,$7.81 , N/A ,$2.49 ,$16.20 ,$5.33 ,$11.36 ,$10.80 ,$16.20 ,$2.37 ,$16.20 ,$16.20 ,$2.37 ,$11.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500106,85018,HC HGB,305,1 ,$18.00 ,$11.70 ,$2.37 ,$18.00 ,$13.41 ,$11.79 ,$2.37 ,$9.49 ,$2.37 ,$11.36 ,$11.36 ,$11.36 ,$11.36 ,$16.20 ,$13.50 ,$2.37 ,$15.84 ,$2.37 ,$13.50 ,$13.50 ,$15.30 ,$15.30 ,$2.37 ,$15.30 ,$2.37 ,$14.22 ,$14.22 ,$14.22 ,$16.20 ,$5.93 ,$16.20 ,$2.37 ,$2.37 ,$11.79 ,$2.37 ,$7.81 , N/A ,$2.49 ,$16.20 ,$5.33 ,$11.36 ,$10.80 ,$16.20 ,$2.37 ,$16.20 ,$16.20 ,$2.37 ,$11.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500107,85025,HC CBC AUTO W/AUTO DIFF,305,1 ,$40.00 ,$26.00 ,$7.77 ,$40.00 ,$29.80 ,$26.20 ,$7.77 ,$21.08 ,$7.77 ,$25.24 ,$25.24 ,$25.24 ,$25.24 ,$36.00 ,$30.00 ,$7.77 ,$35.20 ,$7.77 ,$30.00 ,$30.00 ,$34.00 ,$34.00 ,$7.77 ,$34.00 ,$7.77 ,$31.60 ,$31.60 ,$31.60 ,$36.00 ,$19.43 ,$36.00 ,$7.77 ,$7.77 ,$26.20 ,$7.77 ,$17.36 , N/A ,$8.16 ,$36.00 ,$17.48 ,$25.24 ,$24.00 ,$36.00 ,$7.77 ,$36.00 ,$36.00 ,$7.77 ,$26.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500108,85027,HC CBC W/O DIFF,305,1 ,$33.00 ,$21.45 ,$6.47 ,$33.00 ,$24.59 ,$21.62 ,$6.47 ,$17.39 ,$6.47 ,$20.82 ,$20.82 ,$20.82 ,$20.82 ,$29.70 ,$24.75 ,$6.47 ,$29.04 ,$6.47 ,$24.75 ,$24.75 ,$28.05 ,$28.05 ,$6.47 ,$28.05 ,$6.47 ,$26.07 ,$26.07 ,$26.07 ,$29.70 ,$16.18 ,$29.70 ,$6.47 ,$6.47 ,$21.62 ,$6.47 ,$14.32 , N/A ,$6.79 ,$29.70 ,$14.56 ,$20.82 ,$19.80 ,$29.70 ,$6.47 ,$29.70 ,$29.70 ,$6.47 ,$21.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500112,85048,HC BLOOD COUNT LEUKO AUTO,305,1 ,$42.00 ,$27.30 ,$2.54 ,$42.00 ,$31.29 ,$27.51 ,$2.54 ,$22.13 ,$2.54 ,$26.50 ,$26.50 ,$26.50 ,$26.50 ,$37.80 ,$31.50 ,$2.54 ,$36.96 ,$2.54 ,$31.50 ,$31.50 ,$35.70 ,$35.70 ,$2.54 ,$35.70 ,$2.54 ,$33.18 ,$33.18 ,$33.18 ,$37.80 ,$6.35 ,$37.80 ,$2.54 ,$42.00 ,$27.51 ,$2.54 ,$18.23 , N/A ,$2.67 ,$37.80 ,$5.72 ,$26.50 ,$25.20 ,$37.80 ,$2.54 ,$37.80 ,$37.80 ,$2.54 ,$27.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500113,85049,HC PLATELET COUNT AUTO,305,1 ,$69.00 ,$44.85 ,$4.48 ,$69.00 ,$51.41 ,$45.20 ,$4.48 ,$36.36 ,$4.48 ,$43.54 ,$43.54 ,$43.54 ,$43.54 ,$62.10 ,$51.75 ,$4.48 ,$60.72 ,$4.48 ,$51.75 ,$51.75 ,$58.65 ,$58.65 ,$4.48 ,$58.65 ,$4.48 ,$54.51 ,$54.51 ,$54.51 ,$62.10 ,$11.20 ,$62.10 ,$4.48 ,$69.00 ,$45.20 ,$4.48 ,$29.95 , N/A ,$4.70 ,$62.10 ,$10.08 ,$43.54 ,$41.40 ,$62.10 ,$4.48 ,$62.10 ,$62.10 ,$4.48 ,$44.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500168,85347,HC ACTIVATED CLOTTING TIME,305,1 ,$113.00 ,$73.45 ,$4.28 ,$113.00 ,$84.19 ,$74.02 ,$4.28 ,$59.55 ,$4.28 ,$71.30 ,$71.30 ,$71.30 ,$71.30 ,$101.70 ,$84.75 ,$4.28 ,$99.44 ,$4.28 ,$84.75 ,$84.75 ,$96.05 ,$96.05 ,$4.28 ,$96.05 ,$4.28 ,$89.27 ,$89.27 ,$89.27 ,$101.70 ,$10.70 ,$101.70 ,$4.28 ,$113.00 ,$74.02 ,$4.28 ,$49.04 , N/A ,$4.49 ,$101.70 ,$9.63 ,$71.30 ,$67.80 ,$101.70 ,$4.28 ,$101.70 ,$101.70 ,$4.28 ,$73.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500175,85379,HC D DIMER QN,305,1 ,$84.00 ,$54.60 ,$10.18 ,$84.00 ,$62.58 ,$55.02 ,$10.18 ,$44.27 ,$10.18 ,$53.00 ,$53.00 ,$53.00 ,$53.00 ,$75.60 ,$63.00 ,$10.18 ,$73.92 ,$10.18 ,$63.00 ,$63.00 ,$71.40 ,$71.40 ,$10.18 ,$71.40 ,$10.18 ,$66.36 ,$66.36 ,$66.36 ,$75.60 ,$25.45 ,$75.60 ,$10.18 ,$84.00 ,$55.02 ,$10.18 ,$36.46 , N/A ,$10.69 ,$75.60 ,$22.91 ,$53.00 ,$50.40 ,$75.60 ,$10.18 ,$75.60 ,$75.60 ,$10.18 ,$54.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500176,85384,HC FIBRINOGEN,305,1 ,$93.00 ,$60.45 ,$9.72 ,$93.00 ,$69.29 ,$60.92 ,$9.72 ,$49.01 ,$9.72 ,$58.68 ,$58.68 ,$58.68 ,$58.68 ,$83.70 ,$69.75 ,$9.72 ,$81.84 ,$9.72 ,$69.75 ,$69.75 ,$79.05 ,$79.05 ,$9.72 ,$79.05 ,$9.72 ,$73.47 ,$73.47 ,$73.47 ,$83.70 ,$24.30 ,$83.70 ,$9.72 ,$93.00 ,$60.92 ,$9.72 ,$40.36 , N/A ,$10.21 ,$83.70 ,$21.87 ,$58.68 ,$55.80 ,$83.70 ,$9.72 ,$83.70 ,$83.70 ,$9.72 ,$60.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500185,85460,HC FETAL HGB KLEIHAUER BETKE,305,1 ,$242.00 ,$157.30 ,$7.73 ,$242.00 ,$180.29 ,$158.51 ,$7.73 ,$127.53 ,$7.73 ,$152.70 ,$152.70 ,$152.70 ,$152.70 ,$217.80 ,$181.50 ,$7.73 ,$212.96 ,$7.73 ,$181.50 ,$181.50 ,$205.70 ,$205.70 ,$7.73 ,$205.70 ,$7.73 ,$191.18 ,$191.18 ,$191.18 ,$217.80 ,$19.33 ,$217.80 ,$7.73 ,$242.00 ,$158.51 ,$7.73 ,$105.03 , N/A ,$8.12 ,$217.80 ,$17.39 ,$152.70 ,$145.20 ,$217.80 ,$7.73 ,$217.80 ,$217.80 ,$7.73 ,$157.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500196,85610,HC PROTHROMBIN TIME (PT),305,1 ,$26.00 ,$16.90 ,$4.29 ,$26.00 ,$19.37 ,$17.03 ,$4.29 ,$13.70 ,$4.29 ,$16.41 ,$16.41 ,$16.41 ,$16.41 ,$23.40 ,$19.50 ,$4.29 ,$22.88 ,$4.29 ,$19.50 ,$19.50 ,$22.10 ,$22.10 ,$4.29 ,$22.10 ,$4.29 ,$20.54 ,$20.54 ,$20.54 ,$23.40 ,$10.73 ,$23.40 ,$4.29 ,$26.00 ,$17.03 ,$4.29 ,$11.28 , N/A ,$4.50 ,$23.40 ,$9.65 ,$16.41 ,$15.60 ,$23.40 ,$4.29 ,$23.40 ,$23.40 ,$4.29 ,$16.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500205,85652,HC SED RATE AUTO,305,1 ,$43.00 ,$27.95 ,$2.70 ,$43.00 ,$32.04 ,$28.17 ,$2.70 ,$22.66 ,$2.70 ,$27.13 ,$27.13 ,$27.13 ,$27.13 ,$38.70 ,$32.25 ,$2.70 ,$37.84 ,$2.70 ,$32.25 ,$32.25 ,$36.55 ,$36.55 ,$2.70 ,$36.55 ,$2.70 ,$33.97 ,$33.97 ,$33.97 ,$38.70 ,$6.75 ,$38.70 ,$2.70 ,$43.00 ,$28.17 ,$2.70 ,$18.66 , N/A ,$2.84 ,$38.70 ,$6.08 ,$27.13 ,$25.80 ,$38.70 ,$2.70 ,$38.70 ,$38.70 ,$2.70 ,$27.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500211,85730,HC PTT,305,1 ,$42.00 ,$27.30 ,$6.01 ,$42.00 ,$31.29 ,$27.51 ,$6.01 ,$22.13 ,$6.01 ,$26.50 ,$26.50 ,$26.50 ,$26.50 ,$37.80 ,$31.50 ,$6.01 ,$36.96 ,$6.01 ,$31.50 ,$31.50 ,$35.70 ,$35.70 ,$6.01 ,$35.70 ,$6.01 ,$33.18 ,$33.18 ,$33.18 ,$37.80 ,$15.03 ,$37.80 ,$6.01 ,$42.00 ,$27.51 ,$6.01 ,$18.23 , N/A ,$6.31 ,$37.80 ,$13.52 ,$26.50 ,$25.20 ,$37.80 ,$6.01 ,$37.80 ,$37.80 ,$6.01 ,$27.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500250,85220,HC FACTOR V-90,305,1 ,$95.00 ,$61.75 ,$17.65 ,$95.00 ,$70.78 ,$62.23 ,$17.65 ,$50.07 ,$17.65 ,$59.95 ,$59.95 ,$59.95 ,$59.95 ,$85.50 ,$71.25 ,$17.65 ,$83.60 ,$17.65 ,$71.25 ,$71.25 ,$80.75 ,$80.75 ,$17.65 ,$80.75 ,$17.65 ,$75.05 ,$75.05 ,$75.05 ,$85.50 ,$44.13 ,$85.50 ,$17.65 ,$95.00 ,$62.23 ,$17.65 ,$41.23 , N/A ,$18.53 ,$85.50 ,$39.71 ,$59.95 ,$57.00 ,$85.50 ,$17.65 ,$85.50 ,$85.50 ,$17.65 ,$61.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500251,85230,HC FACTOR VII-90,305,1 ,$96.00 ,$62.40 ,$17.90 ,$96.00 ,$71.52 ,$62.88 ,$17.90 ,$50.59 ,$17.90 ,$60.58 ,$60.58 ,$60.58 ,$60.58 ,$86.40 ,$72.00 ,$17.90 ,$84.48 ,$17.90 ,$72.00 ,$72.00 ,$81.60 ,$81.60 ,$17.90 ,$81.60 ,$17.90 ,$75.84 ,$75.84 ,$75.84 ,$86.40 ,$44.75 ,$86.40 ,$17.90 ,$96.00 ,$62.88 ,$17.90 ,$41.66 , N/A ,$18.80 ,$86.40 ,$40.28 ,$60.58 ,$57.60 ,$86.40 ,$17.90 ,$86.40 ,$86.40 ,$17.90 ,$62.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500252,85240,HC FACTOR VIII AHG-90,305,1 ,$148.00 ,$96.20 ,$17.90 ,$148.00 ,$110.26 ,$96.94 ,$17.90 ,$78.00 ,$17.90 ,$93.39 ,$93.39 ,$93.39 ,$93.39 ,$133.20 ,$111.00 ,$17.90 ,$130.24 ,$17.90 ,$111.00 ,$111.00 ,$125.80 ,$125.80 ,$17.90 ,$125.80 ,$17.90 ,$116.92 ,$116.92 ,$116.92 ,$133.20 ,$44.75 ,$133.20 ,$17.90 ,$148.00 ,$96.94 ,$17.90 ,$64.23 , N/A ,$18.80 ,$133.20 ,$40.28 ,$93.39 ,$88.80 ,$133.20 ,$17.90 ,$133.20 ,$133.20 ,$17.90 ,$96.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500253,85245,HC FACTOR VIII VW RISTO-90,305,1 ,$123.00 ,$79.95 ,$22.94 ,$123.00 ,$91.64 ,$80.57 ,$22.94 ,$64.82 ,$22.94 ,$77.61 ,$77.61 ,$77.61 ,$77.61 ,$110.70 ,$92.25 ,$22.94 ,$108.24 ,$22.94 ,$92.25 ,$92.25 ,$104.55 ,$104.55 ,$22.94 ,$104.55 ,$22.94 ,$97.17 ,$97.17 ,$97.17 ,$110.70 ,$57.35 ,$110.70 ,$22.94 ,$123.00 ,$80.57 ,$22.94 ,$53.38 , N/A ,$24.09 ,$110.70 ,$51.62 ,$77.61 ,$73.80 ,$110.70 ,$22.94 ,$110.70 ,$110.70 ,$22.94 ,$79.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500254,85246,HC FACTOR VIII VW AG-90,305,1 ,$123.00 ,$79.95 ,$22.94 ,$123.00 ,$91.64 ,$80.57 ,$22.94 ,$64.82 ,$22.94 ,$77.61 ,$77.61 ,$77.61 ,$77.61 ,$110.70 ,$92.25 ,$22.94 ,$108.24 ,$22.94 ,$92.25 ,$92.25 ,$104.55 ,$104.55 ,$22.94 ,$104.55 ,$22.94 ,$97.17 ,$97.17 ,$97.17 ,$110.70 ,$57.35 ,$110.70 ,$22.94 ,$123.00 ,$80.57 ,$22.94 ,$53.38 , N/A ,$24.09 ,$110.70 ,$51.62 ,$77.61 ,$73.80 ,$110.70 ,$22.94 ,$110.70 ,$110.70 ,$22.94 ,$79.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500256,85250,HC FACTOR IX-90,305,1 ,$102.00 ,$66.30 ,$19.04 ,$102.00 ,$75.99 ,$66.81 ,$19.04 ,$53.75 ,$19.04 ,$64.36 ,$64.36 ,$64.36 ,$64.36 ,$91.80 ,$76.50 ,$19.04 ,$89.76 ,$19.04 ,$76.50 ,$76.50 ,$86.70 ,$86.70 ,$19.04 ,$86.70 ,$19.04 ,$80.58 ,$80.58 ,$80.58 ,$91.80 ,$47.60 ,$91.80 ,$19.04 ,$102.00 ,$66.81 ,$19.04 ,$44.27 , N/A ,$19.99 ,$91.80 ,$42.84 ,$64.36 ,$61.20 ,$91.80 ,$19.04 ,$91.80 ,$91.80 ,$19.04 ,$66.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500257,85260,HC FACTOR X-90,305,1 ,$96.00 ,$62.40 ,$17.90 ,$96.00 ,$71.52 ,$62.88 ,$17.90 ,$50.59 ,$17.90 ,$60.58 ,$60.58 ,$60.58 ,$60.58 ,$86.40 ,$72.00 ,$17.90 ,$84.48 ,$17.90 ,$72.00 ,$72.00 ,$81.60 ,$81.60 ,$17.90 ,$81.60 ,$17.90 ,$75.84 ,$75.84 ,$75.84 ,$86.40 ,$44.75 ,$86.40 ,$17.90 ,$96.00 ,$62.88 ,$17.90 ,$41.66 , N/A ,$18.80 ,$86.40 ,$40.28 ,$60.58 ,$57.60 ,$86.40 ,$17.90 ,$86.40 ,$86.40 ,$17.90 ,$62.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500258,85270,HC FACTOR XI-90,305,1 ,$96.00 ,$62.40 ,$17.90 ,$96.00 ,$71.52 ,$62.88 ,$17.90 ,$50.59 ,$17.90 ,$60.58 ,$60.58 ,$60.58 ,$60.58 ,$86.40 ,$72.00 ,$17.90 ,$84.48 ,$17.90 ,$72.00 ,$72.00 ,$81.60 ,$81.60 ,$17.90 ,$81.60 ,$17.90 ,$75.84 ,$75.84 ,$75.84 ,$86.40 ,$44.75 ,$86.40 ,$17.90 ,$96.00 ,$62.88 ,$17.90 ,$41.66 , N/A ,$18.80 ,$86.40 ,$40.28 ,$60.58 ,$57.60 ,$86.40 ,$17.90 ,$86.40 ,$86.40 ,$17.90 ,$62.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500259,85280,HC FACTOR XI-90,305,1 ,$104.00 ,$67.60 ,$19.35 ,$104.00 ,$77.48 ,$68.12 ,$19.35 ,$54.81 ,$19.35 ,$65.62 ,$65.62 ,$65.62 ,$65.62 ,$93.60 ,$78.00 ,$19.35 ,$91.52 ,$19.35 ,$78.00 ,$78.00 ,$88.40 ,$88.40 ,$19.35 ,$88.40 ,$19.35 ,$82.16 ,$82.16 ,$82.16 ,$93.60 ,$48.38 ,$93.60 ,$19.35 ,$104.00 ,$68.12 ,$19.35 ,$45.14 , N/A ,$20.32 ,$93.60 ,$43.54 ,$65.62 ,$62.40 ,$93.60 ,$19.35 ,$93.60 ,$93.60 ,$19.35 ,$67.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500261,85300,HC ANTITHROMBIN III ACT-90,305,1 ,$30.00 ,$19.50 ,$11.85 ,$30.00 ,$22.35 ,$19.65 ,$11.85 ,$15.81 ,$11.85 ,$18.93 ,$18.93 ,$18.93 ,$18.93 ,$27.00 ,$22.50 ,$11.85 ,$26.40 ,$11.85 ,$22.50 ,$22.50 ,$25.50 ,$25.50 ,$11.85 ,$25.50 ,$11.85 ,$23.70 ,$23.70 ,$23.70 ,$27.00 ,$29.63 ,$27.00 ,$11.85 ,$30.00 ,$19.65 ,$11.85 ,$13.02 , N/A ,$12.44 ,$27.00 ,$26.66 ,$18.93 ,$18.00 ,$27.00 ,$11.85 ,$27.00 ,$27.00 ,$11.85 ,$19.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500262,85301,HC ANTITHROMBIN III AG-90,305,1 ,$58.00 ,$37.70 ,$10.81 ,$58.00 ,$43.21 ,$37.99 ,$10.81 ,$30.57 ,$10.81 ,$36.60 ,$36.60 ,$36.60 ,$36.60 ,$52.20 ,$43.50 ,$10.81 ,$51.04 ,$10.81 ,$43.50 ,$43.50 ,$49.30 ,$49.30 ,$10.81 ,$49.30 ,$10.81 ,$45.82 ,$45.82 ,$45.82 ,$52.20 ,$27.03 ,$52.20 ,$10.81 ,$58.00 ,$37.99 ,$10.81 ,$25.17 , N/A ,$11.35 ,$52.20 ,$24.32 ,$36.60 ,$34.80 ,$52.20 ,$10.81 ,$52.20 ,$52.20 ,$10.81 ,$37.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500263,85302,HC PROTEIN C AG-90,305,1 ,$65.00 ,$42.25 ,$12.01 ,$65.00 ,$48.43 ,$42.58 ,$12.01 ,$34.26 ,$12.01 ,$41.02 ,$41.02 ,$41.02 ,$41.02 ,$58.50 ,$48.75 ,$12.01 ,$57.20 ,$12.01 ,$48.75 ,$48.75 ,$55.25 ,$55.25 ,$12.01 ,$55.25 ,$12.01 ,$51.35 ,$51.35 ,$51.35 ,$58.50 ,$30.03 ,$58.50 ,$12.01 ,$65.00 ,$42.58 ,$12.01 ,$28.21 , N/A ,$12.61 ,$58.50 ,$27.02 ,$41.02 ,$39.00 ,$58.50 ,$12.01 ,$58.50 ,$58.50 ,$12.01 ,$42.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500264,85303,HC PROTEIN C ACTIVITY-90,305,1 ,$66.00 ,$42.90 ,$13.84 ,$66.00 ,$49.17 ,$43.23 ,$13.84 ,$34.78 ,$13.84 ,$41.65 ,$41.65 ,$41.65 ,$41.65 ,$59.40 ,$49.50 ,$13.84 ,$58.08 ,$13.84 ,$49.50 ,$49.50 ,$56.10 ,$56.10 ,$13.84 ,$56.10 ,$13.84 ,$52.14 ,$52.14 ,$52.14 ,$59.40 ,$34.60 ,$59.40 ,$13.84 ,$66.00 ,$43.23 ,$13.84 ,$28.64 , N/A ,$14.53 ,$59.40 ,$31.14 ,$41.65 ,$39.60 ,$59.40 ,$13.84 ,$59.40 ,$59.40 ,$13.84 ,$42.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500265,85305,HC PROTEIN S TOTAL-90,305,1 ,$62.00 ,$40.30 ,$11.61 ,$62.00 ,$46.19 ,$40.61 ,$11.61 ,$32.67 ,$11.61 ,$39.12 ,$39.12 ,$39.12 ,$39.12 ,$55.80 ,$46.50 ,$11.61 ,$54.56 ,$11.61 ,$46.50 ,$46.50 ,$52.70 ,$52.70 ,$11.61 ,$52.70 ,$11.61 ,$48.98 ,$48.98 ,$48.98 ,$55.80 ,$29.03 ,$55.80 ,$11.61 ,$62.00 ,$40.61 ,$11.61 ,$26.91 , N/A ,$12.19 ,$55.80 ,$26.12 ,$39.12 ,$37.20 ,$55.80 ,$11.61 ,$55.80 ,$55.80 ,$11.61 ,$40.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500266,85306,HC PROTEIN S FREE-90,305,1 ,$82.00 ,$53.30 ,$15.32 ,$82.00 ,$61.09 ,$53.71 ,$15.32 ,$43.21 ,$15.32 ,$51.74 ,$51.74 ,$51.74 ,$51.74 ,$73.80 ,$61.50 ,$15.32 ,$72.16 ,$15.32 ,$61.50 ,$61.50 ,$69.70 ,$69.70 ,$15.32 ,$69.70 ,$15.32 ,$64.78 ,$64.78 ,$64.78 ,$73.80 ,$38.30 ,$73.80 ,$15.32 ,$82.00 ,$53.71 ,$15.32 ,$35.59 , N/A ,$16.09 ,$73.80 ,$34.47 ,$51.74 ,$49.20 ,$73.80 ,$15.32 ,$73.80 ,$73.80 ,$15.32 ,$53.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500267,85307,HC ACTIVATED PROTEIN C RESIST-90,305,1 ,$82.00 ,$53.30 ,$15.32 ,$82.00 ,$61.09 ,$53.71 ,$15.32 ,$43.21 ,$15.32 ,$51.74 ,$51.74 ,$51.74 ,$51.74 ,$73.80 ,$61.50 ,$15.32 ,$72.16 ,$15.32 ,$61.50 ,$61.50 ,$69.70 ,$69.70 ,$15.32 ,$69.70 ,$15.32 ,$64.78 ,$64.78 ,$64.78 ,$73.80 ,$38.30 ,$73.80 ,$15.32 ,$82.00 ,$53.71 ,$15.32 ,$35.59 , N/A ,$16.09 ,$73.80 ,$34.47 ,$51.74 ,$49.20 ,$73.80 ,$15.32 ,$73.80 ,$73.80 ,$15.32 ,$53.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500282,85461,HC FETAL HGB ROSETTE,305,1 ,$60.00 ,$39.00 ,$9.36 ,$60.00 ,$44.70 ,$39.30 ,$9.36 ,$31.62 ,$9.36 ,$37.86 ,$37.86 ,$37.86 ,$37.86 ,$54.00 ,$45.00 ,$9.36 ,$52.80 ,$9.36 ,$45.00 ,$45.00 ,$51.00 ,$51.00 ,$9.36 ,$51.00 ,$9.36 ,$47.40 ,$47.40 ,$47.40 ,$54.00 ,$23.40 ,$54.00 ,$9.36 ,$60.00 ,$39.30 ,$9.36 ,$26.04 , N/A ,$9.83 ,$54.00 ,$21.06 ,$37.86 ,$36.00 ,$54.00 ,$9.36 ,$54.00 ,$54.00 ,$9.36 ,$39.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500289,85597,HC PLATELET NEUTRALIZATION-90,305,1 ,$84.00 ,$54.60 ,$17.98 ,$84.00 ,$62.58 ,$55.02 ,$17.98 ,$44.27 ,$17.98 ,$53.00 ,$53.00 ,$53.00 ,$53.00 ,$75.60 ,$63.00 ,$17.98 ,$73.92 ,$17.98 ,$63.00 ,$63.00 ,$71.40 ,$71.40 ,$17.98 ,$71.40 ,$17.98 ,$66.36 ,$66.36 ,$66.36 ,$75.60 ,$44.95 ,$75.60 ,$17.98 ,$84.00 ,$55.02 ,$17.98 ,$36.46 , N/A ,$18.88 ,$75.60 ,$40.46 ,$53.00 ,$50.40 ,$75.60 ,$17.98 ,$75.60 ,$75.60 ,$17.98 ,$54.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500290,85598,HC HEXAGN NEUTRALIZATION PHOSPH-90,305,1 ,$84.00 ,$54.60 ,$17.98 ,$84.00 ,$62.58 ,$55.02 ,$17.98 ,$44.27 ,$17.98 ,$53.00 ,$53.00 ,$53.00 ,$53.00 ,$75.60 ,$63.00 ,$17.98 ,$73.92 ,$17.98 ,$63.00 ,$63.00 ,$71.40 ,$71.40 ,$17.98 ,$71.40 ,$17.98 ,$66.36 ,$66.36 ,$66.36 ,$75.60 ,$44.95 ,$75.60 ,$17.98 ,$84.00 ,$55.02 ,$17.98 ,$36.46 , N/A ,$18.88 ,$75.60 ,$40.46 ,$53.00 ,$50.40 ,$75.60 ,$17.98 ,$75.60 ,$75.60 ,$17.98 ,$54.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500297,85613,HC RUSSELL VIPER VENOM SCR T1-90,305,1 ,$45.00 ,$29.25 ,$9.58 ,$45.00 ,$33.53 ,$29.48 ,$9.58 ,$23.72 ,$9.58 ,$28.40 ,$28.40 ,$28.40 ,$28.40 ,$40.50 ,$33.75 ,$9.58 ,$39.60 ,$9.58 ,$33.75 ,$33.75 ,$38.25 ,$38.25 ,$9.58 ,$38.25 ,$9.58 ,$35.55 ,$35.55 ,$35.55 ,$40.50 ,$23.95 ,$40.50 ,$9.58 ,$45.00 ,$29.48 ,$9.58 ,$19.53 , N/A ,$10.06 ,$40.50 ,$21.56 ,$28.40 ,$27.00 ,$40.50 ,$9.58 ,$40.50 ,$40.50 ,$9.58 ,$29.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500304,85670,HC THROMBIN TIME PLASMA-90,305,1 ,$38.00 ,$24.70 ,$5.77 ,$38.00 ,$28.31 ,$24.89 ,$5.77 ,$20.03 ,$5.77 ,$23.98 ,$23.98 ,$23.98 ,$23.98 ,$34.20 ,$28.50 ,$5.77 ,$33.44 ,$5.77 ,$28.50 ,$28.50 ,$32.30 ,$32.30 ,$5.77 ,$32.30 ,$5.77 ,$30.02 ,$30.02 ,$30.02 ,$34.20 ,$14.43 ,$34.20 ,$5.77 ,$38.00 ,$24.89 ,$5.77 ,$16.49 , N/A ,$6.06 ,$34.20 ,$12.98 ,$23.98 ,$22.80 ,$34.20 ,$5.77 ,$34.20 ,$34.20 ,$5.77 ,$24.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500305,85730,HC PTT-90,305,1 ,$42.00 ,$27.30 ,$6.01 ,$42.00 ,$31.29 ,$27.51 ,$6.01 ,$22.13 ,$6.01 ,$26.50 ,$26.50 ,$26.50 ,$26.50 ,$37.80 ,$31.50 ,$6.01 ,$36.96 ,$6.01 ,$31.50 ,$31.50 ,$35.70 ,$35.70 ,$6.01 ,$35.70 ,$6.01 ,$33.18 ,$33.18 ,$33.18 ,$37.80 ,$15.03 ,$37.80 ,$6.01 ,$42.00 ,$27.51 ,$6.01 ,$18.23 , N/A ,$6.31 ,$37.80 ,$13.52 ,$26.50 ,$25.20 ,$37.80 ,$6.01 ,$37.80 ,$37.80 ,$6.01 ,$27.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500341,85046,HC BLOOD COUNT RETICULOCYTES AUTO,305,1 ,$56.00 ,$36.40 ,$5.57 ,$56.00 ,$41.72 ,$36.68 ,$5.57 ,$29.51 ,$5.57 ,$35.34 ,$35.34 ,$35.34 ,$35.34 ,$50.40 ,$42.00 ,$5.57 ,$49.28 ,$5.57 ,$42.00 ,$42.00 ,$47.60 ,$47.60 ,$5.57 ,$47.60 ,$5.57 ,$44.24 ,$44.24 ,$44.24 ,$50.40 ,$13.93 ,$50.40 ,$5.57 ,$56.00 ,$36.68 ,$5.57 ,$24.30 , N/A ,$5.85 ,$50.40 ,$12.53 ,$35.34 ,$33.60 ,$50.40 ,$5.57 ,$50.40 ,$50.40 ,$5.57 ,$36.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500829,85300,HC ANTITHROMBIN III ACT,305,1 ,$164.00 ,$106.60 ,$11.85 ,$164.00 ,$122.18 ,$107.42 ,$11.85 ,$86.43 ,$11.85 ,$103.48 ,$103.48 ,$103.48 ,$103.48 ,$147.60 ,$123.00 ,$11.85 ,$144.32 ,$11.85 ,$123.00 ,$123.00 ,$139.40 ,$139.40 ,$11.85 ,$139.40 ,$11.85 ,$129.56 ,$129.56 ,$129.56 ,$147.60 ,$29.63 ,$147.60 ,$11.85 ,$164.00 ,$107.42 ,$11.85 ,$71.18 , N/A ,$12.44 ,$147.60 ,$26.66 ,$103.48 ,$98.40 ,$147.60 ,$11.85 ,$147.60 ,$147.60 ,$11.85 ,$106.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500830,85362,HC FDP/FSP AGGLUT SQ,305,1 ,$75.00 ,$48.75 ,$6.89 ,$75.00 ,$55.88 ,$49.13 ,$6.89 ,$39.53 ,$6.89 ,$47.33 ,$47.33 ,$47.33 ,$47.33 ,$67.50 ,$56.25 ,$6.89 ,$66.00 ,$6.89 ,$56.25 ,$56.25 ,$63.75 ,$63.75 ,$6.89 ,$63.75 ,$6.89 ,$59.25 ,$59.25 ,$59.25 ,$67.50 ,$17.23 ,$67.50 ,$6.89 ,$75.00 ,$49.13 ,$6.89 ,$32.55 , N/A ,$7.23 ,$67.50 ,$15.50 ,$47.33 ,$45.00 ,$67.50 ,$6.89 ,$67.50 ,$67.50 ,$6.89 ,$48.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500833,85520,HC HEPARIN ASSAY,305,1 ,$245.00 ,$159.25 ,$13.09 ,$245.00 ,$182.53 ,$160.48 ,$13.09 ,$129.12 ,$13.09 ,$154.60 ,$154.60 ,$154.60 ,$154.60 ,$220.50 ,$183.75 ,$13.09 ,$215.60 ,$13.09 ,$183.75 ,$183.75 ,$208.25 ,$208.25 ,$13.09 ,$208.25 ,$13.09 ,$193.55 ,$193.55 ,$193.55 ,$220.50 ,$32.73 ,$220.50 ,$13.09 ,$245.00 ,$160.48 ,$13.09 ,$106.33 , N/A ,$13.74 ,$220.50 ,$29.45 ,$154.60 ,$147.00 ,$220.50 ,$13.09 ,$220.50 ,$220.50 ,$13.09 ,$159.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30500837,85610,HC PROTHROMBIN TIME (PT)-QW,305,1 ,$26.00 ,$16.90 ,$4.29 ,$26.00 ,$19.37 ,$17.03 ,$4.29 ,$13.70 ,$4.29 ,$16.41 ,$16.41 ,$16.41 ,$16.41 ,$23.40 ,$19.50 ,$4.29 ,$22.88 ,$4.29 ,$19.50 ,$19.50 ,$22.10 ,$22.10 ,$4.29 ,$22.10 ,$4.29 ,$20.54 ,$20.54 ,$20.54 ,$23.40 ,$10.73 ,$23.40 ,$4.29 ,$26.00 ,$17.03 ,$4.29 ,$11.28 , N/A ,$4.50 ,$23.40 ,$9.65 ,$16.41 ,$15.60 ,$23.40 ,$4.29 ,$23.40 ,$23.40 ,$4.29 ,$16.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600101,87015,HC CONCENTRATION INFECTIOUS AGENT,306,1 ,$44.00 ,$28.60 ,$6.68 ,$44.00 ,$32.78 ,$28.82 ,$6.68 ,$23.19 ,$6.68 ,$27.76 ,$27.76 ,$27.76 ,$27.76 ,$39.60 ,$33.00 ,$6.68 ,$38.72 ,$6.68 ,$33.00 ,$33.00 ,$37.40 ,$37.40 ,$6.68 ,$37.40 ,$6.68 ,$34.76 ,$34.76 ,$34.76 ,$39.60 ,$16.70 ,$39.60 ,$6.68 ,$44.00 ,$28.82 ,$6.68 ,$19.10 , N/A ,$7.01 ,$39.60 ,$15.03 ,$27.76 ,$26.40 ,$39.60 ,$6.68 ,$39.60 ,$39.60 ,$6.68 ,$28.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600102,87040,HC BLOOD CULTURE,306,1 ,$80.00 ,$52.00 ,$10.32 ,$80.00 ,$59.60 ,$52.40 ,$10.32 ,$42.16 ,$10.32 ,$50.48 ,$50.48 ,$50.48 ,$50.48 ,$72.00 ,$60.00 ,$10.32 ,$70.40 ,$10.32 ,$60.00 ,$60.00 ,$68.00 ,$68.00 ,$10.32 ,$68.00 ,$10.32 ,$63.20 ,$63.20 ,$63.20 ,$72.00 ,$25.80 ,$72.00 ,$10.32 ,$80.00 ,$52.40 ,$10.32 ,$34.72 , N/A ,$10.84 ,$72.00 ,$23.22 ,$50.48 ,$48.00 ,$72.00 ,$10.32 ,$72.00 ,$72.00 ,$10.32 ,$52.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600109,87070,HC BODY FLUID CULTURE,306,1 ,$119.00 ,$77.35 ,$8.62 ,$119.00 ,$88.66 ,$77.95 ,$8.62 ,$62.71 ,$8.62 ,$75.09 ,$75.09 ,$75.09 ,$75.09 ,$107.10 ,$89.25 ,$8.62 ,$104.72 ,$8.62 ,$89.25 ,$89.25 ,$101.15 ,$101.15 ,$8.62 ,$101.15 ,$8.62 ,$94.01 ,$94.01 ,$94.01 ,$107.10 ,$21.55 ,$107.10 ,$8.62 ,$119.00 ,$77.95 ,$8.62 ,$51.65 , N/A ,$9.05 ,$107.10 ,$19.40 ,$75.09 ,$71.40 ,$107.10 ,$8.62 ,$107.10 ,$107.10 ,$8.62 ,$77.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600119,87075,HC CULTURE ANAEROBIC,306,1 ,$231.00 ,$150.15 ,$9.47 ,$231.00 ,$172.10 ,$151.31 ,$9.47 ,$121.74 ,$9.47 ,$145.76 ,$145.76 ,$145.76 ,$145.76 ,$207.90 ,$173.25 ,$9.47 ,$203.28 ,$9.47 ,$173.25 ,$173.25 ,$196.35 ,$196.35 ,$9.47 ,$196.35 ,$9.47 ,$182.49 ,$182.49 ,$182.49 ,$207.90 ,$23.68 ,$207.90 ,$9.47 ,$231.00 ,$151.31 ,$9.47 ,$100.25 , N/A ,$9.94 ,$207.90 ,$21.31 ,$145.76 ,$138.60 ,$207.90 ,$9.47 ,$207.90 ,$207.90 ,$9.47 ,$150.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600134,87086,HC CULTURE URINE W/COLONY CT,306,1 ,$107.00 ,$69.55 ,$8.07 ,$107.00 ,$79.72 ,$70.09 ,$8.07 ,$56.39 ,$8.07 ,$67.52 ,$67.52 ,$67.52 ,$67.52 ,$96.30 ,$80.25 ,$8.07 ,$94.16 ,$8.07 ,$80.25 ,$80.25 ,$90.95 ,$90.95 ,$8.07 ,$90.95 ,$8.07 ,$84.53 ,$84.53 ,$84.53 ,$96.30 ,$20.18 ,$96.30 ,$8.07 ,$107.00 ,$70.09 ,$8.07 ,$46.44 , N/A ,$8.47 ,$96.30 ,$18.16 ,$67.52 ,$64.20 ,$96.30 ,$8.07 ,$96.30 ,$96.30 ,$8.07 ,$69.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600135,87088,HC CULTURE URINE ID EA ISOL,306,1 ,$42.00 ,$27.30 ,$8.09 ,$42.00 ,$31.29 ,$27.51 ,$8.09 ,$22.13 ,$8.09 ,$26.50 ,$26.50 ,$26.50 ,$26.50 ,$37.80 ,$31.50 ,$8.09 ,$36.96 ,$8.09 ,$31.50 ,$31.50 ,$35.70 ,$35.70 ,$8.09 ,$35.70 ,$8.09 ,$33.18 ,$33.18 ,$33.18 ,$37.80 ,$20.23 ,$37.80 ,$8.09 ,$42.00 ,$27.51 ,$8.09 ,$18.23 , N/A ,$8.49 ,$37.80 ,$18.20 ,$26.50 ,$25.20 ,$37.80 ,$8.09 ,$37.80 ,$37.80 ,$8.09 ,$27.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600160,87150,HC ID NUCLEAR ACID PROBE,306,1 ,$55.00 ,$35.75 ,$23.87 ,$78.95 ,$40.98 ,$36.03 ,$35.09 ,$28.99 ,$35.09 ,$34.71 ,$34.71 ,$34.71 ,$34.71 ,$49.50 ,$41.25 ,$35.09 ,$48.40 ,$35.09 ,$41.25 ,$41.25 ,$46.75 ,$46.75 ,$35.09 ,$46.75 ,$35.09 ,$43.45 ,$43.45 ,$43.45 ,$49.50 ,$55.00 ,$49.50 ,$35.09 ,$55.00 ,$36.03 ,$35.09 ,$23.87 , N/A ,$36.84 ,$49.50 ,$78.95 ,$34.71 ,$33.00 ,$49.50 ,$35.09 ,$49.50 ,$49.50 ,$35.09 ,$35.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600161,87168,HC EXAM ARTHROPOD,306,1 ,$104.00 ,$67.60 ,$4.27 ,$104.00 ,$77.48 ,$68.12 ,$4.27 ,$54.81 ,$4.27 ,$65.62 ,$65.62 ,$65.62 ,$65.62 ,$93.60 ,$78.00 ,$4.27 ,$91.52 ,$4.27 ,$78.00 ,$78.00 ,$88.40 ,$88.40 ,$4.27 ,$88.40 ,$4.27 ,$82.16 ,$82.16 ,$82.16 ,$93.60 ,$10.68 ,$93.60 ,$4.27 ,$104.00 ,$68.12 ,$4.27 ,$45.14 , N/A ,$4.48 ,$93.60 ,$9.61 ,$65.62 ,$62.40 ,$93.60 ,$4.27 ,$93.60 ,$93.60 ,$4.27 ,$67.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600163,87172,HC PINWORM EXAM,306,1 ,$54.00 ,$35.10 ,$4.27 ,$54.00 ,$40.23 ,$35.37 ,$4.27 ,$28.46 ,$4.27 ,$34.07 ,$34.07 ,$34.07 ,$34.07 ,$48.60 ,$40.50 ,$4.27 ,$47.52 ,$4.27 ,$40.50 ,$40.50 ,$45.90 ,$45.90 ,$4.27 ,$45.90 ,$4.27 ,$42.66 ,$42.66 ,$42.66 ,$48.60 ,$10.68 ,$48.60 ,$4.27 ,$54.00 ,$35.37 ,$4.27 ,$23.44 , N/A ,$4.48 ,$48.60 ,$9.61 ,$34.07 ,$32.40 ,$48.60 ,$4.27 ,$48.60 ,$48.60 ,$4.27 ,$35.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600166,87181,HC SENSITIVITY STUDY AGAR,306,1 ,$22.00 ,$14.30 ,$4.75 ,$22.00 ,$16.39 ,$14.41 ,$4.75 ,$11.59 ,$4.75 ,$13.88 ,$13.88 ,$13.88 ,$13.88 ,$19.80 ,$16.50 ,$4.75 ,$19.36 ,$4.75 ,$16.50 ,$16.50 ,$18.70 ,$18.70 ,$4.75 ,$18.70 ,$4.75 ,$17.38 ,$17.38 ,$17.38 ,$19.80 ,$11.88 ,$19.80 ,$4.75 ,$22.00 ,$14.41 ,$4.75 ,$9.55 , N/A ,$4.99 ,$19.80 ,$10.69 ,$13.88 ,$13.20 ,$19.80 ,$4.75 ,$19.80 ,$19.80 ,$4.75 ,$14.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600172,87186,HC SENSITIVITY MIC,306,1 ,$54.00 ,$35.10 ,$8.65 ,$54.00 ,$40.23 ,$35.37 ,$8.65 ,$28.46 ,$8.65 ,$34.07 ,$34.07 ,$34.07 ,$34.07 ,$48.60 ,$40.50 ,$8.65 ,$47.52 ,$8.65 ,$40.50 ,$40.50 ,$45.90 ,$45.90 ,$8.65 ,$45.90 ,$8.65 ,$42.66 ,$42.66 ,$42.66 ,$48.60 ,$21.63 ,$48.60 ,$8.65 ,$54.00 ,$35.37 ,$8.65 ,$23.44 , N/A ,$9.08 ,$48.60 ,$19.46 ,$34.07 ,$32.40 ,$48.60 ,$8.65 ,$48.60 ,$48.60 ,$8.65 ,$35.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600174,87205,HC SMEAR GRAM/GIEMSA,306,1 ,$43.00 ,$27.95 ,$4.27 ,$43.00 ,$32.04 ,$28.17 ,$4.27 ,$22.66 ,$4.27 ,$27.13 ,$27.13 ,$27.13 ,$27.13 ,$38.70 ,$32.25 ,$4.27 ,$37.84 ,$4.27 ,$32.25 ,$32.25 ,$36.55 ,$36.55 ,$4.27 ,$36.55 ,$4.27 ,$33.97 ,$33.97 ,$33.97 ,$38.70 ,$10.68 ,$38.70 ,$4.27 ,$43.00 ,$28.17 ,$4.27 ,$18.66 , N/A ,$4.48 ,$38.70 ,$9.61 ,$27.13 ,$25.80 ,$38.70 ,$4.27 ,$38.70 ,$38.70 ,$4.27 ,$27.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600183,87210,HC SMEAR WET MOUNT,306,1 ,$74.00 ,$48.10 ,$5.82 ,$74.00 ,$55.13 ,$48.47 ,$5.82 ,$39.00 ,$5.82 ,$46.69 ,$46.69 ,$46.69 ,$46.69 ,$66.60 ,$55.50 ,$5.82 ,$65.12 ,$5.82 ,$55.50 ,$55.50 ,$62.90 ,$62.90 ,$5.82 ,$62.90 ,$5.82 ,$58.46 ,$58.46 ,$58.46 ,$66.60 ,$14.55 ,$66.60 ,$5.82 ,$74.00 ,$48.47 ,$5.82 ,$32.12 , N/A ,$6.11 ,$66.60 ,$13.10 ,$46.69 ,$44.40 ,$66.60 ,$5.82 ,$66.60 ,$66.60 ,$5.82 ,$48.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600213,87324,HC EIA QL CLOS DIFF TOXIN AG,306,1 ,$40.00 ,$26.00 ,$11.98 ,$40.00 ,$29.80 ,$26.20 ,$11.98 ,$21.08 ,$11.98 ,$25.24 ,$25.24 ,$25.24 ,$25.24 ,$36.00 ,$30.00 ,$11.98 ,$35.20 ,$11.98 ,$30.00 ,$30.00 ,$34.00 ,$34.00 ,$11.98 ,$34.00 ,$11.98 ,$31.60 ,$31.60 ,$31.60 ,$36.00 ,$29.95 ,$36.00 ,$11.98 ,$40.00 ,$26.20 ,$11.98 ,$17.36 , N/A ,$12.58 ,$36.00 ,$26.96 ,$25.24 ,$24.00 ,$36.00 ,$11.98 ,$36.00 ,$36.00 ,$11.98 ,$26.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600217,87338,HC EIA QL H PYLORI AG STOOL,306,1 ,$111.00 ,$72.15 ,$14.38 ,$111.00 ,$82.70 ,$72.71 ,$14.38 ,$58.50 ,$14.38 ,$70.04 ,$70.04 ,$70.04 ,$70.04 ,$99.90 ,$83.25 ,$14.38 ,$97.68 ,$14.38 ,$83.25 ,$83.25 ,$94.35 ,$94.35 ,$14.38 ,$94.35 ,$14.38 ,$87.69 ,$87.69 ,$87.69 ,$99.90 ,$35.95 ,$99.90 ,$14.38 ,$111.00 ,$72.71 ,$14.38 ,$48.17 , N/A ,$15.10 ,$99.90 ,$32.36 ,$70.04 ,$66.60 ,$99.90 ,$14.38 ,$99.90 ,$99.90 ,$14.38 ,$72.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600228,87430,HC RAPID STREP,306,1 ,$57.00 ,$37.05 ,$16.81 ,$57.00 ,$42.47 ,$37.34 ,$16.81 ,$30.04 ,$16.81 ,$35.97 ,$35.97 ,$35.97 ,$35.97 ,$51.30 ,$42.75 ,$16.81 ,$50.16 ,$16.81 ,$42.75 ,$42.75 ,$48.45 ,$48.45 ,$16.81 ,$48.45 ,$16.81 ,$45.03 ,$45.03 ,$45.03 ,$51.30 ,$42.03 ,$51.30 ,$16.81 ,$57.00 ,$37.34 ,$16.81 ,$24.74 , N/A ,$17.65 ,$51.30 ,$37.82 ,$35.97 ,$34.20 ,$51.30 ,$16.81 ,$51.30 ,$51.30 ,$16.81 ,$37.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600237,87493,HC CLOSTRIDUM DIFFICILE,306,1 ,$208.00 ,$135.20 ,$37.27 ,$208.00 ,$154.96 ,$136.24 ,$37.27 ,$109.62 ,$37.27 ,$131.25 ,$131.25 ,$131.25 ,$131.25 ,$187.20 ,$156.00 ,$37.27 ,$183.04 ,$37.27 ,$156.00 ,$156.00 ,$176.80 ,$176.80 ,$37.27 ,$176.80 ,$37.27 ,$164.32 ,$164.32 ,$164.32 ,$187.20 ,$93.18 ,$187.20 ,$37.27 ,$208.00 ,$136.24 ,$37.27 ,$90.27 , N/A ,$39.13 ,$187.20 ,$83.86 ,$131.25 ,$124.80 ,$187.20 ,$37.27 ,$187.20 ,$187.20 ,$37.27 ,$135.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600252,87624,HC HPV AMP,306,1 ,$137.00 ,$89.05 ,$35.09 ,$137.00 ,$102.07 ,$89.74 ,$35.09 ,$72.20 ,$35.09 ,$86.45 ,$86.45 ,$86.45 ,$86.45 ,$123.30 ,$102.75 ,$35.09 ,$120.56 ,$35.09 ,$102.75 ,$102.75 ,$116.45 ,$116.45 ,$35.09 ,$116.45 ,$35.09 ,$108.23 ,$108.23 ,$108.23 ,$123.30 ,$87.73 ,$123.30 ,$35.09 ,$35.09 ,$89.74 ,$35.09 ,$59.46 , N/A ,$36.84 ,$123.30 ,$78.95 ,$86.45 ,$82.20 ,$123.30 ,$35.09 ,$123.30 ,$123.30 ,$35.09 ,$89.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600255,87641,HC MRSA AMP,306,1 ,$171.00 ,$111.15 ,$35.09 ,$171.00 ,$127.40 ,$112.01 ,$35.09 ,$90.12 ,$35.09 ,$107.90 ,$107.90 ,$107.90 ,$107.90 ,$153.90 ,$128.25 ,$35.09 ,$150.48 ,$35.09 ,$128.25 ,$128.25 ,$145.35 ,$145.35 ,$35.09 ,$145.35 ,$35.09 ,$135.09 ,$135.09 ,$135.09 ,$153.90 ,$87.73 ,$153.90 ,$35.09 ,$171.00 ,$112.01 ,$35.09 ,$74.21 , N/A ,$36.84 ,$153.90 ,$78.95 ,$107.90 ,$102.60 ,$153.90 ,$35.09 ,$153.90 ,$153.90 ,$35.09 ,$111.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600257,87653,HC INFECT AMP (GRP B STREP),306,1 ,$78.00 ,$50.70 ,$33.85 ,$78.95 ,$58.11 ,$51.09 ,$35.09 ,$41.11 ,$35.09 ,$49.22 ,$49.22 ,$49.22 ,$49.22 ,$70.20 ,$58.50 ,$35.09 ,$68.64 ,$35.09 ,$58.50 ,$58.50 ,$66.30 ,$66.30 ,$35.09 ,$66.30 ,$35.09 ,$61.62 ,$61.62 ,$61.62 ,$70.20 ,$78.00 ,$70.20 ,$35.09 ,$78.00 ,$51.09 ,$35.09 ,$33.85 , N/A ,$36.84 ,$70.20 ,$78.95 ,$49.22 ,$46.80 ,$70.20 ,$35.09 ,$70.20 ,$70.20 ,$35.09 ,$50.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600269,87807,HC QL RSV,306,1 ,$129.00 ,$83.85 ,$13.10 ,$129.00 ,$96.11 ,$84.50 ,$13.10 ,$67.98 ,$13.10 ,$81.40 ,$81.40 ,$81.40 ,$81.40 ,$116.10 ,$96.75 ,$13.10 ,$113.52 ,$13.10 ,$96.75 ,$96.75 ,$109.65 ,$109.65 ,$13.10 ,$109.65 ,$13.10 ,$101.91 ,$101.91 ,$101.91 ,$116.10 ,$32.75 ,$116.10 ,$13.10 ,$129.00 ,$84.50 ,$13.10 ,$55.99 , N/A ,$13.76 ,$116.10 ,$29.48 ,$81.40 ,$77.40 ,$116.10 ,$13.10 ,$116.10 ,$116.10 ,$13.10 ,$83.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600283,87804,HC QL INFLUENZA A/B,306,1 ,$62.00 ,$40.30 ,$16.55 ,$62.00 ,$46.19 ,$40.61 ,$16.55 ,$32.67 ,$16.55 ,$39.12 ,$39.12 ,$39.12 ,$39.12 ,$55.80 ,$46.50 ,$16.55 ,$54.56 ,$16.55 ,$46.50 ,$46.50 ,$52.70 ,$52.70 ,$16.55 ,$52.70 ,$16.55 ,$48.98 ,$48.98 ,$48.98 ,$55.80 ,$41.38 ,$55.80 ,$16.55 ,$62.00 ,$40.61 ,$16.55 ,$26.91 , N/A ,$17.38 ,$55.80 ,$37.24 ,$39.12 ,$37.20 ,$55.80 ,$16.55 ,$55.80 ,$55.80 ,$16.55 ,$40.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600314,87340,HC EIA QL HEPATITIS B AG,306,1 ,$123.00 ,$79.95 ,$10.33 ,$123.00 ,$91.64 ,$80.57 ,$10.33 ,$64.82 ,$10.33 ,$77.61 ,$77.61 ,$77.61 ,$77.61 ,$110.70 ,$92.25 ,$10.33 ,$108.24 ,$10.33 ,$92.25 ,$92.25 ,$104.55 ,$104.55 ,$10.33 ,$104.55 ,$10.33 ,$97.17 ,$97.17 ,$97.17 ,$110.70 ,$25.83 ,$110.70 ,$10.33 ,$123.00 ,$80.57 ,$10.33 ,$53.38 , N/A ,$10.85 ,$110.70 ,$23.24 ,$77.61 ,$73.80 ,$110.70 ,$10.33 ,$110.70 ,$110.70 ,$10.33 ,$79.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600316,87389,HC HIV-1 AG W/HIV-1 AND HIV-2 AB,306,1 ,$129.00 ,$83.85 ,$24.08 ,$129.00 ,$96.11 ,$84.50 ,$24.08 ,$67.98 ,$24.08 ,$81.40 ,$81.40 ,$81.40 ,$81.40 ,$116.10 ,$96.75 ,$24.08 ,$113.52 ,$24.08 ,$96.75 ,$96.75 ,$109.65 ,$109.65 ,$24.08 ,$109.65 ,$24.08 ,$101.91 ,$101.91 ,$101.91 ,$116.10 ,$60.20 ,$116.10 ,$24.08 ,$129.00 ,$84.50 ,$24.08 ,$55.99 , N/A ,$25.28 ,$116.10 ,$54.18 ,$81.40 ,$77.40 ,$116.10 ,$24.08 ,$116.10 ,$116.10 ,$24.08 ,$83.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600333,87808,HC TRICHOMONAS VAGINITIS OPTICAL,306,1 ,$74.00 ,$48.10 ,$15.29 ,$74.00 ,$55.13 ,$48.47 ,$15.29 ,$39.00 ,$15.29 ,$46.69 ,$46.69 ,$46.69 ,$46.69 ,$66.60 ,$55.50 ,$15.29 ,$65.12 ,$15.29 ,$55.50 ,$55.50 ,$62.90 ,$62.90 ,$15.29 ,$62.90 ,$15.29 ,$58.46 ,$58.46 ,$58.46 ,$66.60 ,$38.23 ,$66.60 ,$15.29 ,$74.00 ,$48.47 ,$15.29 ,$32.12 , N/A ,$16.05 ,$66.60 ,$34.40 ,$46.69 ,$44.40 ,$66.60 ,$15.29 ,$66.60 ,$66.60 ,$15.29 ,$48.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600336,87507,HC IF AG DNA/RNA PROBE TQ 12-25 TARGETS,306,1 ,$653.00 ,$424.45 ,$283.40 ,$937.76 ,$486.49 ,$427.72 ,$416.78 ,$344.13 ,$416.78 ,$412.04 ,$412.04 ,$412.04 ,$412.04 ,$587.70 ,$489.75 ,$416.78 ,$574.64 ,$416.78 ,$489.75 ,$489.75 ,$555.05 ,$555.05 ,$416.78 ,$555.05 ,$416.78 ,$515.87 ,$515.87 ,$515.87 ,$587.70 ,$653.00 ,$587.70 ,$416.78 ,$653.00 ,$427.72 ,$416.78 ,$283.40 , N/A ,$437.62 ,$587.70 ,$937.76 ,$412.04 ,$391.80 ,$587.70 ,$416.78 ,$587.70 ,$587.70 ,$416.78 ,$424.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600338,87581,HC IF AG PROBE MYCOPLASMA PNEUMONIAE,306,1 ,$55.00 ,$35.75 ,$23.87 ,$78.95 ,$40.98 ,$36.03 ,$35.09 ,$28.99 ,$35.09 ,$34.71 ,$34.71 ,$34.71 ,$34.71 ,$49.50 ,$41.25 ,$35.09 ,$48.40 ,$35.09 ,$41.25 ,$41.25 ,$46.75 ,$46.75 ,$35.09 ,$46.75 ,$35.09 ,$43.45 ,$43.45 ,$43.45 ,$49.50 ,$55.00 ,$49.50 ,$35.09 ,$55.00 ,$36.03 ,$35.09 ,$23.87 , N/A ,$36.84 ,$49.50 ,$78.95 ,$34.71 ,$33.00 ,$49.50 ,$35.09 ,$49.50 ,$49.50 ,$35.09 ,$35.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600339,87633,HC IF AG RESP VIRUS MAP 12-25 TARGETS,306,1 ,$653.00 ,$424.45 ,$283.40 ,$937.76 ,$486.49 ,$427.72 ,$416.78 ,$344.13 ,$416.78 ,$412.04 ,$412.04 ,$412.04 ,$412.04 ,$587.70 ,$489.75 ,$416.78 ,$574.64 ,$416.78 ,$489.75 ,$489.75 ,$555.05 ,$555.05 ,$416.78 ,$555.05 ,$416.78 ,$515.87 ,$515.87 ,$515.87 ,$587.70 ,$653.00 ,$587.70 ,$416.78 ,$653.00 ,$427.72 ,$416.78 ,$283.40 , N/A ,$437.62 ,$587.70 ,$937.76 ,$412.04 ,$391.80 ,$587.70 ,$416.78 ,$587.70 ,$587.70 ,$416.78 ,$424.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600348,87483,HC INFECT AMP CNS DNA/RNA 14 TARGETS,306,1 ,$697.00 ,$453.05 ,$302.50 ,$937.76 ,$519.27 ,$456.54 ,$416.78 ,$367.32 ,$416.78 ,$439.81 ,$439.81 ,$439.81 ,$439.81 ,$627.30 ,$522.75 ,$416.78 ,$613.36 ,$416.78 ,$522.75 ,$522.75 ,$592.45 ,$592.45 ,$416.78 ,$592.45 ,$416.78 ,$550.63 ,$550.63 ,$550.63 ,$627.30 ,$697.00 ,$627.30 ,$416.78 ,$697.00 ,$456.54 ,$416.78 ,$302.50 , N/A ,$437.62 ,$627.30 ,$937.76 ,$439.81 ,$418.20 ,$627.30 ,$416.78 ,$627.30 ,$627.30 ,$416.78 ,$453.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600357,87077,HC CULTURE AEROBIC ID ADDL T1,306,1 ,$12.00 ,$7.80 ,$5.21 ,$18.18 ,$8.94 ,$7.86 ,$8.08 ,$6.32 ,$8.08 ,$7.57 ,$7.57 ,$7.57 ,$7.57 ,$10.80 ,$9.00 ,$8.08 ,$10.56 ,$8.08 ,$9.00 ,$9.00 ,$10.20 ,$10.20 ,$8.08 ,$10.20 ,$8.08 ,$9.48 ,$9.48 ,$9.48 ,$10.80 ,$12.00 ,$10.80 ,$8.08 ,$12.00 ,$7.86 ,$8.08 ,$5.21 , N/A ,$8.48 ,$10.80 ,$18.18 ,$7.57 ,$7.20 ,$10.80 ,$8.08 ,$10.80 ,$10.80 ,$8.08 ,$7.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600360,87081,HC CULTURE SCR PRESUMP PATHOGENS T1,306,1 ,$66.00 ,$42.90 ,$6.63 ,$66.00 ,$49.17 ,$43.23 ,$6.63 ,$34.78 ,$6.63 ,$41.65 ,$41.65 ,$41.65 ,$41.65 ,$59.40 ,$49.50 ,$6.63 ,$58.08 ,$6.63 ,$49.50 ,$49.50 ,$56.10 ,$56.10 ,$6.63 ,$56.10 ,$6.63 ,$52.14 ,$52.14 ,$52.14 ,$59.40 ,$16.58 ,$59.40 ,$6.63 ,$66.00 ,$43.23 ,$6.63 ,$28.64 , N/A ,$6.96 ,$59.40 ,$14.92 ,$41.65 ,$39.60 ,$59.40 ,$6.63 ,$59.40 ,$59.40 ,$6.63 ,$42.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600368,87116,HC CULTURE AFB/TB/MYCOBACT-90,306,1 ,$87.40 ,$56.81 ,$10.80 ,$87.40 ,$65.11 ,$57.25 ,$10.80 ,$46.06 ,$10.80 ,$55.15 ,$55.15 ,$55.15 ,$55.15 ,$78.66 ,$65.55 ,$10.80 ,$76.91 ,$10.80 ,$65.55 ,$65.55 ,$74.29 ,$74.29 ,$10.80 ,$74.29 ,$10.80 ,$69.05 ,$69.05 ,$69.05 ,$78.66 ,$27.00 ,$78.66 ,$10.80 ,$87.40 ,$57.25 ,$10.80 ,$37.93 , N/A ,$11.34 ,$78.66 ,$24.30 ,$55.15 ,$52.44 ,$78.66 ,$10.80 ,$78.66 ,$78.66 ,$10.80 ,$56.81 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600369,87118,HC CULTURE MYCOBACTERIA ID-90,306,1 ,$105.00 ,$68.25 ,$14.61 ,$105.00 ,$78.23 ,$68.78 ,$14.61 ,$55.34 ,$14.61 ,$66.26 ,$66.26 ,$66.26 ,$66.26 ,$94.50 ,$78.75 ,$14.61 ,$92.40 ,$14.61 ,$78.75 ,$78.75 ,$89.25 ,$89.25 ,$14.61 ,$89.25 ,$14.61 ,$82.95 ,$82.95 ,$82.95 ,$94.50 ,$36.53 ,$94.50 ,$14.61 ,$105.00 ,$68.78 ,$14.61 ,$45.57 , N/A ,$15.34 ,$94.50 ,$32.87 ,$66.26 ,$63.00 ,$94.50 ,$14.61 ,$94.50 ,$94.50 ,$14.61 ,$68.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600370,87140,HC CULTURE TYPE IF EA ANTISERUM-90,306,1 ,$9.10 ,$5.92 ,$3.95 ,$12.53 ,$6.78 ,$5.96 ,$5.57 ,$4.80 ,$5.57 ,$5.74 ,$5.74 ,$5.74 ,$5.74 ,$8.19 ,$6.83 ,$5.57 ,$8.01 ,$5.57 ,$6.83 ,$6.83 ,$7.74 ,$7.74 ,$5.57 ,$7.74 ,$5.57 ,$7.19 ,$7.19 ,$7.19 ,$8.19 ,$9.10 ,$8.19 ,$5.57 ,$9.10 ,$5.96 ,$5.57 ,$3.95 , N/A ,$5.85 ,$8.19 ,$12.53 ,$5.74 ,$5.46 ,$8.19 ,$5.57 ,$8.19 ,$8.19 ,$5.57 ,$5.92 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600380,87177,HC SMEAR OVA PARASITE CONC/ID-90,306,1 ,$99.00 ,$64.35 ,$8.90 ,$99.00 ,$73.76 ,$64.85 ,$8.90 ,$52.17 ,$8.90 ,$62.47 ,$62.47 ,$62.47 ,$62.47 ,$89.10 ,$74.25 ,$8.90 ,$87.12 ,$8.90 ,$74.25 ,$74.25 ,$84.15 ,$84.15 ,$8.90 ,$84.15 ,$8.90 ,$78.21 ,$78.21 ,$78.21 ,$89.10 ,$22.25 ,$89.10 ,$8.90 ,$99.00 ,$64.85 ,$8.90 ,$42.97 , N/A ,$9.35 ,$89.10 ,$20.03 ,$62.47 ,$59.40 ,$89.10 ,$8.90 ,$89.10 ,$89.10 ,$8.90 ,$64.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600389,87186,HC SENSITIVITY MIC EA AD PLATE-90,306,1 ,$54.00 ,$35.10 ,$8.65 ,$54.00 ,$40.23 ,$35.37 ,$8.65 ,$28.46 ,$8.65 ,$34.07 ,$34.07 ,$34.07 ,$34.07 ,$48.60 ,$40.50 ,$8.65 ,$47.52 ,$8.65 ,$40.50 ,$40.50 ,$45.90 ,$45.90 ,$8.65 ,$45.90 ,$8.65 ,$42.66 ,$42.66 ,$42.66 ,$48.60 ,$21.63 ,$48.60 ,$8.65 ,$54.00 ,$35.37 ,$8.65 ,$23.44 , N/A ,$9.08 ,$48.60 ,$19.46 ,$34.07 ,$32.40 ,$48.60 ,$8.65 ,$48.60 ,$48.60 ,$8.65 ,$35.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600395,87206,HC SMEAR ACID FAST/FLUOR-90,306,1 ,$167.00 ,$108.55 ,$5.39 ,$167.00 ,$124.42 ,$109.39 ,$5.39 ,$88.01 ,$5.39 ,$105.38 ,$105.38 ,$105.38 ,$105.38 ,$150.30 ,$125.25 ,$5.39 ,$146.96 ,$5.39 ,$125.25 ,$125.25 ,$141.95 ,$141.95 ,$5.39 ,$141.95 ,$5.39 ,$131.93 ,$131.93 ,$131.93 ,$150.30 ,$13.48 ,$150.30 ,$5.39 ,$167.00 ,$109.39 ,$5.39 ,$72.48 , N/A ,$5.66 ,$150.30 ,$12.13 ,$105.38 ,$100.20 ,$150.30 ,$5.39 ,$150.30 ,$150.30 ,$5.39 ,$108.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600402,87252,HC CULTURE VIRUS ID TISSUE-90,306,1 ,$214.00 ,$139.10 ,$26.07 ,$214.00 ,$159.43 ,$140.17 ,$26.07 ,$112.78 ,$26.07 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$26.07 ,$188.32 ,$26.07 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$26.07 ,$181.90 ,$26.07 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$65.18 ,$192.60 ,$26.07 ,$214.00 ,$140.17 ,$26.07 ,$92.88 , N/A ,$27.37 ,$192.60 ,$58.66 ,$135.03 ,$128.40 ,$192.60 ,$26.07 ,$192.60 ,$192.60 ,$26.07 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600405,87254,HC VIRUS ISOL SHELL ID-90,306,1 ,$104.80 ,$68.12 ,$19.56 ,$104.80 ,$78.08 ,$68.64 ,$19.56 ,$55.23 ,$19.56 ,$66.13 ,$66.13 ,$66.13 ,$66.13 ,$94.32 ,$78.60 ,$19.56 ,$92.22 ,$19.56 ,$78.60 ,$78.60 ,$89.08 ,$89.08 ,$19.56 ,$89.08 ,$19.56 ,$82.79 ,$82.79 ,$82.79 ,$94.32 ,$48.90 ,$94.32 ,$19.56 ,$104.80 ,$68.64 ,$19.56 ,$45.48 , N/A ,$20.54 ,$94.32 ,$44.01 ,$66.13 ,$62.88 ,$94.32 ,$19.56 ,$94.32 ,$94.32 ,$19.56 ,$68.12 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600415,87305,HC EIA QL ASPERGILLUS AG-90,306,1 ,$160.00 ,$104.00 ,$11.98 ,$160.00 ,$119.20 ,$104.80 ,$11.98 ,$84.32 ,$11.98 ,$100.96 ,$100.96 ,$100.96 ,$100.96 ,$144.00 ,$120.00 ,$11.98 ,$140.80 ,$11.98 ,$120.00 ,$120.00 ,$136.00 ,$136.00 ,$11.98 ,$136.00 ,$11.98 ,$126.40 ,$126.40 ,$126.40 ,$144.00 ,$29.95 ,$144.00 ,$11.98 ,$160.00 ,$104.80 ,$11.98 ,$69.44 , N/A ,$12.58 ,$144.00 ,$26.96 ,$100.96 ,$96.00 ,$144.00 ,$11.98 ,$144.00 ,$144.00 ,$11.98 ,$104.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600424,87350,HC HEPATITIS BE AG QL-90,306,1 ,$62.00 ,$40.30 ,$11.53 ,$62.00 ,$46.19 ,$40.61 ,$11.53 ,$32.67 ,$11.53 ,$39.12 ,$39.12 ,$39.12 ,$39.12 ,$55.80 ,$46.50 ,$11.53 ,$54.56 ,$11.53 ,$46.50 ,$46.50 ,$52.70 ,$52.70 ,$11.53 ,$52.70 ,$11.53 ,$48.98 ,$48.98 ,$48.98 ,$55.80 ,$28.83 ,$55.80 ,$11.53 ,$62.00 ,$40.61 ,$11.53 ,$26.91 , N/A ,$12.11 ,$55.80 ,$25.94 ,$39.12 ,$37.20 ,$55.80 ,$11.53 ,$55.80 ,$55.80 ,$11.53 ,$40.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600426,87385,HC EIA QL HISTOPLASMA AG-90,306,1 ,$142.00 ,$92.30 ,$13.25 ,$142.00 ,$105.79 ,$93.01 ,$13.25 ,$74.83 ,$13.25 ,$89.60 ,$89.60 ,$89.60 ,$89.60 ,$127.80 ,$106.50 ,$13.25 ,$124.96 ,$13.25 ,$106.50 ,$106.50 ,$120.70 ,$120.70 ,$13.25 ,$120.70 ,$13.25 ,$112.18 ,$112.18 ,$112.18 ,$127.80 ,$33.13 ,$127.80 ,$13.25 ,$142.00 ,$93.01 ,$13.25 ,$61.63 , N/A ,$13.91 ,$127.80 ,$29.81 ,$89.60 ,$85.20 ,$127.80 ,$13.25 ,$127.80 ,$127.80 ,$13.25 ,$92.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600432,87449,HC EIA QL MLT AG INF-90,306,1 ,$64.00 ,$41.60 ,$11.98 ,$64.00 ,$47.68 ,$41.92 ,$11.98 ,$33.73 ,$11.98 ,$40.38 ,$40.38 ,$40.38 ,$40.38 ,$57.60 ,$48.00 ,$11.98 ,$56.32 ,$11.98 ,$48.00 ,$48.00 ,$54.40 ,$54.40 ,$11.98 ,$54.40 ,$11.98 ,$50.56 ,$50.56 ,$50.56 ,$57.60 ,$29.95 ,$57.60 ,$11.98 ,$64.00 ,$41.92 ,$11.98 ,$27.78 , N/A ,$12.58 ,$57.60 ,$26.96 ,$40.38 ,$38.40 ,$57.60 ,$11.98 ,$57.60 ,$57.60 ,$11.98 ,$41.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600437,87486,HC CHLAMYDIA PNEUM AMP PROBE,306,1 ,$55.00 ,$35.75 ,$23.87 ,$78.95 ,$40.98 ,$36.03 ,$35.09 ,$28.99 ,$35.09 ,$34.71 ,$34.71 ,$34.71 ,$34.71 ,$49.50 ,$41.25 ,$35.09 ,$48.40 ,$35.09 ,$41.25 ,$41.25 ,$46.75 ,$46.75 ,$35.09 ,$46.75 ,$35.09 ,$43.45 ,$43.45 ,$43.45 ,$49.50 ,$55.00 ,$49.50 ,$35.09 ,$55.00 ,$36.03 ,$35.09 ,$23.87 , N/A ,$36.84 ,$49.50 ,$78.95 ,$34.71 ,$33.00 ,$49.50 ,$35.09 ,$49.50 ,$49.50 ,$35.09 ,$35.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600438,87491,HC CHLAMYDIA TRACH AMP-90,306,1 ,$48.50 ,$31.53 ,$21.05 ,$78.95 ,$36.13 ,$31.77 ,$35.09 ,$25.56 ,$35.09 ,$30.60 ,$30.60 ,$30.60 ,$30.60 ,$43.65 ,$36.38 ,$35.09 ,$42.68 ,$35.09 ,$36.38 ,$36.38 ,$41.23 ,$41.23 ,$35.09 ,$41.23 ,$35.09 ,$38.32 ,$38.32 ,$38.32 ,$43.65 ,$48.50 ,$43.65 ,$35.09 ,$48.50 ,$31.77 ,$35.09 ,$21.05 , N/A ,$36.84 ,$43.65 ,$78.95 ,$30.60 ,$29.10 ,$43.65 ,$35.09 ,$43.65 ,$43.65 ,$35.09 ,$31.53 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600442,87496,HC INFECT AMP (CMV) MENI-90,306,1 ,$164.00 ,$106.60 ,$35.09 ,$164.00 ,$122.18 ,$107.42 ,$35.09 ,$86.43 ,$35.09 ,$103.48 ,$103.48 ,$103.48 ,$103.48 ,$147.60 ,$123.00 ,$35.09 ,$144.32 ,$35.09 ,$123.00 ,$123.00 ,$139.40 ,$139.40 ,$35.09 ,$139.40 ,$35.09 ,$129.56 ,$129.56 ,$129.56 ,$147.60 ,$87.73 ,$147.60 ,$35.09 ,$164.00 ,$107.42 ,$35.09 ,$71.18 , N/A ,$36.84 ,$147.60 ,$78.95 ,$103.48 ,$98.40 ,$147.60 ,$35.09 ,$147.60 ,$147.60 ,$35.09 ,$106.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600443,87497,HC CMV QN-90,306,1 ,$230.00 ,$149.50 ,$42.84 ,$230.00 ,$171.35 ,$150.65 ,$42.84 ,$121.21 ,$42.84 ,$145.13 ,$145.13 ,$145.13 ,$145.13 ,$207.00 ,$172.50 ,$42.84 ,$202.40 ,$42.84 ,$172.50 ,$172.50 ,$195.50 ,$195.50 ,$42.84 ,$195.50 ,$42.84 ,$181.70 ,$181.70 ,$181.70 ,$207.00 ,$107.10 ,$207.00 ,$42.84 ,$230.00 ,$150.65 ,$42.84 ,$99.82 , N/A ,$44.98 ,$207.00 ,$96.39 ,$145.13 ,$138.00 ,$207.00 ,$42.84 ,$207.00 ,$207.00 ,$42.84 ,$149.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600448,87517,HC HEPATITIS B QN-90,306,1 ,$140.00 ,$91.00 ,$42.84 ,$140.00 ,$104.30 ,$91.70 ,$42.84 ,$73.78 ,$42.84 ,$88.34 ,$88.34 ,$88.34 ,$88.34 ,$126.00 ,$105.00 ,$42.84 ,$123.20 ,$42.84 ,$105.00 ,$105.00 ,$119.00 ,$119.00 ,$42.84 ,$119.00 ,$42.84 ,$110.60 ,$110.60 ,$110.60 ,$126.00 ,$107.10 ,$126.00 ,$42.84 ,$140.00 ,$91.70 ,$42.84 ,$60.76 , N/A ,$44.98 ,$126.00 ,$96.39 ,$88.34 ,$84.00 ,$126.00 ,$42.84 ,$126.00 ,$126.00 ,$42.84 ,$91.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600449,87521,HC HEPATITIS C PROBE AND RVRS TRNSC-90,306,1 ,$200.00 ,$130.00 ,$35.09 ,$200.00 ,$149.00 ,$131.00 ,$35.09 ,$105.40 ,$35.09 ,$126.20 ,$126.20 ,$126.20 ,$126.20 ,$180.00 ,$150.00 ,$35.09 ,$176.00 ,$35.09 ,$150.00 ,$150.00 ,$170.00 ,$170.00 ,$35.09 ,$170.00 ,$35.09 ,$158.00 ,$158.00 ,$158.00 ,$180.00 ,$87.73 ,$180.00 ,$35.09 ,$200.00 ,$131.00 ,$35.09 ,$86.80 , N/A ,$36.84 ,$180.00 ,$78.95 ,$126.20 ,$120.00 ,$180.00 ,$35.09 ,$180.00 ,$180.00 ,$35.09 ,$130.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600451,87522,HC HEPATITIS C QN-90,306,1 ,$201.00 ,$130.65 ,$42.84 ,$201.00 ,$149.75 ,$131.66 ,$42.84 ,$105.93 ,$42.84 ,$126.83 ,$126.83 ,$126.83 ,$126.83 ,$180.90 ,$150.75 ,$42.84 ,$176.88 ,$42.84 ,$150.75 ,$150.75 ,$170.85 ,$170.85 ,$42.84 ,$170.85 ,$42.84 ,$158.79 ,$158.79 ,$158.79 ,$180.90 ,$107.10 ,$180.90 ,$42.84 ,$201.00 ,$131.66 ,$42.84 ,$87.23 , N/A ,$44.98 ,$180.90 ,$96.39 ,$126.83 ,$120.60 ,$180.90 ,$42.84 ,$180.90 ,$180.90 ,$42.84 ,$130.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600453,87529,HC HERPES SIMPLEX AMP-90,306,1 ,$291.00 ,$189.15 ,$35.09 ,$291.00 ,$216.80 ,$190.61 ,$35.09 ,$153.36 ,$35.09 ,$183.62 ,$183.62 ,$183.62 ,$183.62 ,$261.90 ,$218.25 ,$35.09 ,$256.08 ,$35.09 ,$218.25 ,$218.25 ,$247.35 ,$247.35 ,$35.09 ,$247.35 ,$35.09 ,$229.89 ,$229.89 ,$229.89 ,$261.90 ,$87.73 ,$261.90 ,$35.09 ,$291.00 ,$190.61 ,$35.09 ,$126.29 , N/A ,$36.84 ,$261.90 ,$78.95 ,$183.62 ,$174.60 ,$261.90 ,$35.09 ,$261.90 ,$261.90 ,$35.09 ,$189.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600457,87535,HC PROBE HIV-1 RNA QUAL TMA-90,306,1 ,$500.00 ,$325.00 ,$35.09 ,$500.00 ,$372.50 ,$327.50 ,$35.09 ,$263.50 ,$35.09 ,$315.50 ,$315.50 ,$315.50 ,$315.50 ,$450.00 ,$375.00 ,$35.09 ,$440.00 ,$35.09 ,$375.00 ,$375.00 ,$425.00 ,$425.00 ,$35.09 ,$425.00 ,$35.09 ,$395.00 ,$395.00 ,$395.00 ,$450.00 ,$87.73 ,$450.00 ,$35.09 ,$500.00 ,$327.50 ,$35.09 ,$217.00 , N/A ,$36.84 ,$450.00 ,$78.95 ,$315.50 ,$300.00 ,$450.00 ,$35.09 ,$450.00 ,$450.00 ,$35.09 ,$325.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600458,87536,HC HIV-1 QN-90,306,1 ,$130.00 ,$84.50 ,$56.42 ,$191.48 ,$96.85 ,$85.15 ,$85.10 ,$68.51 ,$85.10 ,$82.03 ,$82.03 ,$82.03 ,$82.03 ,$117.00 ,$97.50 ,$85.10 ,$114.40 ,$85.10 ,$97.50 ,$97.50 ,$110.50 ,$110.50 ,$85.10 ,$110.50 ,$85.10 ,$102.70 ,$102.70 ,$102.70 ,$117.00 ,$130.00 ,$117.00 ,$85.10 ,$130.00 ,$85.15 ,$85.10 ,$56.42 , N/A ,$89.36 ,$117.00 ,$191.48 ,$82.03 ,$78.00 ,$117.00 ,$85.10 ,$117.00 ,$117.00 ,$85.10 ,$84.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600469,87661,HC TRICHOMONAS VAG AMP PROBE-90,306,1 ,$180.00 ,$117.00 ,$35.09 ,$180.00 ,$134.10 ,$117.90 ,$35.09 ,$94.86 ,$35.09 ,$113.58 ,$113.58 ,$113.58 ,$113.58 ,$162.00 ,$135.00 ,$35.09 ,$158.40 ,$35.09 ,$135.00 ,$135.00 ,$153.00 ,$153.00 ,$35.09 ,$153.00 ,$35.09 ,$142.20 ,$142.20 ,$142.20 ,$162.00 ,$87.73 ,$162.00 ,$35.09 ,$180.00 ,$117.90 ,$35.09 ,$78.12 , N/A ,$36.84 ,$162.00 ,$78.95 ,$113.58 ,$108.00 ,$162.00 ,$35.09 ,$162.00 ,$162.00 ,$35.09 ,$117.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600471,87798,HC INFECT AMP-90,306,1 ,$188.00 ,$122.20 ,$35.09 ,$188.00 ,$140.06 ,$123.14 ,$35.09 ,$99.08 ,$35.09 ,$118.63 ,$118.63 ,$118.63 ,$118.63 ,$169.20 ,$141.00 ,$35.09 ,$165.44 ,$35.09 ,$141.00 ,$141.00 ,$159.80 ,$159.80 ,$35.09 ,$159.80 ,$35.09 ,$148.52 ,$148.52 ,$148.52 ,$169.20 ,$87.73 ,$169.20 ,$35.09 ,$188.00 ,$123.14 ,$35.09 ,$81.59 , N/A ,$36.84 ,$169.20 ,$78.95 ,$118.63 ,$112.80 ,$169.20 ,$35.09 ,$169.20 ,$169.20 ,$35.09 ,$122.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600476,87798,HC INFECT AMP T1,306,1 ,$55.00 ,$35.75 ,$23.87 ,$78.95 ,$40.98 ,$36.03 ,$35.09 ,$28.99 ,$35.09 ,$34.71 ,$34.71 ,$34.71 ,$34.71 ,$49.50 ,$41.25 ,$35.09 ,$48.40 ,$35.09 ,$41.25 ,$41.25 ,$46.75 ,$46.75 ,$35.09 ,$46.75 ,$35.09 ,$43.45 ,$43.45 ,$43.45 ,$49.50 ,$55.00 ,$49.50 ,$35.09 ,$55.00 ,$36.03 ,$35.09 ,$23.87 , N/A ,$36.84 ,$49.50 ,$78.95 ,$34.71 ,$33.00 ,$49.50 ,$35.09 ,$49.50 ,$49.50 ,$35.09 ,$35.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600478,87799,HC INFECT AGENT QN-90,306,1 ,$201.00 ,$130.65 ,$42.84 ,$201.00 ,$149.75 ,$131.66 ,$42.84 ,$105.93 ,$42.84 ,$126.83 ,$126.83 ,$126.83 ,$126.83 ,$180.90 ,$150.75 ,$42.84 ,$176.88 ,$42.84 ,$150.75 ,$150.75 ,$170.85 ,$170.85 ,$42.84 ,$170.85 ,$42.84 ,$158.79 ,$158.79 ,$158.79 ,$180.90 ,$107.10 ,$180.90 ,$42.84 ,$201.00 ,$131.66 ,$42.84 ,$87.23 , N/A ,$44.98 ,$180.90 ,$96.39 ,$126.83 ,$120.60 ,$180.90 ,$42.84 ,$180.90 ,$180.90 ,$42.84 ,$130.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600480,87899,HC INFECT AGENT DETECT OPTICAL-90,306,1 ,$82.32 ,$53.51 ,$16.07 ,$82.32 ,$61.33 ,$53.92 ,$16.07 ,$43.38 ,$16.07 ,$51.94 ,$51.94 ,$51.94 ,$51.94 ,$74.09 ,$61.74 ,$16.07 ,$72.44 ,$16.07 ,$61.74 ,$61.74 ,$69.97 ,$69.97 ,$16.07 ,$69.97 ,$16.07 ,$65.03 ,$65.03 ,$65.03 ,$74.09 ,$40.18 ,$74.09 ,$16.07 ,$82.32 ,$53.92 ,$16.07 ,$35.73 , N/A ,$16.87 ,$74.09 ,$36.16 ,$51.94 ,$49.39 ,$74.09 ,$16.07 ,$74.09 ,$74.09 ,$16.07 ,$53.51 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600481,87900,HC PHENOTYPE INFCT AGT DRG SUS-90,306,1 ,$391.05 ,$254.18 ,$130.35 ,$391.05 ,$291.33 ,$256.14 ,$130.35 ,$206.08 ,$130.35 ,$246.75 ,$246.75 ,$246.75 ,$246.75 ,$351.95 ,$293.29 ,$130.35 ,$344.12 ,$130.35 ,$293.29 ,$293.29 ,$332.39 ,$332.39 ,$130.35 ,$332.39 ,$130.35 ,$308.93 ,$308.93 ,$308.93 ,$351.95 ,$325.88 ,$351.95 ,$130.35 ,$391.05 ,$256.14 ,$130.35 ,$169.72 , N/A ,$136.87 ,$351.95 ,$293.29 ,$246.75 ,$234.63 ,$351.95 ,$130.35 ,$351.95 ,$351.95 ,$130.35 ,$254.18 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600482,87901,HC GENOTYPE HIV 1-90,306,1 ,$772.35 ,$502.03 ,$257.45 ,$772.35 ,$575.40 ,$505.89 ,$257.45 ,$407.03 ,$257.45 ,$487.35 ,$487.35 ,$487.35 ,$487.35 ,$695.12 ,$579.26 ,$257.45 ,$679.67 ,$257.45 ,$579.26 ,$579.26 ,$656.50 ,$656.50 ,$257.45 ,$656.50 ,$257.45 ,$610.16 ,$610.16 ,$610.16 ,$695.12 ,$643.63 ,$695.12 ,$257.45 ,$772.35 ,$505.89 ,$257.45 ,$335.20 , N/A ,$270.32 ,$695.12 ,$579.26 ,$487.35 ,$463.41 ,$695.12 ,$257.45 ,$695.12 ,$695.12 ,$257.45 ,$502.03 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600483,87902,HC GENTOYPE HEP C-90,306,1 ,$634.00 ,$412.10 ,$257.45 ,$634.00 ,$472.33 ,$415.27 ,$257.45 ,$334.12 ,$257.45 ,$400.05 ,$400.05 ,$400.05 ,$400.05 ,$570.60 ,$475.50 ,$257.45 ,$557.92 ,$257.45 ,$475.50 ,$475.50 ,$538.90 ,$538.90 ,$257.45 ,$538.90 ,$257.45 ,$500.86 ,$500.86 ,$500.86 ,$570.60 ,$634.00 ,$570.60 ,$257.45 ,$634.00 ,$415.27 ,$257.45 ,$275.16 , N/A ,$270.32 ,$570.60 ,$579.26 ,$400.05 ,$380.40 ,$570.60 ,$257.45 ,$570.60 ,$570.60 ,$257.45 ,$412.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600486,87906,HC GENOTYPE DNA/RNA HIV1-90,306,1 ,"$1,341.60 ",$872.04 ,$128.73 ,"$1,341.60 ",$999.49 ,$878.75 ,$128.73 ,$707.02 ,$128.73 ,$846.55 ,$846.55 ,$846.55 ,$846.55 ,"$1,207.44 ","$1,006.20 ",$128.73 ,"$1,180.61 ",$128.73 ,"$1,006.20 ","$1,006.20 ","$1,140.36 ","$1,140.36 ",$128.73 ,"$1,140.36 ",$128.73 ,"$1,059.86 ","$1,059.86 ","$1,059.86 ","$1,207.44 ",$321.83 ,"$1,207.44 ",$128.73 ,"$1,341.60 ",$878.75 ,$128.73 ,$582.25 , N/A ,$135.17 ,"$1,207.44 ",$289.64 ,$846.55 ,$804.96 ,"$1,207.44 ",$128.73 ,"$1,207.44 ","$1,207.44 ",$128.73 ,$872.04 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600503,87389,HC HIV-1 AG W/HIV-1 AND HIV-2 AB-90,306,1 ,$129.00 ,$83.85 ,$24.08 ,$129.00 ,$96.11 ,$84.50 ,$24.08 ,$67.98 ,$24.08 ,$81.40 ,$81.40 ,$81.40 ,$81.40 ,$116.10 ,$96.75 ,$24.08 ,$113.52 ,$24.08 ,$96.75 ,$96.75 ,$109.65 ,$109.65 ,$24.08 ,$109.65 ,$24.08 ,$101.91 ,$101.91 ,$101.91 ,$116.10 ,$60.20 ,$116.10 ,$24.08 ,$129.00 ,$84.50 ,$24.08 ,$55.99 , N/A ,$25.28 ,$116.10 ,$54.18 ,$81.40 ,$77.40 ,$116.10 ,$24.08 ,$116.10 ,$116.10 ,$24.08 ,$83.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600505,87329,HC EIA QL GIARDIA AG-90,306,1 ,$22.00 ,$14.30 ,$9.55 ,$26.96 ,$16.39 ,$14.41 ,$11.98 ,$11.59 ,$11.98 ,$13.88 ,$13.88 ,$13.88 ,$13.88 ,$19.80 ,$16.50 ,$11.98 ,$19.36 ,$11.98 ,$16.50 ,$16.50 ,$18.70 ,$18.70 ,$11.98 ,$18.70 ,$11.98 ,$17.38 ,$17.38 ,$17.38 ,$19.80 ,$22.00 ,$19.80 ,$11.98 ,$22.00 ,$14.41 ,$11.98 ,$9.55 , N/A ,$12.58 ,$19.80 ,$26.96 ,$13.88 ,$13.20 ,$19.80 ,$11.98 ,$19.80 ,$19.80 ,$11.98 ,$14.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600515,87015,HC CONCENTRATION INFECTIOUS AGENT,306,1 ,$44.00 ,$28.60 ,$6.68 ,$44.00 ,$32.78 ,$28.82 ,$6.68 ,$23.19 ,$6.68 ,$27.76 ,$27.76 ,$27.76 ,$27.76 ,$39.60 ,$33.00 ,$6.68 ,$38.72 ,$6.68 ,$33.00 ,$33.00 ,$37.40 ,$37.40 ,$6.68 ,$37.40 ,$6.68 ,$34.76 ,$34.76 ,$34.76 ,$39.60 ,$16.70 ,$39.60 ,$6.68 ,$44.00 ,$28.82 ,$6.68 ,$19.10 , N/A ,$7.01 ,$39.60 ,$15.03 ,$27.76 ,$26.40 ,$39.60 ,$6.68 ,$39.60 ,$39.60 ,$6.68 ,$28.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600523,87076,HC CULTURE ANAEROBIC ID,306,1 ,$95.00 ,$61.75 ,$8.08 ,$95.00 ,$70.78 ,$62.23 ,$8.08 ,$50.07 ,$8.08 ,$59.95 ,$59.95 ,$59.95 ,$59.95 ,$85.50 ,$71.25 ,$8.08 ,$83.60 ,$8.08 ,$71.25 ,$71.25 ,$80.75 ,$80.75 ,$8.08 ,$80.75 ,$8.08 ,$75.05 ,$75.05 ,$75.05 ,$85.50 ,$20.20 ,$85.50 ,$8.08 ,$95.00 ,$62.23 ,$8.08 ,$41.23 , N/A ,$8.48 ,$85.50 ,$18.18 ,$59.95 ,$57.00 ,$85.50 ,$8.08 ,$85.50 ,$85.50 ,$8.08 ,$61.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600524,87077,HC CULTURE AEROBIC ID ADDL,306,1 ,$12.00 ,$7.80 ,$5.21 ,$18.18 ,$8.94 ,$7.86 ,$8.08 ,$6.32 ,$8.08 ,$7.57 ,$7.57 ,$7.57 ,$7.57 ,$10.80 ,$9.00 ,$8.08 ,$10.56 ,$8.08 ,$9.00 ,$9.00 ,$10.20 ,$10.20 ,$8.08 ,$10.20 ,$8.08 ,$9.48 ,$9.48 ,$9.48 ,$10.80 ,$12.00 ,$10.80 ,$8.08 ,$12.00 ,$7.86 ,$8.08 ,$5.21 , N/A ,$8.48 ,$10.80 ,$18.18 ,$7.57 ,$7.20 ,$10.80 ,$8.08 ,$10.80 ,$10.80 ,$8.08 ,$7.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600530,87101,HC CULTURE FUNGUS SKIN/HAIR/NAIL,306,1 ,$36.00 ,$23.40 ,$7.71 ,$36.00 ,$26.82 ,$23.58 ,$7.71 ,$18.97 ,$7.71 ,$22.72 ,$22.72 ,$22.72 ,$22.72 ,$32.40 ,$27.00 ,$7.71 ,$31.68 ,$7.71 ,$27.00 ,$27.00 ,$30.60 ,$30.60 ,$7.71 ,$30.60 ,$7.71 ,$28.44 ,$28.44 ,$28.44 ,$32.40 ,$19.28 ,$32.40 ,$7.71 ,$36.00 ,$23.58 ,$7.71 ,$15.62 , N/A ,$8.10 ,$32.40 ,$17.35 ,$22.72 ,$21.60 ,$32.40 ,$7.71 ,$32.40 ,$32.40 ,$7.71 ,$23.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600531,87102,HC CULTURE FUNGUS OTHER,306,1 ,$135.00 ,$87.75 ,$8.41 ,$135.00 ,$100.58 ,$88.43 ,$8.41 ,$71.15 ,$8.41 ,$85.19 ,$85.19 ,$85.19 ,$85.19 ,$121.50 ,$101.25 ,$8.41 ,$118.80 ,$8.41 ,$101.25 ,$101.25 ,$114.75 ,$114.75 ,$8.41 ,$114.75 ,$8.41 ,$106.65 ,$106.65 ,$106.65 ,$121.50 ,$21.03 ,$121.50 ,$8.41 ,$135.00 ,$88.43 ,$8.41 ,$58.59 , N/A ,$8.83 ,$121.50 ,$18.92 ,$85.19 ,$81.00 ,$121.50 ,$8.41 ,$121.50 ,$121.50 ,$8.41 ,$87.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600532,87103,HC CULTURE FUNGUS BLOOD,306,1 ,$91.00 ,$59.15 ,$20.46 ,$91.00 ,$67.80 ,$59.61 ,$20.46 ,$47.96 ,$20.46 ,$57.42 ,$57.42 ,$57.42 ,$57.42 ,$81.90 ,$68.25 ,$20.46 ,$80.08 ,$20.46 ,$68.25 ,$68.25 ,$77.35 ,$77.35 ,$20.46 ,$77.35 ,$20.46 ,$71.89 ,$71.89 ,$71.89 ,$81.90 ,$51.15 ,$81.90 ,$20.46 ,$91.00 ,$59.61 ,$20.46 ,$39.49 , N/A ,$21.48 ,$81.90 ,$46.04 ,$57.42 ,$54.60 ,$81.90 ,$20.46 ,$81.90 ,$81.90 ,$20.46 ,$59.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600533,87106,HC CULTURE FUNGUS ID YEAST,306,1 ,$82.00 ,$53.30 ,$10.32 ,$82.00 ,$61.09 ,$53.71 ,$10.32 ,$43.21 ,$10.32 ,$51.74 ,$51.74 ,$51.74 ,$51.74 ,$73.80 ,$61.50 ,$10.32 ,$72.16 ,$10.32 ,$61.50 ,$61.50 ,$69.70 ,$69.70 ,$10.32 ,$69.70 ,$10.32 ,$64.78 ,$64.78 ,$64.78 ,$73.80 ,$25.80 ,$73.80 ,$10.32 ,$82.00 ,$53.71 ,$10.32 ,$35.59 , N/A ,$10.84 ,$73.80 ,$23.22 ,$51.74 ,$49.20 ,$73.80 ,$10.32 ,$73.80 ,$73.80 ,$10.32 ,$53.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600535,87116,HC CULTURE AFB/TB/MYCOBACT,306,1 ,$101.00 ,$65.65 ,$10.80 ,$101.00 ,$75.25 ,$66.16 ,$10.80 ,$53.23 ,$10.80 ,$63.73 ,$63.73 ,$63.73 ,$63.73 ,$90.90 ,$75.75 ,$10.80 ,$88.88 ,$10.80 ,$75.75 ,$75.75 ,$85.85 ,$85.85 ,$10.80 ,$85.85 ,$10.80 ,$79.79 ,$79.79 ,$79.79 ,$90.90 ,$27.00 ,$90.90 ,$10.80 ,$101.00 ,$66.16 ,$10.80 ,$43.83 , N/A ,$11.34 ,$90.90 ,$24.30 ,$63.73 ,$60.60 ,$90.90 ,$10.80 ,$90.90 ,$90.90 ,$10.80 ,$65.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600537,87149,HC CULTURE TYPING ID NUCLEIC ACID,306,1 ,$328.00 ,$213.20 ,$20.05 ,$328.00 ,$244.36 ,$214.84 ,$20.05 ,$172.86 ,$20.05 ,$206.97 ,$206.97 ,$206.97 ,$206.97 ,$295.20 ,$246.00 ,$20.05 ,$288.64 ,$20.05 ,$246.00 ,$246.00 ,$278.80 ,$278.80 ,$20.05 ,$278.80 ,$20.05 ,$259.12 ,$259.12 ,$259.12 ,$295.20 ,$50.13 ,$295.20 ,$20.05 ,$328.00 ,$214.84 ,$20.05 ,$142.35 , N/A ,$21.05 ,$295.20 ,$45.11 ,$206.97 ,$196.80 ,$295.20 ,$20.05 ,$295.20 ,$295.20 ,$20.05 ,$213.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600539,87153,HC ID NUCLEAR ACID SEQ METH ID,306,1 ,"$1,156.00 ",$751.40 ,$115.36 ,"$1,156.00 ",$861.22 ,$757.18 ,$115.36 ,$609.21 ,$115.36 ,$729.44 ,$729.44 ,$729.44 ,$729.44 ,"$1,040.40 ",$867.00 ,$115.36 ,"$1,017.28 ",$115.36 ,$867.00 ,$867.00 ,$982.60 ,$982.60 ,$115.36 ,$982.60 ,$115.36 ,$913.24 ,$913.24 ,$913.24 ,"$1,040.40 ",$288.40 ,"$1,040.40 ",$115.36 ,"$1,156.00 ",$757.18 ,$115.36 ,$501.70 , N/A ,$121.13 ,"$1,040.40 ",$259.56 ,$729.44 ,$693.60 ,"$1,040.40 ",$115.36 ,"$1,040.40 ","$1,040.40 ",$115.36 ,$751.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600544,87181,HC SENSITIVITY STUDY AGAR,306,1 ,$22.00 ,$14.30 ,$4.75 ,$22.00 ,$16.39 ,$14.41 ,$4.75 ,$11.59 ,$4.75 ,$13.88 ,$13.88 ,$13.88 ,$13.88 ,$19.80 ,$16.50 ,$4.75 ,$19.36 ,$4.75 ,$16.50 ,$16.50 ,$18.70 ,$18.70 ,$4.75 ,$18.70 ,$4.75 ,$17.38 ,$17.38 ,$17.38 ,$19.80 ,$11.88 ,$19.80 ,$4.75 ,$22.00 ,$14.41 ,$4.75 ,$9.55 , N/A ,$4.99 ,$19.80 ,$10.69 ,$13.88 ,$13.20 ,$19.80 ,$4.75 ,$19.80 ,$19.80 ,$4.75 ,$14.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600547,87186,HC SENSITIVITY MIC,306,1 ,$54.00 ,$35.10 ,$8.65 ,$54.00 ,$40.23 ,$35.37 ,$8.65 ,$28.46 ,$8.65 ,$34.07 ,$34.07 ,$34.07 ,$34.07 ,$48.60 ,$40.50 ,$8.65 ,$47.52 ,$8.65 ,$40.50 ,$40.50 ,$45.90 ,$45.90 ,$8.65 ,$45.90 ,$8.65 ,$42.66 ,$42.66 ,$42.66 ,$48.60 ,$21.63 ,$48.60 ,$8.65 ,$54.00 ,$35.37 ,$8.65 ,$23.44 , N/A ,$9.08 ,$48.60 ,$19.46 ,$34.07 ,$32.40 ,$48.60 ,$8.65 ,$48.60 ,$48.60 ,$8.65 ,$35.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600549,87188,HC MACROTUBE DIL METH EA AGNT,306,1 ,$75.00 ,$48.75 ,$6.64 ,$75.00 ,$55.88 ,$49.13 ,$6.64 ,$39.53 ,$6.64 ,$47.33 ,$47.33 ,$47.33 ,$47.33 ,$67.50 ,$56.25 ,$6.64 ,$66.00 ,$6.64 ,$56.25 ,$56.25 ,$63.75 ,$63.75 ,$6.64 ,$63.75 ,$6.64 ,$59.25 ,$59.25 ,$59.25 ,$67.50 ,$16.60 ,$67.50 ,$6.64 ,$75.00 ,$49.13 ,$6.64 ,$32.55 , N/A ,$6.97 ,$67.50 ,$14.94 ,$47.33 ,$45.00 ,$67.50 ,$6.64 ,$67.50 ,$67.50 ,$6.64 ,$48.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600551,87205,HC SMEAR GRAM/GIEMSA,306,1 ,$43.00 ,$27.95 ,$4.27 ,$43.00 ,$32.04 ,$28.17 ,$4.27 ,$22.66 ,$4.27 ,$27.13 ,$27.13 ,$27.13 ,$27.13 ,$38.70 ,$32.25 ,$4.27 ,$37.84 ,$4.27 ,$32.25 ,$32.25 ,$36.55 ,$36.55 ,$4.27 ,$36.55 ,$4.27 ,$33.97 ,$33.97 ,$33.97 ,$38.70 ,$10.68 ,$38.70 ,$4.27 ,$43.00 ,$28.17 ,$4.27 ,$18.66 , N/A ,$4.48 ,$38.70 ,$9.61 ,$27.13 ,$25.80 ,$38.70 ,$4.27 ,$38.70 ,$38.70 ,$4.27 ,$27.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600552,87206,HC SMEAR ACID FAST/FLUOR,306,1 ,$55.00 ,$35.75 ,$5.39 ,$55.00 ,$40.98 ,$36.03 ,$5.39 ,$28.99 ,$5.39 ,$34.71 ,$34.71 ,$34.71 ,$34.71 ,$49.50 ,$41.25 ,$5.39 ,$48.40 ,$5.39 ,$41.25 ,$41.25 ,$46.75 ,$46.75 ,$5.39 ,$46.75 ,$5.39 ,$43.45 ,$43.45 ,$43.45 ,$49.50 ,$13.48 ,$49.50 ,$5.39 ,$55.00 ,$36.03 ,$5.39 ,$23.87 , N/A ,$5.66 ,$49.50 ,$12.13 ,$34.71 ,$33.00 ,$49.50 ,$5.39 ,$49.50 ,$49.50 ,$5.39 ,$35.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600553,87207,HC SPECIAL STAIN INCL BODIES/PARASITES,306,1 ,$55.00 ,$35.75 ,$5.99 ,$55.00 ,$40.98 ,$36.03 ,$5.99 ,$28.99 ,$5.99 ,$34.71 ,$34.71 ,$34.71 ,$34.71 ,$49.50 ,$41.25 ,$5.99 ,$48.40 ,$5.99 ,$41.25 ,$41.25 ,$46.75 ,$46.75 ,$5.99 ,$46.75 ,$5.99 ,$43.45 ,$43.45 ,$43.45 ,$49.50 ,$14.98 ,$49.50 ,$5.99 ,$55.00 ,$36.03 ,$5.99 ,$23.87 , N/A ,$6.29 ,$49.50 ,$13.48 ,$34.71 ,$33.00 ,$49.50 ,$5.99 ,$49.50 ,$49.50 ,$5.99 ,$35.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600554,87254,HC VIRUS ISOL SHELL ID,306,1 ,$92.00 ,$59.80 ,$19.56 ,$92.00 ,$68.54 ,$60.26 ,$19.56 ,$48.48 ,$19.56 ,$58.05 ,$58.05 ,$58.05 ,$58.05 ,$82.80 ,$69.00 ,$19.56 ,$80.96 ,$19.56 ,$69.00 ,$69.00 ,$78.20 ,$78.20 ,$19.56 ,$78.20 ,$19.56 ,$72.68 ,$72.68 ,$72.68 ,$82.80 ,$48.90 ,$82.80 ,$19.56 ,$92.00 ,$60.26 ,$19.56 ,$39.93 , N/A ,$20.54 ,$82.80 ,$44.01 ,$58.05 ,$55.20 ,$82.80 ,$19.56 ,$82.80 ,$82.80 ,$19.56 ,$59.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600555,87255,HC VIRUS ID NON-IMMUNOLOGIC OTHER THAN CYTOPATHIC-90,306,1 ,$16.00 ,$10.40 ,$6.94 ,$36.00 ,$11.92 ,$10.48 ,$16.00 ,$8.43 ,$16.00 ,$10.10 ,$10.10 ,$10.10 ,$10.10 ,$14.40 ,$12.00 ,$16.00 ,$14.08 ,$16.00 ,$12.00 ,$12.00 ,$13.60 ,$13.60 ,$16.00 ,$13.60 ,$16.00 ,$12.64 ,$12.64 ,$12.64 ,$14.40 ,$16.00 ,$14.40 ,$16.00 ,$16.00 ,$10.48 ,$16.00 ,$6.94 , N/A ,$16.00 ,$14.40 ,$36.00 ,$10.10 ,$9.60 ,$14.40 ,$16.00 ,$14.40 ,$14.40 ,$16.00 ,$10.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600564,87430,HC RAPID STREP -QW,306,1 ,$57.00 ,$37.05 ,$16.81 ,$57.00 ,$42.47 ,$37.34 ,$16.81 ,$30.04 ,$16.81 ,$35.97 ,$35.97 ,$35.97 ,$35.97 ,$51.30 ,$42.75 ,$16.81 ,$50.16 ,$16.81 ,$42.75 ,$42.75 ,$48.45 ,$48.45 ,$16.81 ,$48.45 ,$16.81 ,$45.03 ,$45.03 ,$45.03 ,$51.30 ,$42.03 ,$51.30 ,$16.81 ,$57.00 ,$37.34 ,$16.81 ,$24.74 , N/A ,$17.65 ,$51.30 ,$37.82 ,$35.97 ,$34.20 ,$51.30 ,$16.81 ,$51.30 ,$51.30 ,$16.81 ,$37.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600570,87491,HC CHLAMYDIA TRACH AMP,306,1 ,$122.00 ,$79.30 ,$35.09 ,$122.00 ,$90.89 ,$79.91 ,$35.09 ,$64.29 ,$35.09 ,$76.98 ,$76.98 ,$76.98 ,$76.98 ,$109.80 ,$91.50 ,$35.09 ,$107.36 ,$35.09 ,$91.50 ,$91.50 ,$103.70 ,$103.70 ,$35.09 ,$103.70 ,$35.09 ,$96.38 ,$96.38 ,$96.38 ,$109.80 ,$87.73 ,$109.80 ,$35.09 ,$122.00 ,$79.91 ,$35.09 ,$52.95 , N/A ,$36.84 ,$109.80 ,$78.95 ,$76.98 ,$73.20 ,$109.80 ,$35.09 ,$109.80 ,$109.80 ,$35.09 ,$79.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600575,87591,HC NEISSERIA AMP,306,1 ,$118.00 ,$76.70 ,$35.09 ,$118.00 ,$87.91 ,$77.29 ,$35.09 ,$62.19 ,$35.09 ,$74.46 ,$74.46 ,$74.46 ,$74.46 ,$106.20 ,$88.50 ,$35.09 ,$103.84 ,$35.09 ,$88.50 ,$88.50 ,$100.30 ,$100.30 ,$35.09 ,$100.30 ,$35.09 ,$93.22 ,$93.22 ,$93.22 ,$106.20 ,$87.73 ,$106.20 ,$35.09 ,$118.00 ,$77.29 ,$35.09 ,$51.21 , N/A ,$36.84 ,$106.20 ,$78.95 ,$74.46 ,$70.80 ,$106.20 ,$35.09 ,$106.20 ,$106.20 ,$35.09 ,$76.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600584,87905,HC IF AGT ENZYMATIC ACT/OTH VIRUS,306,1 ,$76.00 ,$49.40 ,$12.22 ,$76.00 ,$56.62 ,$49.78 ,$12.22 ,$40.05 ,$12.22 ,$47.96 ,$47.96 ,$47.96 ,$47.96 ,$68.40 ,$57.00 ,$12.22 ,$66.88 ,$12.22 ,$57.00 ,$57.00 ,$64.60 ,$64.60 ,$12.22 ,$64.60 ,$12.22 ,$60.04 ,$60.04 ,$60.04 ,$68.40 ,$30.55 ,$68.40 ,$12.22 ,$76.00 ,$49.78 ,$12.22 ,$32.98 , N/A ,$12.83 ,$68.40 ,$27.50 ,$47.96 ,$45.60 ,$68.40 ,$12.22 ,$68.40 ,$68.40 ,$12.22 ,$49.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600607,87661,HC TRICHOMONAS BAG AMP PROBE,306,1 ,$47.00 ,$30.55 ,$20.40 ,$78.95 ,$35.02 ,$30.79 ,$35.09 ,$24.77 ,$35.09 ,$29.66 ,$29.66 ,$29.66 ,$29.66 ,$42.30 ,$35.25 ,$35.09 ,$41.36 ,$35.09 ,$35.25 ,$35.25 ,$39.95 ,$39.95 ,$35.09 ,$39.95 ,$35.09 ,$37.13 ,$37.13 ,$37.13 ,$42.30 ,$47.00 ,$42.30 ,$35.09 ,$47.00 ,$30.79 ,$35.09 ,$20.40 , N/A ,$36.84 ,$42.30 ,$78.95 ,$29.66 ,$28.20 ,$42.30 ,$35.09 ,$42.30 ,$42.30 ,$35.09 ,$30.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600609,87529,HC HERPES SIMPLEX AMP,306,1 ,$291.00 ,$189.15 ,$35.09 ,$291.00 ,$216.80 ,$190.61 ,$35.09 ,$153.36 ,$35.09 ,$183.62 ,$183.62 ,$183.62 ,$183.62 ,$261.90 ,$218.25 ,$35.09 ,$256.08 ,$35.09 ,$218.25 ,$218.25 ,$247.35 ,$247.35 ,$35.09 ,$247.35 ,$35.09 ,$229.89 ,$229.89 ,$229.89 ,$261.90 ,$87.73 ,$261.90 ,$35.09 ,$291.00 ,$190.61 ,$35.09 ,$126.29 , N/A ,$36.84 ,$261.90 ,$78.95 ,$183.62 ,$174.60 ,$261.90 ,$35.09 ,$261.90 ,$261.90 ,$35.09 ,$189.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600615,87169,HC PARASITE ID-90,306,1 ,$21.54 ,$14.00 ,$4.31 ,$21.54 ,$16.05 ,$14.11 ,$4.31 ,$11.35 ,$4.31 ,$13.59 ,$13.59 ,$13.59 ,$13.59 ,$19.39 ,$16.16 ,$4.31 ,$18.96 ,$4.31 ,$16.16 ,$16.16 ,$18.31 ,$18.31 ,$4.31 ,$18.31 ,$4.31 ,$17.02 ,$17.02 ,$17.02 ,$19.39 ,$10.78 ,$19.39 ,$4.31 ,$21.54 ,$14.11 ,$4.31 ,$9.35 , N/A ,$4.53 ,$19.39 ,$9.70 ,$13.59 ,$12.92 ,$19.39 ,$4.31 ,$19.39 ,$19.39 ,$4.31 ,$14.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600621,87551,HC MYCOBACTERIA DAN AMP PROBE-90,306,1 ,$180.00 ,$117.00 ,$48.24 ,$180.00 ,$134.10 ,$117.90 ,$48.24 ,$94.86 ,$48.24 ,$113.58 ,$113.58 ,$113.58 ,$113.58 ,$162.00 ,$135.00 ,$48.24 ,$158.40 ,$48.24 ,$135.00 ,$135.00 ,$153.00 ,$153.00 ,$48.24 ,$153.00 ,$48.24 ,$142.20 ,$142.20 ,$142.20 ,$162.00 ,$120.60 ,$162.00 ,$48.24 ,$180.00 ,$117.90 ,$48.24 ,$78.12 , N/A ,$50.65 ,$162.00 ,$108.54 ,$113.58 ,$108.00 ,$162.00 ,$48.24 ,$162.00 ,$162.00 ,$48.24 ,$117.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600623,87635,HC COVID-19 LAB TEST CDC-90,306,1 ,$398.00 ,$258.70 ,$51.31 ,$398.00 ,$296.51 ,$260.69 ,$51.31 ,$209.75 ,$51.31 ,$251.14 ,$251.14 ,$251.14 ,$251.14 ,$358.20 ,$51.31 ,$51.31 ,$350.24 ,$51.31 ,$298.50 ,$298.50 ,$338.30 ,$338.30 ,$51.31 ,$338.30 ,$51.31 ,$314.42 ,$314.42 ,$314.42 ,$358.20 ,$128.28 ,$358.20 ,$51.31 ,$51.31 ,$260.69 ,$51.31 ,$172.73 , N/A ,$53.88 ,$358.20 ,$115.45 ,$251.14 ,$238.80 ,$358.20 ,$51.31 ,$358.20 ,$358.20 ,$51.31 ,$258.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600630,87481,HC IADNA CANDIDA SPECIES AMPLIFIED PROBE TQ,306,1 ,$18.67 ,$12.14 ,$8.10 ,$42.01 ,$13.91 ,$12.23 ,$18.67 ,$9.84 ,$18.67 ,$11.78 ,$11.78 ,$11.78 ,$11.78 ,$16.80 ,$14.00 ,$18.67 ,$16.43 ,$18.67 ,$14.00 ,$14.00 ,$15.87 ,$15.87 ,$18.67 ,$15.87 ,$18.67 ,$14.75 ,$14.75 ,$14.75 ,$16.80 ,$18.67 ,$16.80 ,$18.67 ,$18.67 ,$12.23 ,$18.67 ,$8.10 , N/A ,$18.67 ,$16.80 ,$42.01 ,$11.78 ,$11.20 ,$16.80 ,$18.67 ,$16.80 ,$16.80 ,$18.67 ,$12.14 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600631,87563,HC IADNA MYCOPLASMA GENITALIUM AMPLIFIED PROBE TECH,306,1 ,$36.25 ,$23.56 ,$15.73 ,$78.95 ,$27.01 ,$23.74 ,$35.09 ,$19.10 ,$35.09 ,$22.87 ,$22.87 ,$22.87 ,$22.87 ,$32.63 ,$27.19 ,$35.09 ,$31.90 ,$35.09 ,$27.19 ,$27.19 ,$30.81 ,$30.81 ,$35.09 ,$30.81 ,$35.09 ,$28.64 ,$28.64 ,$28.64 ,$32.63 ,$36.25 ,$32.63 ,$35.09 ,$36.25 ,$23.74 ,$35.09 ,$15.73 , N/A ,$36.25 ,$32.63 ,$78.95 ,$22.87 ,$21.75 ,$32.63 ,$35.09 ,$32.63 ,$32.63 ,$35.09 ,$23.56 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600632,87801,HC IADNA MULTIPLE ORGANISMS AMPLIFIED PROBE TQ,306,1 ,$26.75 ,$17.39 ,$11.61 ,$60.19 ,$19.93 ,$17.52 ,$26.75 ,$14.10 ,$26.75 ,$16.88 ,$16.88 ,$16.88 ,$16.88 ,$24.08 ,$20.06 ,$26.75 ,$23.54 ,$26.75 ,$20.06 ,$20.06 ,$22.74 ,$22.74 ,$26.75 ,$22.74 ,$26.75 ,$21.13 ,$21.13 ,$21.13 ,$24.08 ,$26.75 ,$24.08 ,$26.75 ,$26.75 ,$17.52 ,$26.75 ,$11.61 , N/A ,$26.75 ,$24.08 ,$60.19 ,$16.88 ,$16.05 ,$24.08 ,$26.75 ,$24.08 ,$24.08 ,$26.75 ,$17.39 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30600633,87168,HC TICK AND OTHER ANTROPODS- 90,306,1 ,$21.54 ,$14.00 ,$4.27 ,$21.54 ,$16.05 ,$14.11 ,$4.27 ,$11.35 ,$4.27 ,$13.59 ,$13.59 ,$13.59 ,$13.59 ,$19.39 ,$16.16 ,$4.27 ,$18.96 ,$4.27 ,$16.16 ,$16.16 ,$18.31 ,$18.31 ,$4.27 ,$18.31 ,$4.27 ,$17.02 ,$17.02 ,$17.02 ,$19.39 ,$10.68 ,$19.39 ,$4.27 ,$21.54 ,$14.11 ,$4.27 ,$9.35 , N/A ,$4.48 ,$19.39 ,$9.61 ,$13.59 ,$12.92 ,$19.39 ,$4.27 ,$19.39 ,$19.39 ,$4.27 ,$14.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30682010,87635,HC COVID-19 LAB TEST NON-CDC-90,306,1 ,$398.00 ,$258.70 ,$51.31 ,$398.00 ,$296.51 ,$260.69 ,$51.31 ,$209.75 ,$51.31 ,$251.14 ,$251.14 ,$251.14 ,$251.14 ,$358.20 ,$51.31 ,$51.31 ,$350.24 ,$51.31 ,$298.50 ,$298.50 ,$338.30 ,$338.30 ,$51.31 ,$338.30 ,$51.31 ,$314.42 ,$314.42 ,$314.42 ,$358.20 ,$128.28 ,$358.20 ,$51.31 ,$51.31 ,$260.69 ,$51.31 ,$172.73 , N/A ,$53.88 ,$358.20 ,$115.45 ,$251.14 ,$238.80 ,$358.20 ,$51.31 ,$358.20 ,$358.20 ,$51.31 ,$258.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30682012,87635,HC COVID-19 LAB TEST,306,1 ,$398.00 ,$258.70 ,$51.31 ,$398.00 ,$296.51 ,$260.69 ,$51.31 ,$209.75 ,$51.31 ,$251.14 ,$251.14 ,$251.14 ,$251.14 ,$358.20 ,$51.31 ,$51.31 ,$350.24 ,$51.31 ,$298.50 ,$298.50 ,$338.30 ,$338.30 ,$51.31 ,$338.30 ,$51.31 ,$314.42 ,$314.42 ,$314.42 ,$358.20 ,$128.28 ,$358.20 ,$51.31 ,$51.31 ,$260.69 ,$51.31 ,$172.73 , N/A ,$53.88 ,$358.20 ,$115.45 ,$251.14 ,$238.80 ,$358.20 ,$51.31 ,$358.20 ,$358.20 ,$51.31 ,$258.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30682013,87635,HC COVID-19 LAB TEST,306,1 ,$398.00 ,$258.70 ,$51.31 ,$398.00 ,$296.51 ,$260.69 ,$51.31 ,$209.75 ,$51.31 ,$251.14 ,$251.14 ,$251.14 ,$251.14 ,$358.20 ,$51.31 ,$51.31 ,$350.24 ,$51.31 ,$298.50 ,$298.50 ,$338.30 ,$338.30 ,$51.31 ,$338.30 ,$51.31 ,$314.42 ,$314.42 ,$314.42 ,$358.20 ,$128.28 ,$358.20 ,$51.31 ,$51.31 ,$260.69 ,$51.31 ,$172.73 , N/A ,$53.88 ,$358.20 ,$115.45 ,$251.14 ,$238.80 ,$358.20 ,$51.31 ,$358.20 ,$358.20 ,$51.31 ,$258.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30682015,86769,HC SARS-COV-2 COVID-19 ANTIBODY-90,306,1 ,$130.00 ,$84.50 ,$42.13 ,$130.00 ,$96.85 ,$85.15 ,$42.13 ,$68.51 ,$42.13 ,$82.03 ,$82.03 ,$82.03 ,$82.03 ,$117.00 ,$42.13 ,$42.13 ,$114.40 ,$42.13 ,$97.50 ,$97.50 ,$110.50 ,$110.50 ,$42.13 ,$110.50 ,$42.13 ,$102.70 ,$102.70 ,$102.70 ,$117.00 ,$105.33 ,$117.00 ,$42.13 ,$130.00 ,$85.15 ,$42.13 ,$56.42 , N/A ,$44.24 ,$117.00 ,$94.79 ,$82.03 ,$78.00 ,$117.00 ,$42.13 ,$117.00 ,$117.00 ,$42.13 ,$84.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30700121,81001,HC URINALYSIS AUTO W/MICRO,307,1 ,$67.00 ,$43.55 ,$3.17 ,$67.00 ,$49.92 ,$43.89 ,$3.17 ,$35.31 ,$3.17 ,$42.28 ,$42.28 ,$42.28 ,$42.28 ,$60.30 ,$50.25 ,$3.17 ,$58.96 ,$3.17 ,$50.25 ,$50.25 ,$56.95 ,$56.95 ,$3.17 ,$56.95 ,$3.17 ,$52.93 ,$52.93 ,$52.93 ,$60.30 ,$7.93 ,$60.30 ,$3.17 ,$3.17 ,$43.89 ,$3.17 ,$29.08 , N/A ,$3.33 ,$60.30 ,$7.13 ,$42.28 ,$40.20 ,$60.30 ,$3.17 ,$60.30 ,$60.30 ,$3.17 ,$43.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30700125,81003,HC URINALYSIS AUTO W/O MICRO,307,1 ,$41.00 ,$26.65 ,$2.25 ,$41.00 ,$30.55 ,$26.86 ,$2.25 ,$21.61 ,$2.25 ,$25.87 ,$25.87 ,$25.87 ,$25.87 ,$36.90 ,$30.75 ,$2.25 ,$36.08 ,$2.25 ,$30.75 ,$30.75 ,$34.85 ,$34.85 ,$2.25 ,$34.85 ,$2.25 ,$32.39 ,$32.39 ,$32.39 ,$36.90 ,$5.63 ,$36.90 ,$2.25 ,$41.00 ,$26.86 ,$2.25 ,$17.79 , N/A ,$2.36 ,$36.90 ,$5.06 ,$25.87 ,$24.60 ,$36.90 ,$2.25 ,$36.90 ,$36.90 ,$2.25 ,$26.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30700128,81025,HC URINE PREGNANCY TEST,307,1 ,$95.00 ,$61.75 ,$8.61 ,$95.00 ,$70.78 ,$62.23 ,$8.61 ,$50.07 ,$8.61 ,$59.95 ,$59.95 ,$59.95 ,$59.95 ,$85.50 ,$71.25 ,$8.61 ,$83.60 ,$8.61 ,$71.25 ,$71.25 ,$80.75 ,$80.75 ,$8.61 ,$80.75 ,$8.61 ,$75.05 ,$75.05 ,$75.05 ,$85.50 ,$21.53 ,$85.50 ,$8.61 ,$8.61 ,$62.23 ,$8.61 ,$41.23 , N/A ,$9.04 ,$85.50 ,$19.37 ,$59.95 ,$57.00 ,$85.50 ,$8.61 ,$85.50 ,$85.50 ,$8.61 ,$61.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30700129,81025,HC URINE PREGNANCY TEST,307,1 ,$95.00 ,$61.75 ,$8.61 ,$95.00 ,$70.78 ,$62.23 ,$8.61 ,$50.07 ,$8.61 ,$59.95 ,$59.95 ,$59.95 ,$59.95 ,$85.50 ,$71.25 ,$8.61 ,$83.60 ,$8.61 ,$71.25 ,$71.25 ,$80.75 ,$80.75 ,$8.61 ,$80.75 ,$8.61 ,$75.05 ,$75.05 ,$75.05 ,$85.50 ,$21.53 ,$85.50 ,$8.61 ,$8.61 ,$62.23 ,$8.61 ,$41.23 , N/A ,$9.04 ,$85.50 ,$19.37 ,$59.95 ,$57.00 ,$85.50 ,$8.61 ,$85.50 ,$85.50 ,$8.61 ,$61.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),30700133,81002,HC URINALYSIS NON AUTO W/O MICRO-QW,307,1 ,$39.00 ,$25.35 ,$3.48 ,$39.00 ,$29.06 ,$25.55 ,$3.48 ,$20.55 ,$3.48 ,$24.61 ,$24.61 ,$24.61 ,$24.61 ,$35.10 ,$29.25 ,$3.48 ,$34.32 ,$3.48 ,$29.25 ,$29.25 ,$33.15 ,$33.15 ,$3.48 ,$33.15 ,$3.48 ,$30.81 ,$30.81 ,$30.81 ,$35.10 ,$8.70 ,$35.10 ,$3.48 ,$39.00 ,$25.55 ,$3.48 ,$16.93 , N/A ,$3.65 ,$35.10 ,$7.83 ,$24.61 ,$23.40 ,$35.10 ,$3.48 ,$35.10 ,$35.10 ,$3.48 ,$25.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000127,80500,HC CLINAL PATH CONSULT LTD,310,1 ,$802.00 ,$521.30 ,$47.23 ,$802.00 ,$597.49 ,$525.31 ,$47.23 ,$422.65 ,$47.23 ,$506.06 ,$506.06 ,$506.06 ,$506.06 ,$721.80 ,$601.50 ,$47.23 ,$705.76 ,$47.23 ,$601.50 ,$601.50 ,$681.70 ,$681.70 ,$47.23 ,$681.70 ,$47.23 ,$633.58 ,$633.58 ,$633.58 ,$721.80 ,$118.08 ,$721.80 ,$47.23 ,$802.00 ,$525.31 ,$47.23 ,$348.07 , N/A ,$49.59 ,$721.80 ,$106.27 ,$506.06 ,$481.20 ,$721.80 ,$47.23 ,$721.80 ,$721.80 ,$47.23 ,$521.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000128,81162,HC BRCA1 AND BRCA2 FULL SEQ/DUPE/DEL ANALYSIS -90,310,1 ,"$3,792.60 ","$2,465.19 ","$1,645.99 ","$4,105.98 ","$2,825.49 ","$2,484.15 ","$1,824.88 ","$1,998.70 ","$1,824.88 ","$2,393.13 ","$2,393.13 ","$2,393.13 ","$2,393.13 ","$3,413.34 ","$2,844.45 ","$1,824.88 ","$3,337.49 ","$1,824.88 ","$2,844.45 ","$2,844.45 ","$3,223.71 ","$3,223.71 ","$1,824.88 ","$3,223.71 ","$1,824.88 ","$2,996.15 ","$2,996.15 ","$2,996.15 ","$3,413.34 ","$3,792.60 ","$3,413.34 ","$1,824.88 ","$3,792.60 ","$2,484.15 ","$1,824.88 ","$1,645.99 ", N/A ,"$1,916.12 ","$3,413.34 ","$4,105.98 ","$2,393.13 ","$2,275.56 ","$3,413.34 ","$1,824.88 ","$3,413.34 ","$3,413.34 ","$1,824.88 ","$2,465.19 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000131,81207,HC BCR/ABL1 GENE MINOR BP DIAG -90,310,1 ,$429.24 ,$279.01 ,$144.84 ,$429.24 ,$319.78 ,$281.15 ,$144.84 ,$226.21 ,$144.84 ,$270.85 ,$270.85 ,$270.85 ,$270.85 ,$386.32 ,$321.93 ,$144.84 ,$377.73 ,$144.84 ,$321.93 ,$321.93 ,$364.85 ,$364.85 ,$144.84 ,$364.85 ,$144.84 ,$339.10 ,$339.10 ,$339.10 ,$386.32 ,$362.10 ,$386.32 ,$144.84 ,$429.24 ,$281.15 ,$144.84 ,$186.29 , N/A ,$152.08 ,$386.32 ,$325.89 ,$270.85 ,$257.54 ,$386.32 ,$144.84 ,$386.32 ,$386.32 ,$144.84 ,$279.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000133,81208,HC BCR/ABL1 GENE OTH BP QL/QN-90,310,1 ,$527.00 ,$342.55 ,$214.62 ,$527.00 ,$392.62 ,$345.19 ,$214.62 ,$277.73 ,$214.62 ,$332.54 ,$332.54 ,$332.54 ,$332.54 ,$474.30 ,$395.25 ,$214.62 ,$463.76 ,$214.62 ,$395.25 ,$395.25 ,$447.95 ,$447.95 ,$214.62 ,$447.95 ,$214.62 ,$416.33 ,$416.33 ,$416.33 ,$474.30 ,$527.00 ,$474.30 ,$214.62 ,$527.00 ,$345.19 ,$214.62 ,$228.72 , N/A ,$225.35 ,$474.30 ,$482.90 ,$332.54 ,$316.20 ,$474.30 ,$214.62 ,$474.30 ,$474.30 ,$214.62 ,$342.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000137,81220,HC CYSTIC FIBROSIS GENE COMMON VARIANTS -90,310,1 ,"$1,007.44 ",$654.84 ,$437.23 ,"$1,252.35 ",$750.54 ,$659.87 ,$556.60 ,$530.92 ,$556.60 ,$635.69 ,$635.69 ,$635.69 ,$635.69 ,$906.70 ,$755.58 ,$556.60 ,$886.55 ,$556.60 ,$755.58 ,$755.58 ,$856.32 ,$856.32 ,$556.60 ,$856.32 ,$556.60 ,$795.88 ,$795.88 ,$795.88 ,$906.70 ,"$1,007.44 ",$906.70 ,$556.60 ,"$1,007.44 ",$659.87 ,$556.60 ,$437.23 , N/A ,$584.43 ,$906.70 ,"$1,252.35 ",$635.69 ,$604.46 ,$906.70 ,$556.60 ,$906.70 ,$906.70 ,$556.60 ,$654.84 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000139,81229,HC CYTOGENOMIC MICROARRY ASSAY-90,310,1 ,"$3,450.00 ","$2,242.50 ","$1,160.00 ","$3,450.00 ","$2,570.25 ","$2,259.75 ","$1,160.00 ","$1,818.15 ","$1,160.00 ","$2,176.95 ","$2,176.95 ","$2,176.95 ","$2,176.95 ","$3,105.00 ","$2,587.50 ","$1,160.00 ","$3,036.00 ","$1,160.00 ","$2,587.50 ","$2,587.50 ","$2,932.50 ","$2,932.50 ","$1,160.00 ","$2,932.50 ","$1,160.00 ","$2,725.50 ","$2,725.50 ","$2,725.50 ","$3,105.00 ","$2,900.00 ","$3,105.00 ","$1,160.00 ","$3,450.00 ","$2,259.75 ","$1,160.00 ","$1,497.30 ", N/A ,"$1,218.00 ","$3,105.00 ","$2,610.00 ","$2,176.95 ","$2,070.00 ","$3,105.00 ","$1,160.00 ","$3,105.00 ","$3,105.00 ","$1,160.00 ","$2,242.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000143,81240,HC F2 GENE ANAL 20210G A VAR -90,310,1 ,$352.00 ,$228.80 ,$65.69 ,$352.00 ,$262.24 ,$230.56 ,$65.69 ,$185.50 ,$65.69 ,$222.11 ,$222.11 ,$222.11 ,$222.11 ,$316.80 ,$264.00 ,$65.69 ,$309.76 ,$65.69 ,$264.00 ,$264.00 ,$299.20 ,$299.20 ,$65.69 ,$299.20 ,$65.69 ,$278.08 ,$278.08 ,$278.08 ,$316.80 ,$164.23 ,$316.80 ,$65.69 ,$352.00 ,$230.56 ,$65.69 ,$152.77 , N/A ,$68.97 ,$316.80 ,$147.80 ,$222.11 ,$211.20 ,$316.80 ,$65.69 ,$316.80 ,$316.80 ,$65.69 ,$228.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000145,81241,HC F5 GENE ANAL LEIDEN VAR -90,310,1 ,$407.00 ,$264.55 ,$73.37 ,$407.00 ,$303.22 ,$266.59 ,$73.37 ,$214.49 ,$73.37 ,$256.82 ,$256.82 ,$256.82 ,$256.82 ,$366.30 ,$305.25 ,$73.37 ,$358.16 ,$73.37 ,$305.25 ,$305.25 ,$345.95 ,$345.95 ,$73.37 ,$345.95 ,$73.37 ,$321.53 ,$321.53 ,$321.53 ,$366.30 ,$183.43 ,$366.30 ,$73.37 ,$407.00 ,$266.59 ,$73.37 ,$176.64 , N/A ,$77.04 ,$366.30 ,$165.08 ,$256.82 ,$244.20 ,$366.30 ,$73.37 ,$366.30 ,$366.30 ,$73.37 ,$264.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000149,81256,HC HFE GENE ANALYSIS -90,310,1 ,$404.00 ,$262.60 ,$65.36 ,$404.00 ,$300.98 ,$264.62 ,$65.36 ,$212.91 ,$65.36 ,$254.92 ,$254.92 ,$254.92 ,$254.92 ,$363.60 ,$303.00 ,$65.36 ,$355.52 ,$65.36 ,$303.00 ,$303.00 ,$343.40 ,$343.40 ,$65.36 ,$343.40 ,$65.36 ,$319.16 ,$319.16 ,$319.16 ,$363.60 ,$163.40 ,$363.60 ,$65.36 ,$404.00 ,$264.62 ,$65.36 ,$175.34 , N/A ,$68.63 ,$363.60 ,$147.06 ,$254.92 ,$242.40 ,$363.60 ,$65.36 ,$363.60 ,$363.60 ,$65.36 ,$262.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000154,81270,HC JAK2 GENE ANALYSIS-90,310,1 ,$566.00 ,$367.90 ,$91.66 ,$566.00 ,$421.67 ,$370.73 ,$91.66 ,$298.28 ,$91.66 ,$357.15 ,$357.15 ,$357.15 ,$357.15 ,$509.40 ,$424.50 ,$91.66 ,$498.08 ,$91.66 ,$424.50 ,$424.50 ,$481.10 ,$481.10 ,$91.66 ,$481.10 ,$91.66 ,$447.14 ,$447.14 ,$447.14 ,$509.40 ,$229.15 ,$509.40 ,$91.66 ,$566.00 ,$370.73 ,$91.66 ,$245.64 , N/A ,$96.24 ,$509.40 ,$206.24 ,$357.15 ,$339.60 ,$509.40 ,$91.66 ,$509.40 ,$509.40 ,$91.66 ,$367.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000162,81299,HC MLH2 GENE FAMILIAL VARIANT-90,310,1 ,"$3,000.00 ","$1,950.00 ",$308.00 ,"$3,000.00 ","$2,235.00 ","$1,965.00 ",$308.00 ,"$1,581.00 ",$308.00 ,"$1,893.00 ","$1,893.00 ","$1,893.00 ","$1,893.00 ","$2,700.00 ","$2,250.00 ",$308.00 ,"$2,640.00 ",$308.00 ,"$2,250.00 ","$2,250.00 ","$2,550.00 ","$2,550.00 ",$308.00 ,"$2,550.00 ",$308.00 ,"$2,370.00 ","$2,370.00 ","$2,370.00 ","$2,700.00 ",$770.00 ,"$2,700.00 ",$308.00 ,"$3,000.00 ","$1,965.00 ",$308.00 ,"$1,302.00 ", N/A ,$323.40 ,"$2,700.00 ",$693.00 ,"$1,893.00 ","$1,800.00 ","$2,700.00 ",$308.00 ,"$2,700.00 ","$2,700.00 ",$308.00 ,"$1,950.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000171,81332,HC SERPINA 1 GENE ANALYSIS-90,310,1 ,$270.00 ,$175.50 ,$43.65 ,$270.00 ,$201.15 ,$176.85 ,$43.65 ,$142.29 ,$43.65 ,$170.37 ,$170.37 ,$170.37 ,$170.37 ,$243.00 ,$202.50 ,$43.65 ,$237.60 ,$43.65 ,$202.50 ,$202.50 ,$229.50 ,$229.50 ,$43.65 ,$229.50 ,$43.65 ,$213.30 ,$213.30 ,$213.30 ,$243.00 ,$109.13 ,$243.00 ,$43.65 ,$270.00 ,$176.85 ,$43.65 ,$117.18 , N/A ,$45.83 ,$243.00 ,$98.21 ,$170.37 ,$162.00 ,$243.00 ,$43.65 ,$243.00 ,$243.00 ,$43.65 ,$175.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000179,81381,HC HLA 1 TYPE 1 ALLELE HIGH RESOLUTION -90,310,1 ,$296.00 ,$192.40 ,$128.46 ,$382.28 ,$220.52 ,$193.88 ,$169.90 ,$155.99 ,$169.90 ,$186.78 ,$186.78 ,$186.78 ,$186.78 ,$266.40 ,$222.00 ,$169.90 ,$260.48 ,$169.90 ,$222.00 ,$222.00 ,$251.60 ,$251.60 ,$169.90 ,$251.60 ,$169.90 ,$233.84 ,$233.84 ,$233.84 ,$266.40 ,$296.00 ,$266.40 ,$169.90 ,$296.00 ,$193.88 ,$169.90 ,$128.46 , N/A ,$178.40 ,$266.40 ,$382.28 ,$186.78 ,$177.60 ,$266.40 ,$169.90 ,$266.40 ,$266.40 ,$169.90 ,$192.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000181,81400,HC MOLECULAR PATH PROC LEVEL 1-90,310,1 ,$602.80 ,$391.82 ,$63.96 ,$602.80 ,$449.09 ,$394.83 ,$63.96 ,$317.68 ,$63.96 ,$380.37 ,$380.37 ,$380.37 ,$380.37 ,$542.52 ,$452.10 ,$63.96 ,$530.46 ,$63.96 ,$452.10 ,$452.10 ,$512.38 ,$512.38 ,$63.96 ,$512.38 ,$63.96 ,$476.21 ,$476.21 ,$476.21 ,$542.52 ,$159.90 ,$542.52 ,$63.96 ,$602.80 ,$394.83 ,$63.96 ,$261.62 , N/A ,$67.16 ,$542.52 ,$143.91 ,$380.37 ,$361.68 ,$542.52 ,$63.96 ,$542.52 ,$542.52 ,$63.96 ,$391.82 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000183,81401,HC MOLECULAR PATH PROC LEVEL 2-90,310,1 ,"$1,151.12 ",$748.23 ,$499.59 ,"$1,151.12 ",$857.58 ,$753.98 , N/A ,$606.64 , N/A ,$726.36 ,$726.36 ,$726.36 ,$726.36 ,"$1,036.01 ",$863.34 , N/A ,"$1,012.99 ", N/A ,$863.34 ,$863.34 ,$978.45 ,$978.45 , N/A ,$978.45 , N/A ,$909.38 ,$909.38 ,$909.38 ,"$1,036.01 ", N/A ,"$1,036.01 ", N/A ,"$1,151.12 ",$753.98 , N/A ,$499.59 , N/A , N/A ,"$1,036.01 ", N/A ,$726.36 ,$690.67 ,"$1,036.01 ", N/A ,"$1,036.01 ","$1,036.01 ", N/A ,$748.23 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000184,81403,HC MOLECULAR PATH PROC LEVEL 4-90,310,1 ,$926.00 ,$601.90 ,$401.88 ,$926.00 ,$689.87 ,$606.53 , N/A ,$488.00 , N/A ,$584.31 ,$584.31 ,$584.31 ,$584.31 ,$833.40 ,$694.50 , N/A ,$814.88 , N/A ,$694.50 ,$694.50 ,$787.10 ,$787.10 , N/A ,$787.10 , N/A ,$731.54 ,$731.54 ,$731.54 ,$833.40 , N/A ,$833.40 , N/A ,$926.00 ,$606.53 , N/A ,$401.88 , N/A , N/A ,$833.40 , N/A ,$584.31 ,$555.60 ,$833.40 , N/A ,$833.40 ,$833.40 , N/A ,$601.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000190,81408,HC MOLECULAR PATH PROC LEVEL 9-90,310,1 ,"$3,950.00 ","$2,567.50 ","$1,714.30 ","$3,950.00 ","$2,942.75 ","$2,587.25 ", N/A ,"$2,081.65 ", N/A ,"$2,492.45 ","$2,492.45 ","$2,492.45 ","$2,492.45 ","$3,555.00 ","$2,962.50 ", N/A ,"$3,476.00 ", N/A ,"$2,962.50 ","$2,962.50 ","$3,357.50 ","$3,357.50 ", N/A ,"$3,357.50 ", N/A ,"$3,120.50 ","$3,120.50 ","$3,120.50 ","$3,555.00 ", N/A ,"$3,555.00 ", N/A ,"$3,950.00 ","$2,587.25 ", N/A ,"$1,714.30 ", N/A , N/A ,"$3,555.00 ", N/A ,"$2,492.45 ","$2,370.00 ","$3,555.00 ", N/A ,"$3,555.00 ","$3,555.00 ", N/A ,"$2,567.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000200,0001U,HC RBC DNA HUMAN GENE ANLYS 35 AG 11 BLOOD GRP-90,310,1 ,"$1,846.00 ","$1,199.90 ",$720.00 ,"$1,846.00 ","$1,375.27 ","$1,209.13 ",$720.00 ,$972.84 ,$720.00 ,"$1,164.83 ","$1,164.83 ","$1,164.83 ","$1,164.83 ","$1,661.40 ","$1,384.50 ",$720.00 ,"$1,624.48 ",$720.00 ,"$1,384.50 ","$1,384.50 ","$1,569.10 ","$1,569.10 ",$720.00 ,"$1,569.10 ",$720.00 ,"$1,458.34 ","$1,458.34 ","$1,458.34 ","$1,661.40 ","$1,800.00 ","$1,661.40 ",$720.00 ,"$1,846.00 ","$1,209.13 ",$720.00 ,$801.16 , N/A ,$756.00 ,"$1,661.40 ","$1,620.00 ","$1,164.83 ","$1,107.60 ","$1,661.40 ",$720.00 ,"$1,661.40 ","$1,661.40 ",$720.00 ,"$1,199.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000242,81329,HC SMN1 GENE DOSAGE/DELETION ANALYSIS-90,310,1 ,$884.00 ,$574.60 ,$137.00 ,$884.00 ,$658.58 ,$579.02 ,$137.00 ,$465.87 ,$137.00 ,$557.80 ,$557.80 ,$557.80 ,$557.80 ,$795.60 ,$663.00 ,$137.00 ,$777.92 ,$137.00 ,$663.00 ,$663.00 ,$751.40 ,$751.40 ,$137.00 ,$751.40 ,$137.00 ,$698.36 ,$698.36 ,$698.36 ,$795.60 ,$342.50 ,$795.60 ,$137.00 ,$884.00 ,$579.02 ,$137.00 ,$383.66 , N/A ,$143.85 ,$795.60 ,$308.25 ,$557.80 ,$530.40 ,$795.60 ,$137.00 ,$795.60 ,$795.60 ,$137.00 ,$574.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000253,81420,HC FETAL CHROMOSOME ANEUPLOIDY -90,310,1 ,"$1,150.00 ",$747.50 ,$499.10 ,"$1,707.86 ",$856.75 ,$753.25 ,$759.05 ,$606.05 ,$759.05 ,$725.65 ,$725.65 ,$725.65 ,$725.65 ,"$1,035.00 ",$862.50 ,$759.05 ,"$1,012.00 ",$759.05 ,$862.50 ,$862.50 ,$977.50 ,$977.50 ,$759.05 ,$977.50 ,$759.05 ,$908.50 ,$908.50 ,$908.50 ,"$1,035.00 ","$1,150.00 ","$1,035.00 ",$759.05 ,"$1,150.00 ",$753.25 ,$759.05 ,$499.10 , N/A ,$797.00 ,"$1,035.00 ","$1,707.86 ",$725.65 ,$690.00 ,"$1,035.00 ",$759.05 ,"$1,035.00 ","$1,035.00 ",$759.05 ,$747.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31000275,81209,HC BLM GENE ANALYSIS 2281DEL6INS7 VARIANT-90,310,1 ,$117.93 ,$76.65 ,$39.31 ,$117.93 ,$87.86 ,$77.24 ,$39.31 ,$62.15 ,$39.31 ,$74.41 ,$74.41 ,$74.41 ,$74.41 ,$106.14 ,$88.45 ,$39.31 ,$103.78 ,$39.31 ,$88.45 ,$88.45 ,$100.24 ,$100.24 ,$39.31 ,$100.24 ,$39.31 ,$93.16 ,$93.16 ,$93.16 ,$106.14 ,$98.28 ,$106.14 ,$39.31 ,$117.93 ,$77.24 ,$39.31 ,$51.18 , N/A ,$41.28 ,$106.14 ,$88.45 ,$74.41 ,$70.76 ,$106.14 ,$39.31 ,$106.14 ,$106.14 ,$39.31 ,$76.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31100101,88104,HC CYTOPATH FLD SMEAR,311,1 ,$120.00 ,$78.00 ,$32.12 ,$120.00 ,$89.40 ,$78.60 ,$32.12 ,$63.24 ,$32.12 ,$75.72 ,$75.72 ,$75.72 ,$75.72 ,$108.00 ,$90.00 ,$32.12 ,$105.60 ,$32.12 ,$90.00 ,$90.00 ,$102.00 ,$102.00 ,$32.12 ,$102.00 ,$32.12 ,$94.80 ,$94.80 ,$94.80 ,$108.00 ,$80.30 ,$108.00 ,$32.12 ,$120.00 ,$78.60 ,$32.12 ,$52.08 , N/A ,$33.73 ,$108.00 ,$72.27 ,$75.72 ,$72.00 ,$108.00 ,$32.12 ,$108.00 ,$108.00 ,$32.12 ,$78.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31100102,88108,HC CYTOPATH CONCENTRATION,311,1 ,$145.00 ,$94.25 ,$32.12 ,$145.00 ,$108.03 ,$94.98 ,$32.12 ,$76.42 ,$32.12 ,$91.50 ,$91.50 ,$91.50 ,$91.50 ,$130.50 ,$108.75 ,$32.12 ,$127.60 ,$32.12 ,$108.75 ,$108.75 ,$123.25 ,$123.25 ,$32.12 ,$123.25 ,$32.12 ,$114.55 ,$114.55 ,$114.55 ,$130.50 ,$80.30 ,$130.50 ,$32.12 ,$145.00 ,$94.98 ,$32.12 ,$62.93 , N/A ,$33.73 ,$130.50 ,$72.27 ,$91.50 ,$87.00 ,$130.50 ,$32.12 ,$130.50 ,$130.50 ,$32.12 ,$94.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31100104,88112,HC CYTOPATH CELL ENHANCE,311,1 ,$168.00 ,$109.20 ,$47.23 ,$168.00 ,$125.16 ,$110.04 ,$47.23 ,$88.54 ,$47.23 ,$106.01 ,$106.01 ,$106.01 ,$106.01 ,$151.20 ,$126.00 ,$47.23 ,$147.84 ,$47.23 ,$126.00 ,$126.00 ,$142.80 ,$142.80 ,$47.23 ,$142.80 ,$47.23 ,$132.72 ,$132.72 ,$132.72 ,$151.20 ,$118.08 ,$151.20 ,$47.23 ,$168.00 ,$110.04 ,$47.23 ,$72.91 , N/A ,$49.59 ,$151.20 ,$106.27 ,$106.01 ,$100.80 ,$151.20 ,$47.23 ,$151.20 ,$151.20 ,$47.23 ,$109.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31100110,88160,HC CYTOPATH SMEAR NON GYN,311,1 ,$49.00 ,$31.85 ,$21.27 ,$52.69 ,$36.51 ,$32.10 ,$23.42 ,$25.82 ,$23.42 ,$30.92 ,$30.92 ,$30.92 ,$30.92 ,$44.10 ,$36.75 ,$23.42 ,$43.12 ,$23.42 ,$36.75 ,$36.75 ,$41.65 ,$41.65 ,$23.42 ,$41.65 ,$23.42 ,$38.71 ,$38.71 ,$38.71 ,$44.10 ,$49.00 ,$44.10 ,$23.42 ,$49.00 ,$32.10 ,$23.42 ,$21.27 , N/A ,$24.59 ,$44.10 ,$52.69 ,$30.92 ,$29.40 ,$44.10 ,$23.42 ,$44.10 ,$44.10 ,$23.42 ,$31.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31100114,88172,HC FINE NEEDLE EVAL,311,1 ,$43.00 ,$27.95 ,$18.66 ,$318.55 ,$32.04 ,$28.17 ,$43.00 ,$22.66 ,$43.00 ,$27.13 ,$27.13 ,$27.13 ,$27.13 ,$38.70 ,$32.25 ,$43.00 ,$37.84 ,$43.00 ,$32.25 ,$32.25 ,$36.55 ,$36.55 ,$43.00 ,$36.55 ,$43.00 ,$33.97 ,$33.97 ,$33.97 ,$38.70 ,$43.00 ,$38.70 ,$43.00 ,$21.05 ,$28.17 ,$43.00 ,$18.66 , N/A ,$43.00 ,$38.70 ,$318.55 ,$27.13 ,$25.80 ,$38.70 ,$43.00 ,$38.70 ,$38.70 ,$43.00 ,$27.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31100115,88173,HC FINE NEEDLE INTERP,311,1 ,$385.00 ,$250.25 ,$47.23 ,$385.00 ,$286.83 ,$252.18 ,$47.23 ,$202.90 ,$47.23 ,$242.94 ,$242.94 ,$242.94 ,$242.94 ,$346.50 ,$288.75 ,$47.23 ,$338.80 ,$47.23 ,$288.75 ,$288.75 ,$327.25 ,$327.25 ,$47.23 ,$327.25 ,$47.23 ,$304.15 ,$304.15 ,$304.15 ,$346.50 ,$118.08 ,$346.50 ,$47.23 ,$89.83 ,$252.18 ,$47.23 ,$167.09 , N/A ,$49.59 ,$346.50 ,$106.27 ,$242.94 ,$231.00 ,$346.50 ,$47.23 ,$346.50 ,$346.50 ,$47.23 ,$250.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31100116,88177,HC FINE NEEDLE EVAL ADDL,311,1 ,$43.00 ,$27.95 ,$18.66 ,$43.00 ,$32.04 ,$28.17 , N/A ,$22.66 , N/A ,$27.13 ,$27.13 ,$27.13 ,$27.13 ,$38.70 ,$32.25 , N/A ,$37.84 , N/A ,$32.25 ,$32.25 ,$36.55 ,$36.55 , N/A ,$36.55 , N/A ,$33.97 ,$33.97 ,$33.97 ,$38.70 , N/A ,$38.70 , N/A ,$43.00 ,$28.17 , N/A ,$18.66 , N/A , N/A ,$38.70 , N/A ,$27.13 ,$25.80 ,$38.70 , N/A ,$38.70 ,$38.70 , N/A ,$27.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31100242,88175,HC CYTOPATH PAP DIAG INIT/REDO,311,1 ,$163.00 ,$105.95 ,$20.26 ,$163.00 ,$121.44 ,$106.77 ,$26.61 ,$85.90 ,$26.61 ,$102.85 ,$102.85 ,$102.85 ,$102.85 ,$146.70 ,$122.25 ,$26.61 ,$143.44 ,$26.61 ,$122.25 ,$122.25 ,$138.55 ,$138.55 ,$26.61 ,$138.55 ,$26.61 ,$128.77 ,$128.77 ,$128.77 ,$146.70 ,$66.53 ,$146.70 ,$26.61 ,$20.26 ,$106.77 ,$26.61 ,$70.74 , N/A ,$27.94 ,$146.70 ,$59.87 ,$102.85 ,$97.80 ,$146.70 ,$26.61 ,$146.70 ,$146.70 ,$26.61 ,$105.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31100251,88230,HC TISSUE CULT NONNEO LYMPHOCYTE-90,311,1 ,$485.00 ,$315.25 ,$116.49 ,$485.00 ,$361.33 ,$317.68 ,$116.49 ,$255.60 ,$116.49 ,$306.04 ,$306.04 ,$306.04 ,$306.04 ,$436.50 ,$363.75 ,$116.49 ,$426.80 ,$116.49 ,$363.75 ,$363.75 ,$412.25 ,$412.25 ,$116.49 ,$412.25 ,$116.49 ,$383.15 ,$383.15 ,$383.15 ,$436.50 ,$291.23 ,$436.50 ,$116.49 ,$485.00 ,$317.68 ,$116.49 ,$210.49 , N/A ,$122.31 ,$436.50 ,$262.10 ,$306.04 ,$291.00 ,$436.50 ,$116.49 ,$436.50 ,$436.50 ,$116.49 ,$315.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31100256,88239,HC TISSUE CULT TUMOR-90,311,1 ,"$1,476.00 ",$959.40 ,$147.52 ,"$1,476.00 ","$1,099.62 ",$966.78 ,$147.52 ,$777.85 ,$147.52 ,$931.36 ,$931.36 ,$931.36 ,$931.36 ,"$1,328.40 ","$1,107.00 ",$147.52 ,"$1,298.88 ",$147.52 ,"$1,107.00 ","$1,107.00 ","$1,254.60 ","$1,254.60 ",$147.52 ,"$1,254.60 ",$147.52 ,"$1,166.04 ","$1,166.04 ","$1,166.04 ","$1,328.40 ",$368.80 ,"$1,328.40 ",$147.52 ,"$1,476.00 ",$966.78 ,$147.52 ,$640.58 , N/A ,$154.90 ,"$1,328.40 ",$331.92 ,$931.36 ,$885.60 ,"$1,328.40 ",$147.52 ,"$1,328.40 ","$1,328.40 ",$147.52 ,$959.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31100257,88262,HC CHROM COUNT 15-20/2-90,311,1 ,"$1,249.00 ",$811.85 ,$125.49 ,"$1,249.00 ",$930.51 ,$818.10 ,$125.49 ,$658.22 ,$125.49 ,$788.12 ,$788.12 ,$788.12 ,$788.12 ,"$1,124.10 ",$936.75 ,$125.49 ,"$1,099.12 ",$125.49 ,$936.75 ,$936.75 ,"$1,061.65 ","$1,061.65 ",$125.49 ,"$1,061.65 ",$125.49 ,$986.71 ,$986.71 ,$986.71 ,"$1,124.10 ",$313.73 ,"$1,124.10 ",$125.49 ,"$1,249.00 ",$818.10 ,$125.49 ,$542.07 , N/A ,$131.76 ,"$1,124.10 ",$282.35 ,$788.12 ,$749.40 ,"$1,124.10 ",$125.49 ,"$1,124.10 ","$1,124.10 ",$125.49 ,$811.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31100261,88271,HC MCG DNA PROBE(FISH)-90,311,1 ,$146.00 ,$94.90 ,$21.42 ,$146.00 ,$108.77 ,$95.63 ,$21.42 ,$76.94 ,$21.42 ,$92.13 ,$92.13 ,$92.13 ,$92.13 ,$131.40 ,$109.50 ,$21.42 ,$128.48 ,$21.42 ,$109.50 ,$109.50 ,$124.10 ,$124.10 ,$21.42 ,$124.10 ,$21.42 ,$115.34 ,$115.34 ,$115.34 ,$131.40 ,$53.55 ,$131.40 ,$21.42 ,$146.00 ,$95.63 ,$21.42 ,$63.36 , N/A ,$22.49 ,$131.40 ,$48.20 ,$92.13 ,$87.60 ,$131.40 ,$21.42 ,$131.40 ,$131.40 ,$21.42 ,$94.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31100270,88275,HC MCG INTERPH INSITU FISH 100-90,311,1 ,$219.00 ,$142.35 ,$51.19 ,$219.00 ,$163.16 ,$143.45 ,$51.19 ,$115.41 ,$51.19 ,$138.19 ,$138.19 ,$138.19 ,$138.19 ,$197.10 ,$164.25 ,$51.19 ,$192.72 ,$51.19 ,$164.25 ,$164.25 ,$186.15 ,$186.15 ,$51.19 ,$186.15 ,$51.19 ,$173.01 ,$173.01 ,$173.01 ,$197.10 ,$127.98 ,$197.10 ,$51.19 ,$219.00 ,$143.45 ,$51.19 ,$95.05 , N/A ,$53.75 ,$197.10 ,$115.18 ,$138.19 ,$131.40 ,$197.10 ,$51.19 ,$197.10 ,$197.10 ,$51.19 ,$142.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31100274,88289,HC CHROM ADDL HIGH RES-90,311,1 ,$120.00 ,$78.00 ,$34.43 ,$120.00 ,$89.40 ,$78.60 ,$34.43 ,$63.24 ,$34.43 ,$75.72 ,$75.72 ,$75.72 ,$75.72 ,$108.00 ,$90.00 ,$34.43 ,$105.60 ,$34.43 ,$90.00 ,$90.00 ,$102.00 ,$102.00 ,$34.43 ,$102.00 ,$34.43 ,$94.80 ,$94.80 ,$94.80 ,$108.00 ,$86.08 ,$108.00 ,$34.43 ,$120.00 ,$78.60 ,$34.43 ,$52.08 , N/A ,$36.15 ,$108.00 ,$77.47 ,$75.72 ,$72.00 ,$108.00 ,$34.43 ,$108.00 ,$108.00 ,$34.43 ,$78.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31100275,88291,HC INTERPRETATION-90,311,1 ,$69.00 ,$44.85 ,$29.95 ,$69.00 ,$51.41 ,$45.20 , N/A ,$36.36 , N/A ,$43.54 ,$43.54 ,$43.54 ,$43.54 ,$62.10 ,$51.75 , N/A ,$60.72 , N/A ,$51.75 ,$51.75 ,$58.65 ,$58.65 , N/A ,$58.65 , N/A ,$54.51 ,$54.51 ,$54.51 ,$62.10 , N/A ,$62.10 , N/A ,$69.00 ,$45.20 , N/A ,$29.95 , N/A , N/A ,$62.10 , N/A ,$43.54 ,$41.40 ,$62.10 , N/A ,$62.10 ,$62.10 , N/A ,$44.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31100280,G0145,HC CYTOPATH PAP SCREEN INIT/REDO,311,1 ,$188.00 ,$122.20 ,$26.49 ,$188.00 ,$140.06 ,$123.14 ,$26.49 ,$99.08 ,$26.49 ,$118.63 ,$118.63 ,$118.63 ,$118.63 ,$169.20 ,$141.00 ,$26.49 ,$165.44 ,$26.49 ,$141.00 ,$141.00 ,$159.80 ,$159.80 ,$26.49 ,$159.80 ,$26.49 ,$148.52 ,$148.52 ,$148.52 ,$169.20 ,$66.23 ,$169.20 ,$26.49 ,$188.00 ,$123.14 ,$26.49 ,$81.59 , N/A ,$27.81 ,$169.20 ,$59.60 ,$118.63 ,$112.80 ,$169.20 ,$26.49 ,$169.20 ,$169.20 ,$26.49 ,$122.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200101,88300,HC GROSS ONLY LEVEL I,312,1 ,$109.00 ,$70.85 ,$23.42 ,$109.00 ,$81.21 ,$71.40 ,$23.42 ,$57.44 ,$23.42 ,$68.78 ,$68.78 ,$68.78 ,$68.78 ,$98.10 ,$81.75 ,$23.42 ,$95.92 ,$23.42 ,$81.75 ,$81.75 ,$92.65 ,$92.65 ,$23.42 ,$92.65 ,$23.42 ,$86.11 ,$86.11 ,$86.11 ,$98.10 ,$58.54 ,$98.10 ,$23.42 ,$109.00 ,$71.40 ,$23.42 ,$47.31 , N/A ,$24.59 ,$98.10 ,$52.69 ,$68.78 ,$65.40 ,$98.10 ,$23.42 ,$98.10 ,$98.10 ,$23.42 ,$70.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200102,88302,HC GROSS AND MICRO LEVEL II,312,1 ,$147.00 ,$95.55 ,$23.42 ,$147.00 ,$109.52 ,$96.29 ,$23.42 ,$77.47 ,$23.42 ,$92.76 ,$92.76 ,$92.76 ,$92.76 ,$132.30 ,$110.25 ,$23.42 ,$129.36 ,$23.42 ,$110.25 ,$110.25 ,$124.95 ,$124.95 ,$23.42 ,$124.95 ,$23.42 ,$116.13 ,$116.13 ,$116.13 ,$132.30 ,$58.54 ,$132.30 ,$23.42 ,$147.00 ,$96.29 ,$23.42 ,$63.80 , N/A ,$24.59 ,$132.30 ,$52.69 ,$92.76 ,$88.20 ,$132.30 ,$23.42 ,$132.30 ,$132.30 ,$23.42 ,$95.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200103,88304,HC GROSS AND MICRO LEVEL III,312,1 ,$261.00 ,$169.65 ,$47.23 ,$261.00 ,$194.45 ,$170.96 ,$47.23 ,$137.55 ,$47.23 ,$164.69 ,$164.69 ,$164.69 ,$164.69 ,$234.90 ,$195.75 ,$47.23 ,$229.68 ,$47.23 ,$195.75 ,$195.75 ,$221.85 ,$221.85 ,$47.23 ,$221.85 ,$47.23 ,$206.19 ,$206.19 ,$206.19 ,$234.90 ,$118.08 ,$234.90 ,$47.23 ,$261.00 ,$170.96 ,$47.23 ,$113.27 , N/A ,$49.59 ,$234.90 ,$106.27 ,$164.69 ,$156.60 ,$234.90 ,$47.23 ,$234.90 ,$234.90 ,$47.23 ,$169.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200108,88305,HC GROSS AND MICRO LEVEL IV,312,1 ,$261.00 ,$169.65 ,$35.62 ,$261.00 ,$194.45 ,$170.96 ,$47.23 ,$137.55 ,$47.23 ,$164.69 ,$164.69 ,$164.69 ,$164.69 ,$234.90 ,$195.75 ,$47.23 ,$229.68 ,$47.23 ,$195.75 ,$195.75 ,$221.85 ,$221.85 ,$47.23 ,$221.85 ,$47.23 ,$206.19 ,$206.19 ,$206.19 ,$234.90 ,$118.08 ,$234.90 ,$47.23 ,$35.62 ,$170.96 ,$47.23 ,$113.27 , N/A ,$49.59 ,$234.90 ,$106.27 ,$164.69 ,$156.60 ,$234.90 ,$47.23 ,$234.90 ,$234.90 ,$47.23 ,$169.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200110,88307,HC GROSS AND MICRO LEVEL V,312,1 ,$802.00 ,$521.30 ,$217.17 ,$802.00 ,$597.49 ,$525.31 ,$276.46 ,$422.65 ,$276.46 ,$506.06 ,$506.06 ,$506.06 ,$506.06 ,$721.80 ,$601.50 ,$276.46 ,$705.76 ,$276.46 ,$601.50 ,$601.50 ,$681.70 ,$681.70 ,$276.46 ,$681.70 ,$276.46 ,$633.58 ,$633.58 ,$633.58 ,$721.80 ,$691.15 ,$721.80 ,$276.46 ,$217.17 ,$525.31 ,$276.46 ,$348.07 , N/A ,$290.28 ,$721.80 ,$622.03 ,$506.06 ,$481.20 ,$721.80 ,$276.46 ,$721.80 ,$721.80 ,$276.46 ,$521.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200113,88309,HC GROSS AND MICRO LEVEL VI,312,1 ,"$1,285.00 ",$835.25 ,$557.69 ,"$1,401.31 ",$957.33 ,$841.68 ,$622.80 ,$677.20 ,$622.80 ,$810.84 ,$810.84 ,$810.84 ,$810.84 ,"$1,156.50 ",$963.75 ,$622.80 ,"$1,130.80 ",$622.80 ,$963.75 ,$963.75 ,"$1,092.25 ","$1,092.25 ",$622.80 ,"$1,092.25 ",$622.80 ,"$1,015.15 ","$1,015.15 ","$1,015.15 ","$1,156.50 ","$1,285.00 ","$1,156.50 ",$622.80 ,"$1,285.00 ",$841.68 ,$622.80 ,$557.69 , N/A ,$653.94 ,"$1,156.50 ","$1,401.31 ",$810.84 ,$771.00 ,"$1,156.50 ",$622.80 ,"$1,156.50 ","$1,156.50 ",$622.80 ,$835.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200116,88311,HC DECALCIFICATION,312,1 ,$98.00 ,$63.70 ,$42.53 ,$98.00 ,$73.01 ,$64.19 , N/A ,$51.65 , N/A ,$61.84 ,$61.84 ,$61.84 ,$61.84 ,$88.20 ,$73.50 , N/A ,$86.24 , N/A ,$73.50 ,$73.50 ,$83.30 ,$83.30 , N/A ,$83.30 , N/A ,$77.42 ,$77.42 ,$77.42 ,$88.20 , N/A ,$88.20 , N/A ,$98.00 ,$64.19 , N/A ,$42.53 , N/A , N/A ,$88.20 , N/A ,$61.84 ,$58.80 ,$88.20 , N/A ,$88.20 ,$88.20 , N/A ,$63.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200123,88312,HC SPECIAL STAIN I,312,1 ,$188.00 ,$122.20 ,$47.23 ,$188.00 ,$140.06 ,$123.14 ,$47.23 ,$99.08 ,$47.23 ,$118.63 ,$118.63 ,$118.63 ,$118.63 ,$169.20 ,$141.00 ,$47.23 ,$165.44 ,$47.23 ,$141.00 ,$141.00 ,$159.80 ,$159.80 ,$47.23 ,$159.80 ,$47.23 ,$148.52 ,$148.52 ,$148.52 ,$169.20 ,$118.08 ,$169.20 ,$47.23 ,$188.00 ,$123.14 ,$47.23 ,$81.59 , N/A ,$49.59 ,$169.20 ,$106.27 ,$118.63 ,$112.80 ,$169.20 ,$47.23 ,$169.20 ,$169.20 ,$47.23 ,$122.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200125,88313,HC SPECIAL STAIN II,312,1 ,$188.00 ,$122.20 ,$32.12 ,$188.00 ,$140.06 ,$123.14 ,$32.12 ,$99.08 ,$32.12 ,$118.63 ,$118.63 ,$118.63 ,$118.63 ,$169.20 ,$141.00 ,$32.12 ,$165.44 ,$32.12 ,$141.00 ,$141.00 ,$159.80 ,$159.80 ,$32.12 ,$159.80 ,$32.12 ,$148.52 ,$148.52 ,$148.52 ,$169.20 ,$80.30 ,$169.20 ,$32.12 ,$188.00 ,$123.14 ,$32.12 ,$81.59 , N/A ,$33.73 ,$169.20 ,$72.27 ,$118.63 ,$112.80 ,$169.20 ,$32.12 ,$169.20 ,$169.20 ,$32.12 ,$122.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200159,88321,HC CONSULT REFERRED SLIDES,312,1 ,$122.00 ,$79.30 ,$32.12 ,$122.00 ,$90.89 ,$79.91 ,$32.12 ,$64.29 ,$32.12 ,$76.98 ,$76.98 ,$76.98 ,$76.98 ,$109.80 ,$91.50 ,$32.12 ,$107.36 ,$32.12 ,$91.50 ,$91.50 ,$103.70 ,$103.70 ,$32.12 ,$103.70 ,$32.12 ,$96.38 ,$96.38 ,$96.38 ,$109.80 ,$80.30 ,$109.80 ,$32.12 ,$122.00 ,$79.91 ,$32.12 ,$52.95 , N/A ,$33.73 ,$109.80 ,$72.27 ,$76.98 ,$73.20 ,$109.80 ,$32.12 ,$109.80 ,$109.80 ,$32.12 ,$79.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200172,88329,HC CONSULT PATH SURGERY,312,1 ,$128.00 ,$83.20 ,$32.12 ,$128.00 ,$95.36 ,$83.84 ,$32.12 ,$67.46 ,$32.12 ,$80.77 ,$80.77 ,$80.77 ,$80.77 ,$115.20 ,$96.00 ,$32.12 ,$112.64 ,$32.12 ,$96.00 ,$96.00 ,$108.80 ,$108.80 ,$32.12 ,$108.80 ,$32.12 ,$101.12 ,$101.12 ,$101.12 ,$115.20 ,$80.30 ,$115.20 ,$32.12 ,$128.00 ,$83.84 ,$32.12 ,$55.55 , N/A ,$33.73 ,$115.20 ,$72.27 ,$80.77 ,$76.80 ,$115.20 ,$32.12 ,$115.20 ,$115.20 ,$32.12 ,$83.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200173,88331,HC CONSULT PATH SURG W/FROZEN,312,1 ,$802.00 ,$521.30 ,$44.37 ,$802.00 ,$597.49 ,$525.31 ,$141.58 ,$422.65 ,$141.58 ,$506.06 ,$506.06 ,$506.06 ,$506.06 ,$721.80 ,$601.50 ,$141.58 ,$705.76 ,$141.58 ,$601.50 ,$601.50 ,$681.70 ,$681.70 ,$141.58 ,$681.70 ,$141.58 ,$633.58 ,$633.58 ,$633.58 ,$721.80 ,$353.95 ,$721.80 ,$141.58 ,$44.37 ,$525.31 ,$141.58 ,$348.07 , N/A ,$148.66 ,$721.80 ,$318.55 ,$506.06 ,$481.20 ,$721.80 ,$141.58 ,$721.80 ,$721.80 ,$141.58 ,$521.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200174,88332,HC CONSULT PATH SURG ADDL FROZEN,312,1 ,$107.00 ,$69.55 ,$25.42 ,$107.00 ,$79.72 ,$70.09 , N/A ,$56.39 , N/A ,$67.52 ,$67.52 ,$67.52 ,$67.52 ,$96.30 ,$80.25 , N/A ,$94.16 , N/A ,$80.25 ,$80.25 ,$90.95 ,$90.95 , N/A ,$90.95 , N/A ,$84.53 ,$84.53 ,$84.53 ,$96.30 , N/A ,$96.30 , N/A ,$25.42 ,$70.09 , N/A ,$46.44 , N/A , N/A ,$96.30 , N/A ,$67.52 ,$64.20 ,$96.30 , N/A ,$96.30 ,$96.30 , N/A ,$69.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200175,88333,HC CONSULT PATH SURG CYTO INIT,312,1 ,"$1,221.00 ",$793.65 ,$529.91 ,"$1,401.31 ",$909.65 ,$799.76 ,$622.80 ,$643.47 ,$622.80 ,$770.45 ,$770.45 ,$770.45 ,$770.45 ,"$1,098.90 ",$915.75 ,$622.80 ,"$1,074.48 ",$622.80 ,$915.75 ,$915.75 ,"$1,037.85 ","$1,037.85 ",$622.80 ,"$1,037.85 ",$622.80 ,$964.59 ,$964.59 ,$964.59 ,"$1,098.90 ","$1,221.00 ","$1,098.90 ",$622.80 ,"$1,221.00 ",$799.76 ,$622.80 ,$529.91 , N/A ,$653.94 ,"$1,098.90 ","$1,401.31 ",$770.45 ,$732.60 ,"$1,098.90 ",$622.80 ,"$1,098.90 ","$1,098.90 ",$622.80 ,$793.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200176,88334,HC CONSULT PATH SURG EA ADDL,312,1 ,$196.00 ,$127.40 ,$85.06 ,$196.00 ,$146.02 ,$128.38 , N/A ,$103.29 , N/A ,$123.68 ,$123.68 ,$123.68 ,$123.68 ,$176.40 ,$147.00 , N/A ,$172.48 , N/A ,$147.00 ,$147.00 ,$166.60 ,$166.60 , N/A ,$166.60 , N/A ,$154.84 ,$154.84 ,$154.84 ,$176.40 , N/A ,$176.40 , N/A ,$196.00 ,$128.38 , N/A ,$85.06 , N/A , N/A ,$176.40 , N/A ,$123.68 ,$117.60 ,$176.40 , N/A ,$176.40 ,$176.40 , N/A ,$127.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200220,88342,HC IMMUNOHISTOCHEM AB-INITIAL,312,1 ,$729.00 ,$473.85 ,$74.24 ,$729.00 ,$543.11 ,$477.50 ,$141.58 ,$384.18 ,$141.58 ,$460.00 ,$460.00 ,$460.00 ,$460.00 ,$656.10 ,$546.75 ,$141.58 ,$641.52 ,$141.58 ,$546.75 ,$546.75 ,$619.65 ,$619.65 ,$141.58 ,$619.65 ,$141.58 ,$575.91 ,$575.91 ,$575.91 ,$656.10 ,$353.95 ,$656.10 ,$141.58 ,$74.24 ,$477.50 ,$141.58 ,$316.39 , N/A ,$148.66 ,$656.10 ,$318.55 ,$460.00 ,$437.40 ,$656.10 ,$141.58 ,$656.10 ,$656.10 ,$141.58 ,$473.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200249,88344,HC IMMUNOHISTOCHEM EA AB STAIN,312,1 ,$606.00 ,$393.90 ,$263.00 ,$622.03 ,$451.47 ,$396.93 ,$276.46 ,$319.36 ,$276.46 ,$382.39 ,$382.39 ,$382.39 ,$382.39 ,$545.40 ,$454.50 ,$276.46 ,$533.28 ,$276.46 ,$454.50 ,$454.50 ,$515.10 ,$515.10 ,$276.46 ,$515.10 ,$276.46 ,$478.74 ,$478.74 ,$478.74 ,$545.40 ,$606.00 ,$545.40 ,$276.46 ,$606.00 ,$396.93 ,$276.46 ,$263.00 , N/A ,$290.28 ,$545.40 ,$622.03 ,$382.39 ,$363.60 ,$545.40 ,$276.46 ,$545.40 ,$545.40 ,$276.46 ,$393.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200253,88305,HC CELLIENT CELL BLOCK,312,1 ,$261.00 ,$169.65 ,$35.62 ,$261.00 ,$194.45 ,$170.96 ,$47.23 ,$137.55 ,$47.23 ,$164.69 ,$164.69 ,$164.69 ,$164.69 ,$234.90 ,$195.75 ,$47.23 ,$229.68 ,$47.23 ,$195.75 ,$195.75 ,$221.85 ,$221.85 ,$47.23 ,$221.85 ,$47.23 ,$206.19 ,$206.19 ,$206.19 ,$234.90 ,$118.08 ,$234.90 ,$47.23 ,$35.62 ,$170.96 ,$47.23 ,$113.27 , N/A ,$49.59 ,$234.90 ,$106.27 ,$164.69 ,$156.60 ,$234.90 ,$47.23 ,$234.90 ,$234.90 ,$47.23 ,$169.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200256,88313,HC SPECIAL STAIN II-90,312,1 ,$306.00 ,$198.90 ,$32.12 ,$306.00 ,$227.97 ,$200.43 ,$32.12 ,$161.26 ,$32.12 ,$193.09 ,$193.09 ,$193.09 ,$193.09 ,$275.40 ,$229.50 ,$32.12 ,$269.28 ,$32.12 ,$229.50 ,$229.50 ,$260.10 ,$260.10 ,$32.12 ,$260.10 ,$32.12 ,$241.74 ,$241.74 ,$241.74 ,$275.40 ,$80.30 ,$275.40 ,$32.12 ,$306.00 ,$200.43 ,$32.12 ,$132.80 , N/A ,$33.73 ,$275.40 ,$72.27 ,$193.09 ,$183.60 ,$275.40 ,$32.12 ,$275.40 ,$275.40 ,$32.12 ,$198.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200266,88341,HC IMMUNOHISOCHEMIS EA AD SGL STN,312,1 ,$802.00 ,$521.30 ,$68.12 ,$802.00 ,$597.49 ,$525.31 , N/A ,$422.65 , N/A ,$506.06 ,$506.06 ,$506.06 ,$506.06 ,$721.80 ,$601.50 , N/A ,$705.76 , N/A ,$601.50 ,$601.50 ,$681.70 ,$681.70 , N/A ,$681.70 , N/A ,$633.58 ,$633.58 ,$633.58 ,$721.80 , N/A ,$721.80 , N/A ,$68.12 ,$525.31 , N/A ,$348.07 , N/A , N/A ,$721.80 , N/A ,$506.06 ,$481.20 ,$721.80 , N/A ,$721.80 ,$721.80 , N/A ,$521.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200270,88342,HC IMMUNOHISOCHEMIST EA AB REPEAT,312,1 ,$729.00 ,$473.85 ,$74.24 ,$729.00 ,$543.11 ,$477.50 ,$141.58 ,$384.18 ,$141.58 ,$460.00 ,$460.00 ,$460.00 ,$460.00 ,$656.10 ,$546.75 ,$141.58 ,$641.52 ,$141.58 ,$546.75 ,$546.75 ,$619.65 ,$619.65 ,$141.58 ,$619.65 ,$141.58 ,$575.91 ,$575.91 ,$575.91 ,$656.10 ,$353.95 ,$656.10 ,$141.58 ,$74.24 ,$477.50 ,$141.58 ,$316.39 , N/A ,$148.66 ,$656.10 ,$318.55 ,$460.00 ,$437.40 ,$656.10 ,$141.58 ,$656.10 ,$656.10 ,$141.58 ,$473.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200272,88346,HC IF DIRECT-90,312,1 ,$207.00 ,$134.55 ,$89.84 ,$622.03 ,$154.22 ,$135.59 ,$207.00 ,$109.09 ,$207.00 ,$130.62 ,$130.62 ,$130.62 ,$130.62 ,$186.30 ,$155.25 ,$207.00 ,$182.16 ,$207.00 ,$155.25 ,$155.25 ,$175.95 ,$175.95 ,$207.00 ,$175.95 ,$207.00 ,$163.53 ,$163.53 ,$163.53 ,$186.30 ,$207.00 ,$186.30 ,$207.00 ,$207.00 ,$135.59 ,$207.00 ,$89.84 , N/A ,$207.00 ,$186.30 ,$622.03 ,$130.62 ,$124.20 ,$186.30 ,$207.00 ,$186.30 ,$186.30 ,$207.00 ,$134.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200274,88350,HC IMMUNOFLUOR PER SPEC EA ADDN SINGLE STAIN-90,312,1 ,$207.00 ,$134.55 ,$89.84 ,$207.00 ,$154.22 ,$135.59 , N/A ,$109.09 , N/A ,$130.62 ,$130.62 ,$130.62 ,$130.62 ,$186.30 ,$155.25 , N/A ,$182.16 , N/A ,$155.25 ,$155.25 ,$175.95 ,$175.95 , N/A ,$175.95 , N/A ,$163.53 ,$163.53 ,$163.53 ,$186.30 , N/A ,$186.30 , N/A ,$207.00 ,$135.59 , N/A ,$89.84 , N/A , N/A ,$186.30 , N/A ,$130.62 ,$124.20 ,$186.30 , N/A ,$186.30 ,$186.30 , N/A ,$134.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200275,88360,HC MORPHO ANLYS TUMOR MAN-90,312,1 ,$566.00 ,$367.90 ,$86.62 ,$566.00 ,$421.67 ,$370.73 ,$141.58 ,$298.28 ,$141.58 ,$357.15 ,$357.15 ,$357.15 ,$357.15 ,$509.40 ,$424.50 ,$141.58 ,$498.08 ,$141.58 ,$424.50 ,$424.50 ,$481.10 ,$481.10 ,$141.58 ,$481.10 ,$141.58 ,$447.14 ,$447.14 ,$447.14 ,$509.40 ,$353.95 ,$509.40 ,$141.58 ,$86.62 ,$370.73 ,$141.58 ,$245.64 , N/A ,$148.66 ,$509.40 ,$318.55 ,$357.15 ,$339.60 ,$509.40 ,$141.58 ,$509.40 ,$509.40 ,$141.58 ,$367.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200287,88387,HC TISSUE EXAM MOLECULAR STUDY,312,1 ,$153.00 ,$99.45 ,$66.40 ,$153.00 ,$113.99 ,$100.22 , N/A ,$80.63 , N/A ,$96.54 ,$96.54 ,$96.54 ,$96.54 ,$137.70 ,$114.75 , N/A ,$134.64 , N/A ,$114.75 ,$114.75 ,$130.05 ,$130.05 , N/A ,$130.05 , N/A ,$120.87 ,$120.87 ,$120.87 ,$137.70 , N/A ,$137.70 , N/A ,$153.00 ,$100.22 , N/A ,$66.40 , N/A , N/A ,$137.70 , N/A ,$96.54 ,$91.80 ,$137.70 , N/A ,$137.70 ,$137.70 , N/A ,$99.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200288,88388,HC TISSUE EXAM MOLECULR ST ADD ON,312,1 ,$175.00 ,$113.75 ,$75.95 ,$175.00 ,$130.38 ,$114.63 , N/A ,$92.23 , N/A ,$110.43 ,$110.43 ,$110.43 ,$110.43 ,$157.50 ,$131.25 , N/A ,$154.00 , N/A ,$131.25 ,$131.25 ,$148.75 ,$148.75 , N/A ,$148.75 , N/A ,$138.25 ,$138.25 ,$138.25 ,$157.50 , N/A ,$157.50 , N/A ,$175.00 ,$114.63 , N/A ,$75.95 , N/A , N/A ,$157.50 , N/A ,$110.43 ,$105.00 ,$157.50 , N/A ,$157.50 ,$157.50 , N/A ,$113.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),31200317,88305,HC GROSS AND MICRO LEVEL IV,312,1 ,$11.00 ,$7.15 ,$4.77 ,$106.27 ,$8.20 ,$7.21 ,$11.00 ,$5.80 ,$11.00 ,$6.94 ,$6.94 ,$6.94 ,$6.94 ,$9.90 ,$8.25 ,$11.00 ,$9.68 ,$11.00 ,$8.25 ,$8.25 ,$9.35 ,$9.35 ,$11.00 ,$9.35 ,$11.00 ,$8.69 ,$8.69 ,$8.69 ,$9.90 ,$11.00 ,$9.90 ,$11.00 ,$11.00 ,$7.21 ,$11.00 ,$4.77 , N/A ,$11.00 ,$9.90 ,$106.27 ,$6.94 ,$6.60 ,$9.90 ,$11.00 ,$9.90 ,$9.90 ,$11.00 ,$7.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000003,22510,HC VERTEBROPLASTY INJ PERC THOR,320,1 ,"$7,901.00 ","$5,135.65 ","$2,877.30 ","$7,901.00 ","$5,886.25 ","$5,175.16 ","$2,877.30 ","$4,163.83 ","$2,877.30 ","$4,985.53 ","$4,985.53 ","$4,985.53 ","$4,985.53 ","$7,110.90 ","$5,925.75 ","$2,877.30 ","$6,952.88 ","$2,877.30 ","$5,925.75 ","$5,925.75 ","$6,715.85 ","$6,715.85 ","$2,877.30 ","$6,715.85 ","$2,877.30 ","$6,241.79 ","$6,241.79 ","$6,241.79 ","$7,110.90 ","$6,907.14 ","$7,110.90 ","$2,877.30 ","$7,901.00 ","$5,175.16 ","$2,877.30 ","$3,429.03 ", N/A ,"$3,011.63 ","$7,110.90 ","$6,235.50 ","$4,985.53 ","$4,740.60 ","$7,110.90 ","$2,877.30 ","$7,110.90 ","$7,110.90 ","$2,877.30 ","$5,135.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000005,22512,HC VERTEBROPLASTY INJ PERC ADDL,320,1 ,"$1,608.00 ","$1,045.20 ",$697.87 ,"$1,608.00 ","$1,197.96 ","$1,053.24 ", N/A ,$847.42 , N/A ,"$1,014.65 ","$1,014.65 ","$1,014.65 ","$1,014.65 ","$1,447.20 ","$1,206.00 ", N/A ,"$1,415.04 ", N/A ,"$1,206.00 ","$1,206.00 ","$1,366.80 ","$1,366.80 ", N/A ,"$1,366.80 ", N/A ,"$1,270.32 ","$1,270.32 ","$1,270.32 ","$1,447.20 ", N/A ,"$1,447.20 ", N/A ,"$1,608.00 ","$1,053.24 ", N/A ,$697.87 , N/A , N/A ,"$1,447.20 ", N/A ,"$1,014.65 ",$964.80 ,"$1,447.20 ", N/A ,"$1,447.20 ","$1,447.20 ", N/A ,"$1,045.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000009,23350,HC ARTHROGRAM INJ SHOULDER,320,1 ,$309.00 ,$200.85 ,$134.11 ,$309.00 ,$230.21 ,$202.40 , N/A ,$162.84 , N/A ,$194.98 ,$194.98 ,$194.98 ,$194.98 ,$278.10 ,$231.75 , N/A ,$271.92 , N/A ,$231.75 ,$231.75 ,$262.65 ,$262.65 , N/A ,$262.65 , N/A ,$244.11 ,$244.11 ,$244.11 ,$278.10 , N/A ,$278.10 , N/A ,$309.00 ,$202.40 , N/A ,$134.11 , N/A , N/A ,$278.10 , N/A ,$194.98 ,$185.40 ,$278.10 , N/A ,$278.10 ,$278.10 , N/A ,$200.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000010,24220,HC ARTHROGRAM INJ ELBOW,320,1 ,$309.00 ,$200.85 ,$134.11 ,$309.00 ,$230.21 ,$202.40 , N/A ,$162.84 , N/A ,$194.98 ,$194.98 ,$194.98 ,$194.98 ,$278.10 ,$231.75 , N/A ,$271.92 , N/A ,$231.75 ,$231.75 ,$262.65 ,$262.65 , N/A ,$262.65 , N/A ,$244.11 ,$244.11 ,$244.11 ,$278.10 , N/A ,$278.10 , N/A ,$309.00 ,$202.40 , N/A ,$134.11 , N/A , N/A ,$278.10 , N/A ,$194.98 ,$185.40 ,$278.10 , N/A ,$278.10 ,$278.10 , N/A ,$200.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000011,25246,HC ARTHROGRAM INJ WRIST,320,1 ,$460.00 ,$299.00 ,$199.64 ,$460.00 ,$342.70 ,$301.30 , N/A ,$242.42 , N/A ,$290.26 ,$290.26 ,$290.26 ,$290.26 ,$414.00 ,$345.00 , N/A ,$404.80 , N/A ,$345.00 ,$345.00 ,$391.00 ,$391.00 , N/A ,$391.00 , N/A ,$363.40 ,$363.40 ,$363.40 ,$414.00 , N/A ,$414.00 , N/A ,$460.00 ,$301.30 , N/A ,$199.64 , N/A , N/A ,$414.00 , N/A ,$290.26 ,$276.00 ,$414.00 , N/A ,$414.00 ,$414.00 , N/A ,$299.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000012,27093,HC INJ ARTHROGRAM HIP W/O,320,1 ,$431.00 ,$280.15 ,$187.05 ,$431.00 ,$321.10 ,$282.31 , N/A ,$227.14 , N/A ,$271.96 ,$271.96 ,$271.96 ,$271.96 ,$387.90 ,$323.25 , N/A ,$379.28 , N/A ,$323.25 ,$323.25 ,$366.35 ,$366.35 , N/A ,$366.35 , N/A ,$340.49 ,$340.49 ,$340.49 ,$387.90 , N/A ,$387.90 , N/A ,$431.00 ,$282.31 , N/A ,$187.05 , N/A , N/A ,$387.90 , N/A ,$271.96 ,$258.60 ,$387.90 , N/A ,$387.90 ,$387.90 , N/A ,$280.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000015,27369,HC ARTHROGRAM INJ KNEE,320,1 ,$366.00 ,$237.90 ,$158.84 ,$366.00 ,$272.67 ,$239.73 , N/A ,$192.88 , N/A ,$230.95 ,$230.95 ,$230.95 ,$230.95 ,$329.40 ,$274.50 , N/A ,$322.08 , N/A ,$274.50 ,$274.50 ,$311.10 ,$311.10 , N/A ,$311.10 , N/A ,$289.14 ,$289.14 ,$289.14 ,$329.40 , N/A ,$329.40 , N/A ,$366.00 ,$239.73 , N/A ,$158.84 , N/A , N/A ,$329.40 , N/A ,$230.95 ,$219.60 ,$329.40 , N/A ,$329.40 ,$329.40 , N/A ,$237.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000016,27648,HC ARTHROGRAM INJ ANKLE,320,1 ,$202.00 ,$131.30 ,$87.67 ,$202.00 ,$150.49 ,$132.31 , N/A ,$106.45 , N/A ,$127.46 ,$127.46 ,$127.46 ,$127.46 ,$181.80 ,$151.50 , N/A ,$177.76 , N/A ,$151.50 ,$151.50 ,$171.70 ,$171.70 , N/A ,$171.70 , N/A ,$159.58 ,$159.58 ,$159.58 ,$181.80 , N/A ,$181.80 , N/A ,$202.00 ,$132.31 , N/A ,$87.67 , N/A , N/A ,$181.80 , N/A ,$127.46 ,$121.20 ,$181.80 , N/A ,$181.80 ,$181.80 , N/A ,$131.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000018,32550,HC INSERT CATH PLEURAL INDWELL W/,320,1 ,"$6,690.00 ","$4,348.50 ","$2,903.46 ","$7,013.20 ","$4,984.05 ","$4,381.95 ","$3,236.16 ","$3,525.63 ","$3,236.16 ","$4,221.39 ","$4,221.39 ","$4,221.39 ","$4,221.39 ","$6,021.00 ","$5,017.50 ","$3,236.16 ","$5,887.20 ","$3,236.16 ","$5,017.50 ","$5,017.50 ","$5,686.50 ","$5,686.50 ","$3,236.16 ","$5,686.50 ","$3,236.16 ","$5,285.10 ","$5,285.10 ","$5,285.10 ","$6,021.00 ","$6,690.00 ","$6,021.00 ","$3,236.16 ","$6,690.00 ","$4,381.95 ","$3,236.16 ","$2,903.46 ", N/A ,"$3,387.25 ","$6,021.00 ","$7,013.20 ","$4,221.39 ","$4,014.00 ","$6,021.00 ","$3,236.16 ","$6,021.00 ","$6,021.00 ","$3,236.16 ","$4,348.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000019,32551,HC CHEST TUBE INSERTION 32551,320,1 ,"$1,731.00 ","$1,125.15 ",$751.25 ,"$3,097.79 ","$1,289.60 ","$1,133.81 ","$1,429.44 ",$912.24 ,"$1,429.44 ","$1,092.26 ","$1,092.26 ","$1,092.26 ","$1,092.26 ","$1,557.90 ","$1,298.25 ","$1,429.44 ","$1,523.28 ","$1,429.44 ","$1,298.25 ","$1,298.25 ","$1,471.35 ","$1,471.35 ","$1,429.44 ","$1,471.35 ","$1,429.44 ","$1,367.49 ","$1,367.49 ","$1,367.49 ","$1,557.90 ","$1,731.00 ","$1,557.90 ","$1,429.44 ","$1,731.00 ","$1,133.81 ","$1,429.44 ",$751.25 , N/A ,"$1,496.18 ","$1,557.90 ","$3,097.79 ","$1,092.26 ","$1,038.60 ","$1,557.90 ","$1,429.44 ","$1,557.90 ","$1,557.90 ","$1,429.44 ","$1,125.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000020,32552,HC REMOVAL TUNNELED PLEURAL CATH,320,1 ,"$1,891.53 ","$1,229.49 ",$550.60 ,"$1,891.53 ","$1,409.19 ","$1,238.95 ",$550.60 ,$996.84 ,$550.60 ,"$1,193.56 ","$1,193.56 ","$1,193.56 ","$1,193.56 ","$1,702.38 ","$1,418.65 ",$550.60 ,"$1,664.55 ",$550.60 ,"$1,418.65 ","$1,418.65 ","$1,607.80 ","$1,607.80 ",$550.60 ,"$1,607.80 ",$550.60 ,"$1,494.31 ","$1,494.31 ","$1,494.31 ","$1,702.38 ","$1,321.74 ","$1,702.38 ",$550.60 ,"$1,891.53 ","$1,238.95 ",$550.60 ,$820.92 , N/A ,$576.30 ,"$1,702.38 ","$1,193.21 ","$1,193.56 ","$1,134.92 ","$1,702.38 ",$550.60 ,"$1,702.38 ","$1,702.38 ",$550.60 ,"$1,229.49 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000026,36000,HC IV START > 3YR OLD,320,1 ,$318.00 ,$206.70 ,$138.01 ,$318.00 ,$236.91 ,$208.29 , N/A ,$167.59 , N/A ,$200.66 ,$200.66 ,$200.66 ,$200.66 ,$286.20 ,$238.50 , N/A ,$279.84 , N/A ,$238.50 ,$238.50 ,$270.30 ,$270.30 , N/A ,$270.30 , N/A ,$251.22 ,$251.22 ,$251.22 ,$286.20 , N/A ,$286.20 , N/A ,$318.00 ,$208.29 , N/A ,$138.01 , N/A , N/A ,$286.20 , N/A ,$200.66 ,$190.80 ,$286.20 , N/A ,$286.20 ,$286.20 , N/A ,$206.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000026,36000,HC IV START > 3YR OLD,320,1 ,$478.00 ,$310.70 ,$207.45 ,$478.00 ,$356.11 ,$313.09 , N/A ,$251.91 , N/A ,$301.62 ,$301.62 ,$301.62 ,$301.62 ,$430.20 ,$358.50 , N/A ,$420.64 , N/A ,$358.50 ,$358.50 ,$406.30 ,$406.30 , N/A ,$406.30 , N/A ,$377.62 ,$377.62 ,$377.62 ,$430.20 , N/A ,$430.20 , N/A ,$478.00 ,$313.09 , N/A ,$207.45 , N/A , N/A ,$430.20 , N/A ,$301.62 ,$286.80 ,$430.20 , N/A ,$430.20 ,$430.20 , N/A ,$310.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000028,36005,HC VENOGRAM INJECTION 36005,320,1 ,"$1,242.00 ",$807.30 ,$539.03 ,"$1,242.00 ",$925.29 ,$813.51 , N/A ,$654.53 , N/A ,$783.70 ,$783.70 ,$783.70 ,$783.70 ,"$1,117.80 ",$931.50 , N/A ,"$1,092.96 ", N/A ,$931.50 ,$931.50 ,"$1,055.70 ","$1,055.70 ", N/A ,"$1,055.70 ", N/A ,$981.18 ,$981.18 ,$981.18 ,"$1,117.80 ", N/A ,"$1,117.80 ", N/A ,"$1,242.00 ",$813.51 , N/A ,$539.03 , N/A , N/A ,"$1,117.80 ", N/A ,$783.70 ,$745.20 ,"$1,117.80 ", N/A ,"$1,117.80 ","$1,117.80 ", N/A ,$807.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000028,36005,HC VENOGRAM INJECTION 36005,320,1 ,"$1,864.00 ","$1,211.60 ",$808.98 ,"$1,864.00 ","$1,388.68 ","$1,220.92 ", N/A ,$982.33 , N/A ,"$1,176.18 ","$1,176.18 ","$1,176.18 ","$1,176.18 ","$1,677.60 ","$1,398.00 ", N/A ,"$1,640.32 ", N/A ,"$1,398.00 ","$1,398.00 ","$1,584.40 ","$1,584.40 ", N/A ,"$1,584.40 ", N/A ,"$1,472.56 ","$1,472.56 ","$1,472.56 ","$1,677.60 ", N/A ,"$1,677.60 ", N/A ,"$1,864.00 ","$1,220.92 ", N/A ,$808.98 , N/A , N/A ,"$1,677.60 ", N/A ,"$1,176.18 ","$1,118.40 ","$1,677.60 ", N/A ,"$1,677.60 ","$1,677.60 ", N/A ,"$1,211.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000029,36410,HC VENIPUNCTURE > AGE 3 REQUIR MD,320,1 ,$10.00 ,$6.50 ,$4.34 ,$10.00 ,$7.45 ,$6.55 , N/A ,$5.27 , N/A ,$6.31 ,$6.31 ,$6.31 ,$6.31 ,$9.00 ,$7.50 , N/A ,$8.80 , N/A ,$7.50 ,$7.50 ,$8.50 ,$8.50 , N/A ,$8.50 , N/A ,$7.90 ,$7.90 ,$7.90 ,$9.00 , N/A ,$9.00 , N/A ,$10.00 ,$6.55 , N/A ,$4.34 , N/A , N/A ,$9.00 , N/A ,$6.31 ,$6.00 ,$9.00 , N/A ,$9.00 ,$9.00 , N/A ,$6.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000030,36598,HC CONTRAST INJ CV CATH W/FLUORO,320,1 ,$403.00 ,$261.95 ,$174.90 ,$448.32 ,$300.24 ,$263.97 ,$206.87 ,$212.38 ,$206.87 ,$254.29 ,$254.29 ,$254.29 ,$254.29 ,$362.70 ,$302.25 ,$206.87 ,$354.64 ,$206.87 ,$302.25 ,$302.25 ,$342.55 ,$342.55 ,$206.87 ,$342.55 ,$206.87 ,$318.37 ,$318.37 ,$318.37 ,$362.70 ,$403.00 ,$362.70 ,$206.87 ,$403.00 ,$263.97 ,$206.87 ,$174.90 , N/A ,$216.53 ,$362.70 ,$448.32 ,$254.29 ,$241.80 ,$362.70 ,$206.87 ,$362.70 ,$362.70 ,$206.87 ,$261.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000031,36598,HC CONTRAST INJ CENTRAL VENOUS CATH W/FLUORO,320,1 ,$403.00 ,$261.95 ,$174.90 ,$448.32 ,$300.24 ,$263.97 ,$206.87 ,$212.38 ,$206.87 ,$254.29 ,$254.29 ,$254.29 ,$254.29 ,$362.70 ,$302.25 ,$206.87 ,$354.64 ,$206.87 ,$302.25 ,$302.25 ,$342.55 ,$342.55 ,$206.87 ,$342.55 ,$206.87 ,$318.37 ,$318.37 ,$318.37 ,$362.70 ,$403.00 ,$362.70 ,$206.87 ,$403.00 ,$263.97 ,$206.87 ,$174.90 , N/A ,$216.53 ,$362.70 ,$448.32 ,$254.29 ,$241.80 ,$362.70 ,$206.87 ,$362.70 ,$362.70 ,$206.87 ,$261.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000035,43752,HC PLACE TUBE NASOGASTRIC,320,1 ,$284.00 ,$184.60 ,$123.26 ,$595.31 ,$211.58 ,$186.02 ,$274.70 ,$149.67 ,$274.70 ,$179.20 ,$179.20 ,$179.20 ,$179.20 ,$255.60 ,$213.00 ,$274.70 ,$249.92 ,$274.70 ,$213.00 ,$213.00 ,$241.40 ,$241.40 ,$274.70 ,$241.40 ,$274.70 ,$224.36 ,$224.36 ,$224.36 ,$255.60 ,$284.00 ,$255.60 ,$274.70 ,$284.00 ,$186.02 ,$274.70 ,$123.26 , N/A ,$284.00 ,$255.60 ,$595.31 ,$179.20 ,$170.40 ,$255.60 ,$274.70 ,$255.60 ,$255.60 ,$274.70 ,$184.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000044,47535,HC REVISE/REINSERT TUBE TRNSHEPAT,320,1 ,"$6,146.00 ","$3,994.90 ","$2,667.36 ","$7,013.20 ","$4,578.77 ","$4,025.63 ","$3,236.16 ","$3,238.94 ","$3,236.16 ","$3,878.13 ","$3,878.13 ","$3,878.13 ","$3,878.13 ","$5,531.40 ","$4,609.50 ","$3,236.16 ","$5,408.48 ","$3,236.16 ","$4,609.50 ","$4,609.50 ","$5,224.10 ","$5,224.10 ","$3,236.16 ","$5,224.10 ","$3,236.16 ","$4,855.34 ","$4,855.34 ","$4,855.34 ","$5,531.40 ","$6,146.00 ","$5,531.40 ","$3,236.16 ","$6,146.00 ","$4,025.63 ","$3,236.16 ","$2,667.36 ", N/A ,"$3,387.25 ","$5,531.40 ","$7,013.20 ","$3,878.13 ","$3,687.60 ","$5,531.40 ","$3,236.16 ","$5,531.40 ","$5,531.40 ","$3,236.16 ","$3,994.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000051,49406,HC DRN ABSC RETROPERITONEAL PERC,320,1 ,"$4,043.00 ","$2,627.95 ","$1,430.32 ","$4,043.00 ","$3,012.04 ","$2,648.17 ","$1,430.32 ","$2,130.66 ","$1,430.32 ","$2,551.13 ","$2,551.13 ","$2,551.13 ","$2,551.13 ","$3,638.70 ","$3,032.25 ","$1,430.32 ","$3,557.84 ","$1,430.32 ","$3,032.25 ","$3,032.25 ","$3,436.55 ","$3,436.55 ","$1,430.32 ","$3,436.55 ","$1,430.32 ","$3,193.97 ","$3,193.97 ","$3,193.97 ","$3,638.70 ","$3,433.56 ","$3,638.70 ","$1,430.32 ","$4,043.00 ","$2,648.17 ","$1,430.32 ","$1,754.66 ", N/A ,"$1,497.09 ","$3,638.70 ","$3,099.69 ","$2,551.13 ","$2,425.80 ","$3,638.70 ","$1,430.32 ","$3,638.70 ","$3,638.70 ","$1,430.32 ","$2,627.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000053,49423,HC EXCHG CATH ABSC/CYST DRAIN,320,1 ,"$1,847.00 ","$1,200.55 ",$801.60 ,"$3,580.00 ","$1,376.02 ","$1,209.79 ","$1,651.95 ",$973.37 ,"$1,651.95 ","$1,165.46 ","$1,165.46 ","$1,165.46 ","$1,165.46 ","$1,662.30 ","$1,385.25 ","$1,651.95 ","$1,625.36 ","$1,651.95 ","$1,385.25 ","$1,385.25 ","$1,569.95 ","$1,569.95 ","$1,651.95 ","$1,569.95 ","$1,651.95 ","$1,459.13 ","$1,459.13 ","$1,459.13 ","$1,662.30 ","$1,847.00 ","$1,662.30 ","$1,651.95 ","$1,847.00 ","$1,209.79 ","$1,651.95 ",$801.60 , N/A ,"$1,729.07 ","$1,662.30 ","$3,580.00 ","$1,165.46 ","$1,108.20 ","$1,662.30 ","$1,651.95 ","$1,662.30 ","$1,662.30 ","$1,651.95 ","$1,200.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000054,49424,HC INJ CONTRAST ABSC/CYST,320,1 ,"$1,446.00 ",$939.90 ,$627.56 ,"$1,446.00 ","$1,077.27 ",$947.13 , N/A ,$762.04 , N/A ,$912.43 ,$912.43 ,$912.43 ,$912.43 ,"$1,301.40 ","$1,084.50 ", N/A ,"$1,272.48 ", N/A ,"$1,084.50 ","$1,084.50 ","$1,229.10 ","$1,229.10 ", N/A ,"$1,229.10 ", N/A ,"$1,142.34 ","$1,142.34 ","$1,142.34 ","$1,301.40 ", N/A ,"$1,301.40 ", N/A ,"$1,446.00 ",$947.13 , N/A ,$627.56 , N/A , N/A ,"$1,301.40 ", N/A ,$912.43 ,$867.60 ,"$1,301.40 ", N/A ,"$1,301.40 ","$1,301.40 ", N/A ,$939.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000060,49450,HC RPLC G/CEC/OTH TB UNDER FLUORO,320,1 ,"$1,830.00 ","$1,189.50 ",$794.22 ,"$1,830.00 ","$1,363.35 ","$1,198.65 ",$823.02 ,$964.41 ,$823.02 ,"$1,154.73 ","$1,154.73 ","$1,154.73 ","$1,154.73 ","$1,647.00 ","$1,372.50 ",$823.02 ,"$1,610.40 ",$823.02 ,"$1,372.50 ","$1,372.50 ","$1,555.50 ","$1,555.50 ",$823.02 ,"$1,555.50 ",$823.02 ,"$1,445.70 ","$1,445.70 ","$1,445.70 ","$1,647.00 ","$1,830.00 ","$1,647.00 ",$823.02 ,"$1,830.00 ","$1,198.65 ",$823.02 ,$794.22 , N/A ,$861.44 ,"$1,647.00 ","$1,783.59 ","$1,154.73 ","$1,098.00 ","$1,647.00 ",$823.02 ,"$1,647.00 ","$1,647.00 ",$823.02 ,"$1,189.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000062,49452,HC RPLC GASTRO-JEJUN TB FLUORO,361,1 ,"$2,184.00 ","$1,419.60 ",$823.02 ,"$2,184.00 ","$1,627.08 ","$1,430.52 ",$823.02 ,"$1,150.97 ",$823.02 ,"$1,378.10 ","$1,378.10 ","$1,378.10 ","$1,378.10 ","$1,965.60 ","$1,638.00 ",$823.02 ,"$1,921.92 ",$823.02 ,"$1,638.00 ","$1,638.00 ","$1,856.40 ","$1,856.40 ",$823.02 ,"$1,856.40 ",$823.02 ,"$1,725.36 ","$1,725.36 ","$1,725.36 ","$1,965.60 ","$1,975.70 ","$1,965.60 ",$823.02 ,"$2,184.00 ","$1,430.52 ",$823.02 ,$947.86 , N/A ,$861.44 ,"$1,965.60 ","$1,783.59 ","$1,378.10 ","$1,310.40 ","$1,965.60 ",$823.02 ,"$1,965.60 ","$1,965.60 ",$823.02 ,"$1,419.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000063,49465,HC INJ CNTR W/FLUOR EVAL G/D/J TB,320,1 ,$706.00 ,$458.90 ,$233.94 ,$706.00 ,$525.97 ,$462.43 ,$233.94 ,$372.06 ,$233.94 ,$445.49 ,$445.49 ,$445.49 ,$445.49 ,$635.40 ,$529.50 ,$233.94 ,$621.28 ,$233.94 ,$529.50 ,$529.50 ,$600.10 ,$600.10 ,$233.94 ,$600.10 ,$233.94 ,$557.74 ,$557.74 ,$557.74 ,$635.40 ,$561.60 ,$635.40 ,$233.94 ,$706.00 ,$462.43 ,$233.94 ,$306.40 , N/A ,$244.87 ,$635.40 ,$506.99 ,$445.49 ,$423.60 ,$635.40 ,$233.94 ,$635.40 ,$635.40 ,$233.94 ,$458.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000066,49405,HC DRN ABSC PERIRENAL PERC,320,1 ,"$2,924.00 ","$1,900.60 ","$1,269.02 ","$3,099.69 ","$2,178.38 ","$1,915.22 ","$1,430.32 ","$1,540.95 ","$1,430.32 ","$1,845.04 ","$1,845.04 ","$1,845.04 ","$1,845.04 ","$2,631.60 ","$2,193.00 ","$1,430.32 ","$2,573.12 ","$1,430.32 ","$2,193.00 ","$2,193.00 ","$2,485.40 ","$2,485.40 ","$1,430.32 ","$2,485.40 ","$1,430.32 ","$2,309.96 ","$2,309.96 ","$2,309.96 ","$2,631.60 ","$2,924.00 ","$2,631.60 ","$1,430.32 ","$2,924.00 ","$1,915.22 ","$1,430.32 ","$1,269.02 ", N/A ,"$1,497.09 ","$2,631.60 ","$3,099.69 ","$1,845.04 ","$1,754.40 ","$2,631.60 ","$1,430.32 ","$2,631.60 ","$2,631.60 ","$1,430.32 ","$1,900.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000071,50387,HC CHANGE EXT/INT URET STENT,320,1 ,"$3,213.00 ","$2,088.45 ","$1,394.44 ","$3,950.04 ","$2,393.69 ","$2,104.52 ","$1,822.70 ","$1,693.25 ","$1,822.70 ","$2,027.40 ","$2,027.40 ","$2,027.40 ","$2,027.40 ","$2,891.70 ","$2,409.75 ","$1,822.70 ","$2,827.44 ","$1,822.70 ","$2,409.75 ","$2,409.75 ","$2,731.05 ","$2,731.05 ","$1,822.70 ","$2,731.05 ","$1,822.70 ","$2,538.27 ","$2,538.27 ","$2,538.27 ","$2,891.70 ","$3,213.00 ","$2,891.70 ","$1,822.70 ","$3,213.00 ","$2,104.52 ","$1,822.70 ","$1,394.44 ", N/A ,"$1,907.80 ","$2,891.70 ","$3,950.04 ","$2,027.40 ","$1,927.80 ","$2,891.70 ","$1,822.70 ","$2,891.70 ","$2,891.70 ","$1,822.70 ","$2,088.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000072,50389,HC REM NEPHRO TUBE FLUORO,320,1 ,"$1,291.00 ",$839.15 ,$560.29 ,"$1,291.00 ",$961.80 ,$845.61 ,$584.29 ,$680.36 ,$584.29 ,$814.62 ,$814.62 ,$814.62 ,$814.62 ,"$1,161.90 ",$968.25 ,$584.29 ,"$1,136.08 ",$584.29 ,$968.25 ,$968.25 ,"$1,097.35 ","$1,097.35 ",$584.29 ,"$1,097.35 ",$584.29 ,"$1,019.89 ","$1,019.89 ","$1,019.89 ","$1,161.90 ","$1,291.00 ","$1,161.90 ",$584.29 ,"$1,291.00 ",$845.61 ,$584.29 ,$560.29 , N/A ,$611.57 ,"$1,161.90 ","$1,266.25 ",$814.62 ,$774.60 ,"$1,161.90 ",$584.29 ,"$1,161.90 ","$1,161.90 ",$584.29 ,$839.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000077,50693,HC INTRO GUIDE RENAL PELVIS URET DIL,320,1 ,"$6,331.00 ","$4,115.15 ","$2,747.65 ","$6,777.32 ","$4,716.60 ","$4,146.81 ","$3,127.32 ","$3,336.44 ","$3,127.32 ","$3,994.86 ","$3,994.86 ","$3,994.86 ","$3,994.86 ","$5,697.90 ","$4,748.25 ","$3,127.32 ","$5,571.28 ","$3,127.32 ","$4,748.25 ","$4,748.25 ","$5,381.35 ","$5,381.35 ","$3,127.32 ","$5,381.35 ","$3,127.32 ","$5,001.49 ","$5,001.49 ","$5,001.49 ","$5,697.90 ","$6,331.00 ","$5,697.90 ","$3,127.32 ","$6,331.00 ","$4,146.81 ","$3,127.32 ","$2,747.65 ", N/A ,"$3,273.32 ","$5,697.90 ","$6,777.32 ","$3,994.86 ","$3,798.60 ","$5,697.90 ","$3,127.32 ","$5,697.90 ","$5,697.90 ","$3,127.32 ","$4,115.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000079,50435,HC CHANGE NEPHROSTOMY TUBE,320,1 ,"$5,012.00 ","$3,257.80 ","$1,822.70 ","$5,012.00 ","$3,733.94 ","$3,282.86 ","$1,822.70 ","$2,641.32 ","$1,822.70 ","$3,162.57 ","$3,162.57 ","$3,162.57 ","$3,162.57 ","$4,510.80 ","$3,759.00 ","$1,822.70 ","$4,410.56 ","$1,822.70 ","$3,759.00 ","$3,759.00 ","$4,260.20 ","$4,260.20 ","$1,822.70 ","$4,260.20 ","$1,822.70 ","$3,959.48 ","$3,959.48 ","$3,959.48 ","$4,510.80 ","$4,375.51 ","$4,510.80 ","$1,822.70 ","$5,012.00 ","$3,282.86 ","$1,822.70 ","$2,175.21 ", N/A ,"$1,907.80 ","$4,510.80 ","$3,950.04 ","$3,162.57 ","$3,007.20 ","$4,510.80 ","$1,822.70 ","$4,510.80 ","$4,510.80 ","$1,822.70 ","$3,257.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000079,50435,HC CHANGE NEPHROSTOMY TUBE,320,1 ,"$7,518.00 ","$4,886.70 ","$1,822.70 ","$7,518.00 ","$5,600.91 ","$4,924.29 ","$1,822.70 ","$3,961.99 ","$1,822.70 ","$4,743.86 ","$4,743.86 ","$4,743.86 ","$4,743.86 ","$6,766.20 ","$5,638.50 ","$1,822.70 ","$6,615.84 ","$1,822.70 ","$5,638.50 ","$5,638.50 ","$6,390.30 ","$6,390.30 ","$1,822.70 ","$6,390.30 ","$1,822.70 ","$5,939.22 ","$5,939.22 ","$5,939.22 ","$6,766.20 ","$4,375.51 ","$6,766.20 ","$1,822.70 ","$7,518.00 ","$4,924.29 ","$1,822.70 ","$3,262.81 ", N/A ,"$1,907.80 ","$6,766.20 ","$3,950.04 ","$4,743.86 ","$4,510.80 ","$6,766.20 ","$1,822.70 ","$6,766.20 ","$6,766.20 ","$1,822.70 ","$4,886.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000083,50690,HC INJ ILEAL CONDUIT,320,1 ,$223.00 ,$144.95 ,$96.78 ,$223.00 ,$166.14 ,$146.07 , N/A ,$117.52 , N/A ,$140.71 ,$140.71 ,$140.71 ,$140.71 ,$200.70 ,$167.25 , N/A ,$196.24 , N/A ,$167.25 ,$167.25 ,$189.55 ,$189.55 , N/A ,$189.55 , N/A ,$176.17 ,$176.17 ,$176.17 ,$200.70 , N/A ,$200.70 , N/A ,$223.00 ,$146.07 , N/A ,$96.78 , N/A , N/A ,$200.70 , N/A ,$140.71 ,$133.80 ,$200.70 , N/A ,$200.70 ,$200.70 , N/A ,$144.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000085,51600,HC INJ CYSTOGRAM,320,1 ,$561.00 ,$364.65 ,$243.47 ,$561.00 ,$417.95 ,$367.46 , N/A ,$295.65 , N/A ,$353.99 ,$353.99 ,$353.99 ,$353.99 ,$504.90 ,$420.75 , N/A ,$493.68 , N/A ,$420.75 ,$420.75 ,$476.85 ,$476.85 , N/A ,$476.85 , N/A ,$443.19 ,$443.19 ,$443.19 ,$504.90 , N/A ,$504.90 , N/A ,$561.00 ,$367.46 , N/A ,$243.47 , N/A , N/A ,$504.90 , N/A ,$353.99 ,$336.60 ,$504.90 , N/A ,$504.90 ,$504.90 , N/A ,$364.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000086,51610,HC INJ URETHROCYSTOGRAM RETRO,320,1 ,$258.00 ,$167.70 ,$111.97 ,$258.00 ,$192.21 ,$168.99 , N/A ,$135.97 , N/A ,$162.80 ,$162.80 ,$162.80 ,$162.80 ,$232.20 ,$193.50 , N/A ,$227.04 , N/A ,$193.50 ,$193.50 ,$219.30 ,$219.30 , N/A ,$219.30 , N/A ,$203.82 ,$203.82 ,$203.82 ,$232.20 , N/A ,$232.20 , N/A ,$258.00 ,$168.99 , N/A ,$111.97 , N/A , N/A ,$232.20 , N/A ,$162.80 ,$154.80 ,$232.20 , N/A ,$232.20 ,$232.20 , N/A ,$167.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000087,58340,HC CATH/INTRO SALINE/CONTRAST SIS,320,1 ,$532.00 ,$345.80 ,$230.89 ,$532.00 ,$396.34 ,$348.46 , N/A ,$280.36 , N/A ,$335.69 ,$335.69 ,$335.69 ,$335.69 ,$478.80 ,$399.00 , N/A ,$468.16 , N/A ,$399.00 ,$399.00 ,$452.20 ,$452.20 , N/A ,$452.20 , N/A ,$420.28 ,$420.28 ,$420.28 ,$478.80 , N/A ,$478.80 , N/A ,$532.00 ,$348.46 , N/A ,$230.89 , N/A , N/A ,$478.80 , N/A ,$335.69 ,$319.20 ,$478.80 , N/A ,$478.80 ,$478.80 , N/A ,$345.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000098,70030,HC XRAY EYE (FOREIGN BODY),320,1 ,$614.00 ,$399.10 ,$82.24 ,$614.00 ,$457.43 ,$402.17 ,$82.24 ,$323.58 ,$82.24 ,$387.43 ,$387.43 ,$387.43 ,$387.43 ,$552.60 ,$460.50 ,$82.24 ,$540.32 ,$82.24 ,$460.50 ,$460.50 ,$521.90 ,$521.90 ,$82.24 ,$521.90 ,$82.24 ,$485.06 ,$485.06 ,$485.06 ,$552.60 ,$197.42 ,$552.60 ,$82.24 ,$614.00 ,$402.17 ,$82.24 ,$266.48 , N/A ,$86.08 ,$552.60 ,$178.23 ,$387.43 ,$368.40 ,$552.60 ,$82.24 ,$552.60 ,$552.60 ,$82.24 ,$399.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000100,70110,HC MANDIBLE MIN 4 VIEWS,320,1 ,$912.00 ,$592.80 ,$110.78 ,$912.00 ,$679.44 ,$597.36 ,$110.78 ,$480.62 ,$110.78 ,$575.47 ,$575.47 ,$575.47 ,$575.47 ,$820.80 ,$684.00 ,$110.78 ,$802.56 ,$110.78 ,$684.00 ,$684.00 ,$775.20 ,$775.20 ,$110.78 ,$775.20 ,$110.78 ,$720.48 ,$720.48 ,$720.48 ,$820.80 ,$265.92 ,$820.80 ,$110.78 ,$912.00 ,$597.36 ,$110.78 ,$395.81 , N/A ,$115.95 ,$820.80 ,$240.07 ,$575.47 ,$547.20 ,$820.80 ,$110.78 ,$820.80 ,$820.80 ,$110.78 ,$592.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000103,70140,HC FACIAL BONES < 3 VIEWS,320,1 ,$298.00 ,$193.70 ,$82.24 ,$298.00 ,$222.01 ,$195.19 ,$82.24 ,$157.05 ,$82.24 ,$188.04 ,$188.04 ,$188.04 ,$188.04 ,$268.20 ,$223.50 ,$82.24 ,$262.24 ,$82.24 ,$223.50 ,$223.50 ,$253.30 ,$253.30 ,$82.24 ,$253.30 ,$82.24 ,$235.42 ,$235.42 ,$235.42 ,$268.20 ,$197.42 ,$268.20 ,$82.24 ,$298.00 ,$195.19 ,$82.24 ,$129.33 , N/A ,$86.08 ,$268.20 ,$178.23 ,$188.04 ,$178.80 ,$268.20 ,$82.24 ,$268.20 ,$268.20 ,$82.24 ,$193.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000104,70150,HC FACIAL BONES MIN 3 VIEWS,320,1 ,$867.00 ,$563.55 ,$110.78 ,$867.00 ,$645.92 ,$567.89 ,$110.78 ,$456.91 ,$110.78 ,$547.08 ,$547.08 ,$547.08 ,$547.08 ,$780.30 ,$650.25 ,$110.78 ,$762.96 ,$110.78 ,$650.25 ,$650.25 ,$736.95 ,$736.95 ,$110.78 ,$736.95 ,$110.78 ,$684.93 ,$684.93 ,$684.93 ,$780.30 ,$265.92 ,$780.30 ,$110.78 ,$867.00 ,$567.89 ,$110.78 ,$376.28 , N/A ,$115.95 ,$780.30 ,$240.07 ,$547.08 ,$520.20 ,$780.30 ,$110.78 ,$780.30 ,$780.30 ,$110.78 ,$563.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000105,70160,HC NASAL BONES MIN 3 VIEWS,320,1 ,$627.00 ,$407.55 ,$82.24 ,$627.00 ,$467.12 ,$410.69 ,$82.24 ,$330.43 ,$82.24 ,$395.64 ,$395.64 ,$395.64 ,$395.64 ,$564.30 ,$470.25 ,$82.24 ,$551.76 ,$82.24 ,$470.25 ,$470.25 ,$532.95 ,$532.95 ,$82.24 ,$532.95 ,$82.24 ,$495.33 ,$495.33 ,$495.33 ,$564.30 ,$197.42 ,$564.30 ,$82.24 ,$627.00 ,$410.69 ,$82.24 ,$272.12 , N/A ,$86.08 ,$564.30 ,$178.23 ,$395.64 ,$376.20 ,$564.30 ,$82.24 ,$564.30 ,$564.30 ,$82.24 ,$407.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000106,70200,HC XRAY ORBITS (EYE) (MIN 4 V),320,1 ,$675.00 ,$438.75 ,$110.78 ,$675.00 ,$502.88 ,$442.13 ,$110.78 ,$355.73 ,$110.78 ,$425.93 ,$425.93 ,$425.93 ,$425.93 ,$607.50 ,$506.25 ,$110.78 ,$594.00 ,$110.78 ,$506.25 ,$506.25 ,$573.75 ,$573.75 ,$110.78 ,$573.75 ,$110.78 ,$533.25 ,$533.25 ,$533.25 ,$607.50 ,$265.92 ,$607.50 ,$110.78 ,$675.00 ,$442.13 ,$110.78 ,$292.95 , N/A ,$115.95 ,$607.50 ,$240.07 ,$425.93 ,$405.00 ,$607.50 ,$110.78 ,$607.50 ,$607.50 ,$110.78 ,$438.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000107,70210,HC XRAY SINUS WATERS VIEW,320,1 ,$253.00 ,$164.45 ,$82.24 ,$253.00 ,$188.49 ,$165.72 ,$82.24 ,$133.33 ,$82.24 ,$159.64 ,$159.64 ,$159.64 ,$159.64 ,$227.70 ,$189.75 ,$82.24 ,$222.64 ,$82.24 ,$189.75 ,$189.75 ,$215.05 ,$215.05 ,$82.24 ,$215.05 ,$82.24 ,$199.87 ,$199.87 ,$199.87 ,$227.70 ,$197.42 ,$227.70 ,$82.24 ,$253.00 ,$165.72 ,$82.24 ,$109.80 , N/A ,$86.08 ,$227.70 ,$178.23 ,$159.64 ,$151.80 ,$227.70 ,$82.24 ,$227.70 ,$227.70 ,$82.24 ,$164.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000108,70220,HC SINUSES MIN 3 VIEWS,320,1 ,$727.00 ,$472.55 ,$82.24 ,$727.00 ,$541.62 ,$476.19 ,$82.24 ,$383.13 ,$82.24 ,$458.74 ,$458.74 ,$458.74 ,$458.74 ,$654.30 ,$545.25 ,$82.24 ,$639.76 ,$82.24 ,$545.25 ,$545.25 ,$617.95 ,$617.95 ,$82.24 ,$617.95 ,$82.24 ,$574.33 ,$574.33 ,$574.33 ,$654.30 ,$197.42 ,$654.30 ,$82.24 ,$727.00 ,$476.19 ,$82.24 ,$315.52 , N/A ,$86.08 ,$654.30 ,$178.23 ,$458.74 ,$436.20 ,$654.30 ,$82.24 ,$654.30 ,$654.30 ,$82.24 ,$472.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000110,70250,HC SKULL LESS THAN 4 VIEWS,320,1 ,$384.00 ,$249.60 ,$110.78 ,$384.00 ,$286.08 ,$251.52 ,$110.78 ,$202.37 ,$110.78 ,$242.30 ,$242.30 ,$242.30 ,$242.30 ,$345.60 ,$288.00 ,$110.78 ,$337.92 ,$110.78 ,$288.00 ,$288.00 ,$326.40 ,$326.40 ,$110.78 ,$326.40 ,$110.78 ,$303.36 ,$303.36 ,$303.36 ,$345.60 ,$265.92 ,$345.60 ,$110.78 ,$384.00 ,$251.52 ,$110.78 ,$166.66 , N/A ,$115.95 ,$345.60 ,$240.07 ,$242.30 ,$230.40 ,$345.60 ,$110.78 ,$345.60 ,$345.60 ,$110.78 ,$249.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000112,70260,HC SKULL MIN 4 VIEWS,320,1 ,$857.00 ,$557.05 ,$110.78 ,$857.00 ,$638.47 ,$561.34 ,$110.78 ,$451.64 ,$110.78 ,$540.77 ,$540.77 ,$540.77 ,$540.77 ,$771.30 ,$642.75 ,$110.78 ,$754.16 ,$110.78 ,$642.75 ,$642.75 ,$728.45 ,$728.45 ,$110.78 ,$728.45 ,$110.78 ,$677.03 ,$677.03 ,$677.03 ,$771.30 ,$265.92 ,$771.30 ,$110.78 ,$857.00 ,$561.34 ,$110.78 ,$371.94 , N/A ,$115.95 ,$771.30 ,$240.07 ,$540.77 ,$514.20 ,$771.30 ,$110.78 ,$771.30 ,$771.30 ,$110.78 ,$557.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000113,70330,HC TEMPOROMANDIBULAR JOINTS BILAT,320,1 ,$644.00 ,$418.60 ,$82.24 ,$644.00 ,$479.78 ,$421.82 ,$82.24 ,$339.39 ,$82.24 ,$406.36 ,$406.36 ,$406.36 ,$406.36 ,$579.60 ,$483.00 ,$82.24 ,$566.72 ,$82.24 ,$483.00 ,$483.00 ,$547.40 ,$547.40 ,$82.24 ,$547.40 ,$82.24 ,$508.76 ,$508.76 ,$508.76 ,$579.60 ,$197.42 ,$579.60 ,$82.24 ,$644.00 ,$421.82 ,$82.24 ,$279.50 , N/A ,$86.08 ,$579.60 ,$178.23 ,$406.36 ,$386.40 ,$579.60 ,$82.24 ,$579.60 ,$579.60 ,$82.24 ,$418.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000114,70336,HC MRI TMJ,320,1 ,"$2,420.00 ","$1,573.00 ",$233.94 ,"$2,420.00 ","$1,802.90 ","$1,585.10 ",$233.94 ,"$1,275.34 ",$233.94 ,"$1,527.02 ","$1,527.02 ","$1,527.02 ","$1,527.02 ","$2,178.00 ","$1,815.00 ",$233.94 ,"$2,129.60 ",$233.94 ,"$1,815.00 ","$1,815.00 ","$2,057.00 ","$2,057.00 ",$233.94 ,"$2,057.00 ",$233.94 ,"$1,911.80 ","$1,911.80 ","$1,911.80 ","$2,178.00 ",$561.60 ,"$2,178.00 ",$233.94 ,"$2,420.00 ","$1,585.10 ",$233.94 ,"$1,050.28 ", N/A ,$244.87 ,"$2,178.00 ",$506.99 ,"$1,527.02 ","$1,452.00 ","$2,178.00 ",$233.94 ,"$2,178.00 ","$2,178.00 ",$233.94 ,"$1,573.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000115,70355,HC XRAY PAN MANDIBLE/MAXLA,320,1 ,$351.00 ,$228.15 ,$82.24 ,$351.00 ,$261.50 ,$229.91 ,$82.24 ,$184.98 ,$82.24 ,$221.48 ,$221.48 ,$221.48 ,$221.48 ,$315.90 ,$263.25 ,$82.24 ,$308.88 ,$82.24 ,$263.25 ,$263.25 ,$298.35 ,$298.35 ,$82.24 ,$298.35 ,$82.24 ,$277.29 ,$277.29 ,$277.29 ,$315.90 ,$197.42 ,$315.90 ,$82.24 ,$351.00 ,$229.91 ,$82.24 ,$152.33 , N/A ,$86.08 ,$315.90 ,$178.23 ,$221.48 ,$210.60 ,$315.90 ,$82.24 ,$315.90 ,$315.90 ,$82.24 ,$228.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000116,70360,HC XRAY NECK SOFT TISSUE,320,1 ,$504.00 ,$327.60 ,$82.24 ,$504.00 ,$375.48 ,$330.12 ,$82.24 ,$265.61 ,$82.24 ,$318.02 ,$318.02 ,$318.02 ,$318.02 ,$453.60 ,$378.00 ,$82.24 ,$443.52 ,$82.24 ,$378.00 ,$378.00 ,$428.40 ,$428.40 ,$82.24 ,$428.40 ,$82.24 ,$398.16 ,$398.16 ,$398.16 ,$453.60 ,$197.42 ,$453.60 ,$82.24 ,$504.00 ,$330.12 ,$82.24 ,$218.74 , N/A ,$86.08 ,$453.60 ,$178.23 ,$318.02 ,$302.40 ,$453.60 ,$82.24 ,$453.60 ,$453.60 ,$82.24 ,$327.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000121,71045,HC XR CHEST 1V,320,1 ,$390.00 ,$253.50 ,$18.14 ,$390.00 ,$290.55 ,$255.45 ,$82.24 ,$205.53 ,$82.24 ,$246.09 ,$246.09 ,$246.09 ,$246.09 ,$351.00 ,$292.50 ,$82.24 ,$343.20 ,$82.24 ,$292.50 ,$292.50 ,$331.50 ,$331.50 ,$82.24 ,$331.50 ,$82.24 ,$308.10 ,$308.10 ,$308.10 ,$351.00 ,$197.42 ,$351.00 ,$82.24 ,$18.14 ,$255.45 ,$82.24 ,$169.26 , N/A ,$86.08 ,$351.00 ,$178.23 ,$246.09 ,$234.00 ,$351.00 ,$82.24 ,$351.00 ,$351.00 ,$82.24 ,$253.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000127,71046,HC XR CHEST 2V,320,1 ,$524.00 ,$340.60 ,$24.70 ,$524.00 ,$390.38 ,$343.22 ,$82.24 ,$276.15 ,$82.24 ,$330.64 ,$330.64 ,$330.64 ,$330.64 ,$471.60 ,$393.00 ,$82.24 ,$461.12 ,$82.24 ,$393.00 ,$393.00 ,$445.40 ,$445.40 ,$82.24 ,$445.40 ,$82.24 ,$413.96 ,$413.96 ,$413.96 ,$471.60 ,$197.42 ,$471.60 ,$82.24 ,$24.70 ,$343.22 ,$82.24 ,$227.42 , N/A ,$86.08 ,$471.60 ,$178.23 ,$330.64 ,$314.40 ,$471.60 ,$82.24 ,$471.60 ,$471.60 ,$82.24 ,$340.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000130,71047,HC XR CHEST 2V W/LORDOTIC,320,1 ,$537.00 ,$349.05 ,$82.24 ,$537.00 ,$400.07 ,$351.74 ,$82.24 ,$283.00 ,$82.24 ,$338.85 ,$338.85 ,$338.85 ,$338.85 ,$483.30 ,$402.75 ,$82.24 ,$472.56 ,$82.24 ,$402.75 ,$402.75 ,$456.45 ,$456.45 ,$82.24 ,$456.45 ,$82.24 ,$424.23 ,$424.23 ,$424.23 ,$483.30 ,$197.42 ,$483.30 ,$82.24 ,$537.00 ,$351.74 ,$82.24 ,$233.06 , N/A ,$86.08 ,$483.30 ,$178.23 ,$338.85 ,$322.20 ,$483.30 ,$82.24 ,$483.30 ,$483.30 ,$82.24 ,$349.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000133,71048,HC XR CHEST 4+V,320,1 ,$551.00 ,$358.15 ,$110.78 ,$551.00 ,$410.50 ,$360.91 ,$110.78 ,$290.38 ,$110.78 ,$347.68 ,$347.68 ,$347.68 ,$347.68 ,$495.90 ,$413.25 ,$110.78 ,$484.88 ,$110.78 ,$413.25 ,$413.25 ,$468.35 ,$468.35 ,$110.78 ,$468.35 ,$110.78 ,$435.29 ,$435.29 ,$435.29 ,$495.90 ,$265.92 ,$495.90 ,$110.78 ,$551.00 ,$360.91 ,$110.78 ,$239.13 , N/A ,$115.95 ,$495.90 ,$240.07 ,$347.68 ,$330.60 ,$495.90 ,$110.78 ,$495.90 ,$495.90 ,$110.78 ,$358.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000135,71046,HC XR CHEST SPECIAL VIEWS,320,1 ,$524.00 ,$340.60 ,$24.70 ,$524.00 ,$390.38 ,$343.22 ,$82.24 ,$276.15 ,$82.24 ,$330.64 ,$330.64 ,$330.64 ,$330.64 ,$471.60 ,$393.00 ,$82.24 ,$461.12 ,$82.24 ,$393.00 ,$393.00 ,$445.40 ,$445.40 ,$82.24 ,$445.40 ,$82.24 ,$413.96 ,$413.96 ,$413.96 ,$471.60 ,$197.42 ,$471.60 ,$82.24 ,$24.70 ,$343.22 ,$82.24 ,$227.42 , N/A ,$86.08 ,$471.60 ,$178.23 ,$330.64 ,$314.40 ,$471.60 ,$82.24 ,$471.60 ,$471.60 ,$82.24 ,$340.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000137,71100,HC XR RIBS 2V UNI,320,1 ,$585.00 ,$380.25 ,$82.24 ,$585.00 ,$435.83 ,$383.18 ,$82.24 ,$308.30 ,$82.24 ,$369.14 ,$369.14 ,$369.14 ,$369.14 ,$526.50 ,$438.75 ,$82.24 ,$514.80 ,$82.24 ,$438.75 ,$438.75 ,$497.25 ,$497.25 ,$82.24 ,$497.25 ,$82.24 ,$462.15 ,$462.15 ,$462.15 ,$526.50 ,$197.42 ,$526.50 ,$82.24 ,$585.00 ,$383.18 ,$82.24 ,$253.89 , N/A ,$86.08 ,$526.50 ,$178.23 ,$369.14 ,$351.00 ,$526.50 ,$82.24 ,$526.50 ,$526.50 ,$82.24 ,$380.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000138,71101,HC XR RIBS W/CXR 3+V UNI,320,1 ,$699.00 ,$454.35 ,$110.78 ,$699.00 ,$520.76 ,$457.85 ,$110.78 ,$368.37 ,$110.78 ,$441.07 ,$441.07 ,$441.07 ,$441.07 ,$629.10 ,$524.25 ,$110.78 ,$615.12 ,$110.78 ,$524.25 ,$524.25 ,$594.15 ,$594.15 ,$110.78 ,$594.15 ,$110.78 ,$552.21 ,$552.21 ,$552.21 ,$629.10 ,$265.92 ,$629.10 ,$110.78 ,$699.00 ,$457.85 ,$110.78 ,$303.37 , N/A ,$115.95 ,$629.10 ,$240.07 ,$441.07 ,$419.40 ,$629.10 ,$110.78 ,$629.10 ,$629.10 ,$110.78 ,$454.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000139,71110,HC XR RIBS 3 V BIL,320,1 ,$972.00 ,$631.80 ,$110.78 ,$972.00 ,$724.14 ,$636.66 ,$110.78 ,$512.24 ,$110.78 ,$613.33 ,$613.33 ,$613.33 ,$613.33 ,$874.80 ,$729.00 ,$110.78 ,$855.36 ,$110.78 ,$729.00 ,$729.00 ,$826.20 ,$826.20 ,$110.78 ,$826.20 ,$110.78 ,$767.88 ,$767.88 ,$767.88 ,$874.80 ,$265.92 ,$874.80 ,$110.78 ,$972.00 ,$636.66 ,$110.78 ,$421.85 , N/A ,$115.95 ,$874.80 ,$240.07 ,$613.33 ,$583.20 ,$874.80 ,$110.78 ,$874.80 ,$874.80 ,$110.78 ,$631.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000140,71111,HC XR RIBS W/CXR 4+V BI,320,1 ,"$1,010.00 ",$656.50 ,$110.78 ,"$1,010.00 ",$752.45 ,$661.55 ,$110.78 ,$532.27 ,$110.78 ,$637.31 ,$637.31 ,$637.31 ,$637.31 ,$909.00 ,$757.50 ,$110.78 ,$888.80 ,$110.78 ,$757.50 ,$757.50 ,$858.50 ,$858.50 ,$110.78 ,$858.50 ,$110.78 ,$797.90 ,$797.90 ,$797.90 ,$909.00 ,$265.92 ,$909.00 ,$110.78 ,"$1,010.00 ",$661.55 ,$110.78 ,$438.34 , N/A ,$115.95 ,$909.00 ,$240.07 ,$637.31 ,$606.00 ,$909.00 ,$110.78 ,$909.00 ,$909.00 ,$110.78 ,$656.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000141,71120,HC XR STERNUM 2+V,320,1 ,$622.00 ,$404.30 ,$82.24 ,$622.00 ,$463.39 ,$407.41 ,$82.24 ,$327.79 ,$82.24 ,$392.48 ,$392.48 ,$392.48 ,$392.48 ,$559.80 ,$466.50 ,$82.24 ,$547.36 ,$82.24 ,$466.50 ,$466.50 ,$528.70 ,$528.70 ,$82.24 ,$528.70 ,$82.24 ,$491.38 ,$491.38 ,$491.38 ,$559.80 ,$197.42 ,$559.80 ,$82.24 ,$622.00 ,$407.41 ,$82.24 ,$269.95 , N/A ,$86.08 ,$559.80 ,$178.23 ,$392.48 ,$373.20 ,$559.80 ,$82.24 ,$559.80 ,$559.80 ,$82.24 ,$404.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000142,71130,HC XR STERNOCLAVIC JT 3+V,320,1 ,$385.00 ,$250.25 ,$82.24 ,$385.00 ,$286.83 ,$252.18 ,$82.24 ,$202.90 ,$82.24 ,$242.94 ,$242.94 ,$242.94 ,$242.94 ,$346.50 ,$288.75 ,$82.24 ,$338.80 ,$82.24 ,$288.75 ,$288.75 ,$327.25 ,$327.25 ,$82.24 ,$327.25 ,$82.24 ,$304.15 ,$304.15 ,$304.15 ,$346.50 ,$197.42 ,$346.50 ,$82.24 ,$385.00 ,$252.18 ,$82.24 ,$167.09 , N/A ,$86.08 ,$346.50 ,$178.23 ,$242.94 ,$231.00 ,$346.50 ,$82.24 ,$346.50 ,$346.50 ,$82.24 ,$250.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000144,71250,HC CT CHEST W/O CONTRAST,350,1 ,"$2,392.00 ","$1,554.80 ",$110.78 ,"$2,392.00 ","$1,782.04 ","$1,566.76 ",$110.78 ,"$1,260.58 ",$110.78 ,"$1,509.35 ","$1,509.35 ","$1,509.35 ","$1,509.35 ","$2,152.80 ","$1,794.00 ",$110.78 ,"$2,104.96 ",$110.78 ,"$1,794.00 ","$1,794.00 ","$2,033.20 ","$2,033.20 ",$110.78 ,"$2,033.20 ",$110.78 ,"$1,889.68 ","$1,889.68 ","$1,889.68 ","$2,152.80 ",$265.92 ,"$2,152.80 ",$110.78 ,"$2,392.00 ","$1,566.76 ",$110.78 ,"$1,038.13 ", N/A ,$115.95 ,"$2,152.80 ",$240.07 ,"$1,509.35 ","$1,000.00 ","$2,152.80 ",$110.78 ,"$2,152.80 ","$2,152.80 ",$110.78 ,"$1,554.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000146,71260,HC CT CHEST W/CONTRAST,350,1 ,"$2,750.00 ","$1,787.50 ",$181.51 ,"$2,750.00 ","$2,048.75 ","$1,801.25 ",$181.51 ,"$1,449.25 ",$181.51 ,"$1,735.25 ","$1,735.25 ","$1,735.25 ","$1,735.25 ","$2,475.00 ","$2,062.50 ",$181.51 ,"$2,420.00 ",$181.51 ,"$2,062.50 ","$2,062.50 ","$2,337.50 ","$2,337.50 ",$181.51 ,"$2,337.50 ",$181.51 ,"$2,172.50 ","$2,172.50 ","$2,172.50 ","$2,475.00 ",$435.72 ,"$2,475.00 ",$181.51 ,"$2,750.00 ","$1,801.25 ",$181.51 ,"$1,193.50 ", N/A ,$189.98 ,"$2,475.00 ",$393.35 ,"$1,735.25 ","$1,000.00 ","$2,475.00 ",$181.51 ,"$2,475.00 ","$2,475.00 ",$181.51 ,"$1,787.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000148,71270,HC CT CHEST W AND W/O CONTRAST,350,1 ,"$3,729.00 ","$2,423.85 ",$181.51 ,"$3,729.00 ","$2,778.11 ","$2,442.50 ",$181.51 ,"$1,965.18 ",$181.51 ,"$2,353.00 ","$2,353.00 ","$2,353.00 ","$2,353.00 ","$3,356.10 ","$2,796.75 ",$181.51 ,"$3,281.52 ",$181.51 ,"$2,796.75 ","$2,796.75 ","$3,169.65 ","$3,169.65 ",$181.51 ,"$3,169.65 ",$181.51 ,"$2,945.91 ","$2,945.91 ","$2,945.91 ","$3,356.10 ",$435.72 ,"$3,356.10 ",$181.51 ,"$3,729.00 ","$2,442.50 ",$181.51 ,"$1,618.39 ", N/A ,$189.98 ,"$3,356.10 ",$393.35 ,"$2,353.00 ","$1,000.00 ","$3,356.10 ",$181.51 ,"$3,356.10 ","$3,356.10 ",$181.51 ,"$2,423.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000150,71275,HC CTA CHEST W AND W/O CONTRAST,350,1 ,"$4,779.00 ","$3,106.35 ",$181.51 ,"$4,779.00 ","$3,560.36 ","$3,130.25 ",$181.51 ,"$2,518.53 ",$181.51 ,"$3,015.55 ","$3,015.55 ","$3,015.55 ","$3,015.55 ","$4,301.10 ","$3,584.25 ",$181.51 ,"$4,205.52 ",$181.51 ,"$3,584.25 ","$3,584.25 ","$4,062.15 ","$4,062.15 ",$181.51 ,"$4,062.15 ",$181.51 ,"$3,775.41 ","$3,775.41 ","$3,775.41 ","$4,301.10 ",$435.72 ,"$4,301.10 ",$181.51 ,"$4,779.00 ","$3,130.25 ",$181.51 ,"$2,074.09 ", N/A ,$189.98 ,"$4,301.10 ",$393.35 ,"$3,015.55 ","$1,000.00 ","$4,301.10 ",$181.51 ,"$4,301.10 ","$4,301.10 ",$181.51 ,"$3,106.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000151,71550,HC MRI CHEST W/O CON,610,1 ,"$2,816.00 ","$1,830.40 ",$233.94 ,"$2,816.00 ","$2,097.92 ","$1,844.48 ",$233.94 ,"$1,484.03 ",$233.94 ,"$1,776.90 ","$1,776.90 ","$1,776.90 ","$1,776.90 ","$2,534.40 ","$2,112.00 ",$233.94 ,"$2,478.08 ",$233.94 ,"$2,112.00 ","$2,112.00 ","$2,393.60 ","$2,393.60 ",$233.94 ,"$2,393.60 ",$233.94 ,"$2,224.64 ","$2,224.64 ","$2,224.64 ","$2,534.40 ",$561.60 ,"$2,534.40 ",$233.94 ,"$2,816.00 ","$1,844.48 ",$233.94 ,"$1,222.14 ", N/A ,$244.87 ,"$2,534.40 ",$506.99 ,"$1,776.90 ","$1,304.00 ","$2,534.40 ",$233.94 ,"$2,534.40 ","$2,534.40 ",$233.94 ,"$1,830.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000152,71551,HC MRI CHEST W/CONTRAST,610,1 ,"$3,283.00 ","$2,133.95 ",$727.03 ,"$3,283.00 ","$2,445.84 ","$2,150.37 ",$727.03 ,"$1,730.14 ",$727.03 ,"$2,071.57 ","$2,071.57 ","$2,071.57 ","$2,071.57 ","$2,954.70 ","$2,462.25 ",$727.03 ,"$2,889.04 ",$727.03 ,"$2,462.25 ","$2,462.25 ","$2,790.55 ","$2,790.55 ",$727.03 ,"$2,790.55 ",$727.03 ,"$2,593.57 ","$2,593.57 ","$2,593.57 ","$2,954.70 ","$1,745.28 ","$2,954.70 ",$727.03 ,"$3,283.00 ","$2,150.37 ",$727.03 ,"$1,424.82 ", N/A ,$760.97 ,"$2,954.70 ","$1,575.58 ","$2,071.57 ","$1,304.00 ","$2,954.70 ",$727.03 ,"$2,954.70 ","$2,954.70 ",$727.03 ,"$2,133.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000153,71552,HC MRI CHEST W AND W/O CONTRAST,610,1 ,"$3,395.00 ","$2,206.75 ",$374.22 ,"$3,395.00 ","$2,529.28 ","$2,223.73 ",$374.22 ,"$1,789.17 ",$374.22 ,"$2,142.25 ","$2,142.25 ","$2,142.25 ","$2,142.25 ","$3,055.50 ","$2,546.25 ",$374.22 ,"$2,987.60 ",$374.22 ,"$2,546.25 ","$2,546.25 ","$2,885.75 ","$2,885.75 ",$374.22 ,"$2,885.75 ",$374.22 ,"$2,682.05 ","$2,682.05 ","$2,682.05 ","$3,055.50 ",$898.34 ,"$3,055.50 ",$374.22 ,"$3,395.00 ","$2,223.73 ",$374.22 ,"$1,473.43 ", N/A ,$391.69 ,"$3,055.50 ",$810.99 ,"$2,142.25 ","$1,304.00 ","$3,055.50 ",$374.22 ,"$3,055.50 ","$3,055.50 ",$374.22 ,"$2,206.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000155,72020,HC XR SPINE 1V ANY LEVEL,320,1 ,$579.00 ,$376.35 ,$82.24 ,$579.00 ,$431.36 ,$379.25 ,$82.24 ,$305.13 ,$82.24 ,$365.35 ,$365.35 ,$365.35 ,$365.35 ,$521.10 ,$434.25 ,$82.24 ,$509.52 ,$82.24 ,$434.25 ,$434.25 ,$492.15 ,$492.15 ,$82.24 ,$492.15 ,$82.24 ,$457.41 ,$457.41 ,$457.41 ,$521.10 ,$197.42 ,$521.10 ,$82.24 ,$579.00 ,$379.25 ,$82.24 ,$251.29 , N/A ,$86.08 ,$521.10 ,$178.23 ,$365.35 ,$347.40 ,$521.10 ,$82.24 ,$521.10 ,$521.10 ,$82.24 ,$376.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000161,72020,HC XR L-SPINE 1V,320,1 ,$579.00 ,$376.35 ,$82.24 ,$579.00 ,$431.36 ,$379.25 ,$82.24 ,$305.13 ,$82.24 ,$365.35 ,$365.35 ,$365.35 ,$365.35 ,$521.10 ,$434.25 ,$82.24 ,$509.52 ,$82.24 ,$434.25 ,$434.25 ,$492.15 ,$492.15 ,$82.24 ,$492.15 ,$82.24 ,$457.41 ,$457.41 ,$457.41 ,$521.10 ,$197.42 ,$521.10 ,$82.24 ,$579.00 ,$379.25 ,$82.24 ,$251.29 , N/A ,$86.08 ,$521.10 ,$178.23 ,$365.35 ,$347.40 ,$521.10 ,$82.24 ,$521.10 ,$521.10 ,$82.24 ,$376.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000164,72040,HC XR C-SPINE 2-3V,320,1 ,$696.00 ,$452.40 ,$82.24 ,$696.00 ,$518.52 ,$455.88 ,$82.24 ,$366.79 ,$82.24 ,$439.18 ,$439.18 ,$439.18 ,$439.18 ,$626.40 ,$522.00 ,$82.24 ,$612.48 ,$82.24 ,$522.00 ,$522.00 ,$591.60 ,$591.60 ,$82.24 ,$591.60 ,$82.24 ,$549.84 ,$549.84 ,$549.84 ,$626.40 ,$197.42 ,$626.40 ,$82.24 ,$696.00 ,$455.88 ,$82.24 ,$302.06 , N/A ,$86.08 ,$626.40 ,$178.23 ,$439.18 ,$417.60 ,$626.40 ,$82.24 ,$626.40 ,$626.40 ,$82.24 ,$452.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000168,72050,HC XR C-SPINE 4-5 VIEW,320,1 ,$814.00 ,$529.10 ,$110.78 ,$814.00 ,$606.43 ,$533.17 ,$110.78 ,$428.98 ,$110.78 ,$513.63 ,$513.63 ,$513.63 ,$513.63 ,$732.60 ,$610.50 ,$110.78 ,$716.32 ,$110.78 ,$610.50 ,$610.50 ,$691.90 ,$691.90 ,$110.78 ,$691.90 ,$110.78 ,$643.06 ,$643.06 ,$643.06 ,$732.60 ,$265.92 ,$732.60 ,$110.78 ,$814.00 ,$533.17 ,$110.78 ,$353.28 , N/A ,$115.95 ,$732.60 ,$240.07 ,$513.63 ,$488.40 ,$732.60 ,$110.78 ,$732.60 ,$732.60 ,$110.78 ,$529.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000170,72052,HC XR C-SPINE 6+ VIEWS,320,1 ,"$1,248.00 ",$811.20 ,$110.78 ,"$1,248.00 ",$929.76 ,$817.44 ,$110.78 ,$657.70 ,$110.78 ,$787.49 ,$787.49 ,$787.49 ,$787.49 ,"$1,123.20 ",$936.00 ,$110.78 ,"$1,098.24 ",$110.78 ,$936.00 ,$936.00 ,"$1,060.80 ","$1,060.80 ",$110.78 ,"$1,060.80 ",$110.78 ,$985.92 ,$985.92 ,$985.92 ,"$1,123.20 ",$265.92 ,"$1,123.20 ",$110.78 ,"$1,248.00 ",$817.44 ,$110.78 ,$541.63 , N/A ,$115.95 ,"$1,123.20 ",$240.07 ,$787.49 ,$748.80 ,"$1,123.20 ",$110.78 ,"$1,123.20 ","$1,123.20 ",$110.78 ,$811.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000172,72070,HC XR T-SPINE 2V,320,1 ,$366.00 ,$237.90 ,$110.78 ,$366.00 ,$272.67 ,$239.73 ,$110.78 ,$192.88 ,$110.78 ,$230.95 ,$230.95 ,$230.95 ,$230.95 ,$329.40 ,$274.50 ,$110.78 ,$322.08 ,$110.78 ,$274.50 ,$274.50 ,$311.10 ,$311.10 ,$110.78 ,$311.10 ,$110.78 ,$289.14 ,$289.14 ,$289.14 ,$329.40 ,$265.92 ,$329.40 ,$110.78 ,$366.00 ,$239.73 ,$110.78 ,$158.84 , N/A ,$115.95 ,$329.40 ,$240.07 ,$230.95 ,$219.60 ,$329.40 ,$110.78 ,$329.40 ,$329.40 ,$110.78 ,$237.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000174,72072,HC XR T-SPINE 3V,320,1 ,$854.00 ,$555.10 ,$110.78 ,$854.00 ,$636.23 ,$559.37 ,$110.78 ,$450.06 ,$110.78 ,$538.87 ,$538.87 ,$538.87 ,$538.87 ,$768.60 ,$640.50 ,$110.78 ,$751.52 ,$110.78 ,$640.50 ,$640.50 ,$725.90 ,$725.90 ,$110.78 ,$725.90 ,$110.78 ,$674.66 ,$674.66 ,$674.66 ,$768.60 ,$265.92 ,$768.60 ,$110.78 ,$854.00 ,$559.37 ,$110.78 ,$370.64 , N/A ,$115.95 ,$768.60 ,$240.07 ,$538.87 ,$512.40 ,$768.60 ,$110.78 ,$768.60 ,$768.60 ,$110.78 ,$555.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000178,72100,HC XR L-SPINE 2-3V,320,1 ,$706.00 ,$458.90 ,$110.78 ,$706.00 ,$525.97 ,$462.43 ,$110.78 ,$372.06 ,$110.78 ,$445.49 ,$445.49 ,$445.49 ,$445.49 ,$635.40 ,$529.50 ,$110.78 ,$621.28 ,$110.78 ,$529.50 ,$529.50 ,$600.10 ,$600.10 ,$110.78 ,$600.10 ,$110.78 ,$557.74 ,$557.74 ,$557.74 ,$635.40 ,$265.92 ,$635.40 ,$110.78 ,$706.00 ,$462.43 ,$110.78 ,$306.40 , N/A ,$115.95 ,$635.40 ,$240.07 ,$445.49 ,$423.60 ,$635.40 ,$110.78 ,$635.40 ,$635.40 ,$110.78 ,$458.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000181,72110,HC XR L-SPINE 4+V,320,1 ,"$1,011.00 ",$657.15 ,$110.78 ,"$1,011.00 ",$753.20 ,$662.21 ,$110.78 ,$532.80 ,$110.78 ,$637.94 ,$637.94 ,$637.94 ,$637.94 ,$909.90 ,$758.25 ,$110.78 ,$889.68 ,$110.78 ,$758.25 ,$758.25 ,$859.35 ,$859.35 ,$110.78 ,$859.35 ,$110.78 ,$798.69 ,$798.69 ,$798.69 ,$909.90 ,$265.92 ,$909.90 ,$110.78 ,"$1,011.00 ",$662.21 ,$110.78 ,$438.77 , N/A ,$115.95 ,$909.90 ,$240.07 ,$637.94 ,$606.60 ,$909.90 ,$110.78 ,$909.90 ,$909.90 ,$110.78 ,$657.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000183,72120,HC XR L-SPINE BENDING ONLY MIN 4V,320,1 ,$660.00 ,$429.00 ,$110.78 ,$660.00 ,$491.70 ,$432.30 ,$110.78 ,$347.82 ,$110.78 ,$416.46 ,$416.46 ,$416.46 ,$416.46 ,$594.00 ,$495.00 ,$110.78 ,$580.80 ,$110.78 ,$495.00 ,$495.00 ,$561.00 ,$561.00 ,$110.78 ,$561.00 ,$110.78 ,$521.40 ,$521.40 ,$521.40 ,$594.00 ,$265.92 ,$594.00 ,$110.78 ,$660.00 ,$432.30 ,$110.78 ,$286.44 , N/A ,$115.95 ,$594.00 ,$240.07 ,$416.46 ,$396.00 ,$594.00 ,$110.78 ,$594.00 ,$594.00 ,$110.78 ,$429.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000184,72114,HC XR L-SPINE CMPL W/BEND MIN 6 VIEW,320,1 ,"$1,175.00 ",$763.75 ,$110.78 ,"$1,175.00 ",$875.38 ,$769.63 ,$110.78 ,$619.23 ,$110.78 ,$741.43 ,$741.43 ,$741.43 ,$741.43 ,"$1,057.50 ",$881.25 ,$110.78 ,"$1,034.00 ",$110.78 ,$881.25 ,$881.25 ,$998.75 ,$998.75 ,$110.78 ,$998.75 ,$110.78 ,$928.25 ,$928.25 ,$928.25 ,"$1,057.50 ",$265.92 ,"$1,057.50 ",$110.78 ,"$1,175.00 ",$769.63 ,$110.78 ,$509.95 , N/A ,$115.95 ,"$1,057.50 ",$240.07 ,$741.43 ,$705.00 ,"$1,057.50 ",$110.78 ,"$1,057.50 ","$1,057.50 ",$110.78 ,$763.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000186,72170,HC XR PELVIS 1-2V,320,1 ,$452.00 ,$293.80 ,$110.78 ,$452.00 ,$336.74 ,$296.06 ,$110.78 ,$238.20 ,$110.78 ,$285.21 ,$285.21 ,$285.21 ,$285.21 ,$406.80 ,$339.00 ,$110.78 ,$397.76 ,$110.78 ,$339.00 ,$339.00 ,$384.20 ,$384.20 ,$110.78 ,$384.20 ,$110.78 ,$357.08 ,$357.08 ,$357.08 ,$406.80 ,$265.92 ,$406.80 ,$110.78 ,$452.00 ,$296.06 ,$110.78 ,$196.17 , N/A ,$115.95 ,$406.80 ,$240.07 ,$285.21 ,$271.20 ,$406.80 ,$110.78 ,$406.80 ,$406.80 ,$110.78 ,$293.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000189,72190,HC XR PELVIS CMPL 3+V,320,1 ,$552.00 ,$358.80 ,$110.78 ,$552.00 ,$411.24 ,$361.56 ,$110.78 ,$290.90 ,$110.78 ,$348.31 ,$348.31 ,$348.31 ,$348.31 ,$496.80 ,$414.00 ,$110.78 ,$485.76 ,$110.78 ,$414.00 ,$414.00 ,$469.20 ,$469.20 ,$110.78 ,$469.20 ,$110.78 ,$436.08 ,$436.08 ,$436.08 ,$496.80 ,$265.92 ,$496.80 ,$110.78 ,$552.00 ,$361.56 ,$110.78 ,$239.57 , N/A ,$115.95 ,$496.80 ,$240.07 ,$348.31 ,$331.20 ,$496.80 ,$110.78 ,$496.80 ,$496.80 ,$110.78 ,$358.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000190,72202,HC XR SACROILI JT 3+V,320,1 ,$624.00 ,$405.60 ,$110.78 ,$624.00 ,$464.88 ,$408.72 ,$110.78 ,$328.85 ,$110.78 ,$393.74 ,$393.74 ,$393.74 ,$393.74 ,$561.60 ,$468.00 ,$110.78 ,$549.12 ,$110.78 ,$468.00 ,$468.00 ,$530.40 ,$530.40 ,$110.78 ,$530.40 ,$110.78 ,$492.96 ,$492.96 ,$492.96 ,$561.60 ,$265.92 ,$561.60 ,$110.78 ,$624.00 ,$408.72 ,$110.78 ,$270.82 , N/A ,$115.95 ,$561.60 ,$240.07 ,$393.74 ,$374.40 ,$561.60 ,$110.78 ,$561.60 ,$561.60 ,$110.78 ,$405.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000191,72220,HC XR SACRUM/COCCYX 2+V,320,1 ,$599.00 ,$389.35 ,$82.24 ,$599.00 ,$446.26 ,$392.35 ,$82.24 ,$315.67 ,$82.24 ,$377.97 ,$377.97 ,$377.97 ,$377.97 ,$539.10 ,$449.25 ,$82.24 ,$527.12 ,$82.24 ,$449.25 ,$449.25 ,$509.15 ,$509.15 ,$82.24 ,$509.15 ,$82.24 ,$473.21 ,$473.21 ,$473.21 ,$539.10 ,$197.42 ,$539.10 ,$82.24 ,$599.00 ,$392.35 ,$82.24 ,$259.97 , N/A ,$86.08 ,$539.10 ,$178.23 ,$377.97 ,$359.40 ,$539.10 ,$82.24 ,$539.10 ,$539.10 ,$82.24 ,$389.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000194,62302,HC XR MYELOGRAM C-SPINE,320,1 ,"$2,136.00 ","$1,388.40 ",$727.03 ,"$2,136.00 ","$1,591.32 ","$1,399.08 ",$727.03 ,"$1,125.67 ",$727.03 ,"$1,347.82 ","$1,347.82 ","$1,347.82 ","$1,347.82 ","$1,922.40 ","$1,602.00 ",$727.03 ,"$1,879.68 ",$727.03 ,"$1,602.00 ","$1,602.00 ","$1,815.60 ","$1,815.60 ",$727.03 ,"$1,815.60 ",$727.03 ,"$1,687.44 ","$1,687.44 ","$1,687.44 ","$1,922.40 ","$1,745.28 ","$1,922.40 ",$727.03 ,"$2,136.00 ","$1,399.08 ",$727.03 ,$927.02 , N/A ,$760.97 ,"$1,922.40 ","$1,575.58 ","$1,347.82 ","$1,281.60 ","$1,922.40 ",$727.03 ,"$1,922.40 ","$1,922.40 ",$727.03 ,"$1,388.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000195,62303,HC XR MYELOGRAM T-SPINE,320,1 ,"$2,038.00 ","$1,324.70 ",$727.03 ,"$2,038.00 ","$1,518.31 ","$1,334.89 ",$727.03 ,"$1,074.03 ",$727.03 ,"$1,285.98 ","$1,285.98 ","$1,285.98 ","$1,285.98 ","$1,834.20 ","$1,528.50 ",$727.03 ,"$1,793.44 ",$727.03 ,"$1,528.50 ","$1,528.50 ","$1,732.30 ","$1,732.30 ",$727.03 ,"$1,732.30 ",$727.03 ,"$1,610.02 ","$1,610.02 ","$1,610.02 ","$1,834.20 ","$1,745.28 ","$1,834.20 ",$727.03 ,"$2,038.00 ","$1,334.89 ",$727.03 ,$884.49 , N/A ,$760.97 ,"$1,834.20 ","$1,575.58 ","$1,285.98 ","$1,222.80 ","$1,834.20 ",$727.03 ,"$1,834.20 ","$1,834.20 ",$727.03 ,"$1,324.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000196,62304,HC XR MYELOGRAM L-SPINE,320,1 ,"$2,386.00 ","$1,550.90 ",$727.03 ,"$2,386.00 ","$1,777.57 ","$1,562.83 ",$727.03 ,"$1,257.42 ",$727.03 ,"$1,505.57 ","$1,505.57 ","$1,505.57 ","$1,505.57 ","$2,147.40 ","$1,789.50 ",$727.03 ,"$2,099.68 ",$727.03 ,"$1,789.50 ","$1,789.50 ","$2,028.10 ","$2,028.10 ",$727.03 ,"$2,028.10 ",$727.03 ,"$1,884.94 ","$1,884.94 ","$1,884.94 ","$2,147.40 ","$1,745.28 ","$2,147.40 ",$727.03 ,"$2,386.00 ","$1,562.83 ",$727.03 ,"$1,035.52 ", N/A ,$760.97 ,"$2,147.40 ","$1,575.58 ","$1,505.57 ","$1,431.60 ","$2,147.40 ",$727.03 ,"$2,147.40 ","$2,147.40 ",$727.03 ,"$1,550.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000197,62305,HC XR MYELOGRAM >2 REGIONS,320,1 ,"$3,196.00 ","$2,077.40 ",$727.03 ,"$3,196.00 ","$2,381.02 ","$2,093.38 ",$727.03 ,"$1,684.29 ",$727.03 ,"$2,016.68 ","$2,016.68 ","$2,016.68 ","$2,016.68 ","$2,876.40 ","$2,397.00 ",$727.03 ,"$2,812.48 ",$727.03 ,"$2,397.00 ","$2,397.00 ","$2,716.60 ","$2,716.60 ",$727.03 ,"$2,716.60 ",$727.03 ,"$2,524.84 ","$2,524.84 ","$2,524.84 ","$2,876.40 ","$1,745.28 ","$2,876.40 ",$727.03 ,"$3,196.00 ","$2,093.38 ",$727.03 ,"$1,387.06 ", N/A ,$760.97 ,"$2,876.40 ","$1,575.58 ","$2,016.68 ","$1,917.60 ","$2,876.40 ",$727.03 ,"$2,876.40 ","$2,876.40 ",$727.03 ,"$2,077.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000200,72295,HC XR DISKOGRAM L-SPINE,320,1 ,"$3,328.00 ","$2,163.20 ","$1,444.35 ","$3,865.00 ","$2,479.36 ","$2,179.84 ","$1,783.46 ","$1,753.86 ","$1,783.46 ","$2,099.97 ","$2,099.97 ","$2,099.97 ","$2,099.97 ","$2,995.20 ","$2,496.00 ","$1,783.46 ","$2,928.64 ","$1,783.46 ","$2,496.00 ","$2,496.00 ","$2,828.80 ","$2,828.80 ","$1,783.46 ","$2,828.80 ","$1,783.46 ","$2,629.12 ","$2,629.12 ","$2,629.12 ","$2,995.20 ","$3,328.00 ","$2,995.20 ","$1,783.46 ","$3,328.00 ","$2,179.84 ","$1,783.46 ","$1,444.35 ", N/A ,"$1,866.72 ","$2,995.20 ","$3,865.00 ","$2,099.97 ","$1,996.80 ","$2,995.20 ","$1,783.46 ","$2,995.20 ","$2,995.20 ","$1,783.46 ","$2,163.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000201,73000,HC XRAY CLAVICLE,320,1 ,$404.00 ,$262.60 ,$82.24 ,$404.00 ,$300.98 ,$264.62 ,$82.24 ,$212.91 ,$82.24 ,$254.92 ,$254.92 ,$254.92 ,$254.92 ,$363.60 ,$303.00 ,$82.24 ,$355.52 ,$82.24 ,$303.00 ,$303.00 ,$343.40 ,$343.40 ,$82.24 ,$343.40 ,$82.24 ,$319.16 ,$319.16 ,$319.16 ,$363.60 ,$197.42 ,$363.60 ,$82.24 ,$404.00 ,$264.62 ,$82.24 ,$175.34 , N/A ,$86.08 ,$363.60 ,$178.23 ,$254.92 ,$242.40 ,$363.60 ,$82.24 ,$363.60 ,$363.60 ,$82.24 ,$262.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000201,73000,HC XRAY CLAVICLE,320,1 ,$606.00 ,$393.90 ,$82.24 ,$606.00 ,$451.47 ,$396.93 ,$82.24 ,$319.36 ,$82.24 ,$382.39 ,$382.39 ,$382.39 ,$382.39 ,$545.40 ,$454.50 ,$82.24 ,$533.28 ,$82.24 ,$454.50 ,$454.50 ,$515.10 ,$515.10 ,$82.24 ,$515.10 ,$82.24 ,$478.74 ,$478.74 ,$478.74 ,$545.40 ,$197.42 ,$545.40 ,$82.24 ,$606.00 ,$396.93 ,$82.24 ,$263.00 , N/A ,$86.08 ,$545.40 ,$178.23 ,$382.39 ,$363.60 ,$545.40 ,$82.24 ,$545.40 ,$545.40 ,$82.24 ,$393.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000204,73010,HC XRAY SCAPULA,320,1 ,$546.00 ,$354.90 ,$110.78 ,$546.00 ,$406.77 ,$357.63 ,$110.78 ,$287.74 ,$110.78 ,$344.53 ,$344.53 ,$344.53 ,$344.53 ,$491.40 ,$409.50 ,$110.78 ,$480.48 ,$110.78 ,$409.50 ,$409.50 ,$464.10 ,$464.10 ,$110.78 ,$464.10 ,$110.78 ,$431.34 ,$431.34 ,$431.34 ,$491.40 ,$265.92 ,$491.40 ,$110.78 ,$546.00 ,$357.63 ,$110.78 ,$236.96 , N/A ,$115.95 ,$491.40 ,$240.07 ,$344.53 ,$327.60 ,$491.40 ,$110.78 ,$491.40 ,$491.40 ,$110.78 ,$354.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000205,73020,HC XRAY SHOULDER (1 V),320,1 ,$291.00 ,$189.15 ,$82.24 ,$291.00 ,$216.80 ,$190.61 ,$82.24 ,$153.36 ,$82.24 ,$183.62 ,$183.62 ,$183.62 ,$183.62 ,$261.90 ,$218.25 ,$82.24 ,$256.08 ,$82.24 ,$218.25 ,$218.25 ,$247.35 ,$247.35 ,$82.24 ,$247.35 ,$82.24 ,$229.89 ,$229.89 ,$229.89 ,$261.90 ,$197.42 ,$261.90 ,$82.24 ,$291.00 ,$190.61 ,$82.24 ,$126.29 , N/A ,$86.08 ,$261.90 ,$178.23 ,$183.62 ,$174.60 ,$261.90 ,$82.24 ,$261.90 ,$261.90 ,$82.24 ,$189.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000205,73020,HC XRAY SHOULDER (1 V),320,1 ,$469.00 ,$304.85 ,$82.24 ,$469.00 ,$349.41 ,$307.20 ,$82.24 ,$247.16 ,$82.24 ,$295.94 ,$295.94 ,$295.94 ,$295.94 ,$422.10 ,$351.75 ,$82.24 ,$412.72 ,$82.24 ,$351.75 ,$351.75 ,$398.65 ,$398.65 ,$82.24 ,$398.65 ,$82.24 ,$370.51 ,$370.51 ,$370.51 ,$422.10 ,$197.42 ,$422.10 ,$82.24 ,$469.00 ,$307.20 ,$82.24 ,$203.55 , N/A ,$86.08 ,$422.10 ,$178.23 ,$295.94 ,$281.40 ,$422.10 ,$82.24 ,$422.10 ,$422.10 ,$82.24 ,$304.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,$656.00 ,$426.40 ,$82.24 ,$656.00 ,$488.72 ,$429.68 ,$82.24 ,$345.71 ,$82.24 ,$413.94 ,$413.94 ,$413.94 ,$413.94 ,$590.40 ,$492.00 ,$82.24 ,$577.28 ,$82.24 ,$492.00 ,$492.00 ,$557.60 ,$557.60 ,$82.24 ,$557.60 ,$82.24 ,$518.24 ,$518.24 ,$518.24 ,$590.40 ,$197.42 ,$590.40 ,$82.24 ,$656.00 ,$429.68 ,$82.24 ,$284.70 , N/A ,$86.08 ,$590.40 ,$178.23 ,$413.94 ,$393.60 ,$590.40 ,$82.24 ,$590.40 ,$590.40 ,$82.24 ,$426.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000208,73030,HC XRAY SHOULDER (MIN 2 V),320,1 ,"$1,190.00 ",$773.50 ,$82.24 ,"$1,190.00 ",$886.55 ,$779.45 ,$82.24 ,$627.13 ,$82.24 ,$750.89 ,$750.89 ,$750.89 ,$750.89 ,"$1,071.00 ",$892.50 ,$82.24 ,"$1,047.20 ",$82.24 ,$892.50 ,$892.50 ,"$1,011.50 ","$1,011.50 ",$82.24 ,"$1,011.50 ",$82.24 ,$940.10 ,$940.10 ,$940.10 ,"$1,071.00 ",$197.42 ,"$1,071.00 ",$82.24 ,"$1,190.00 ",$779.45 ,$82.24 ,$516.46 , N/A ,$86.08 ,"$1,071.00 ",$178.23 ,$750.89 ,$714.00 ,"$1,071.00 ",$82.24 ,"$1,071.00 ","$1,071.00 ",$82.24 ,$773.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000212,73040,HC XRAY SHOULDER ARTHRO,320,1 ,$850.00 ,$552.50 ,$368.90 ,$850.00 ,$633.25 ,$556.75 ,$374.22 ,$447.95 ,$374.22 ,$536.35 ,$536.35 ,$536.35 ,$536.35 ,$765.00 ,$637.50 ,$374.22 ,$748.00 ,$374.22 ,$637.50 ,$637.50 ,$722.50 ,$722.50 ,$374.22 ,$722.50 ,$374.22 ,$671.50 ,$671.50 ,$671.50 ,$765.00 ,$850.00 ,$765.00 ,$374.22 ,$850.00 ,$556.75 ,$374.22 ,$368.90 , N/A ,$391.69 ,$765.00 ,$810.99 ,$536.35 ,$510.00 ,$765.00 ,$374.22 ,$765.00 ,$765.00 ,$374.22 ,$552.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000213,73050,HC XR AC JOINTS BI W/W/O WTS,320,1 ,$636.00 ,$413.40 ,$82.24 ,$636.00 ,$473.82 ,$416.58 ,$82.24 ,$335.17 ,$82.24 ,$401.32 ,$401.32 ,$401.32 ,$401.32 ,$572.40 ,$477.00 ,$82.24 ,$559.68 ,$82.24 ,$477.00 ,$477.00 ,$540.60 ,$540.60 ,$82.24 ,$540.60 ,$82.24 ,$502.44 ,$502.44 ,$502.44 ,$572.40 ,$197.42 ,$572.40 ,$82.24 ,$636.00 ,$416.58 ,$82.24 ,$276.02 , N/A ,$86.08 ,$572.40 ,$178.23 ,$401.32 ,$381.60 ,$572.40 ,$82.24 ,$572.40 ,$572.40 ,$82.24 ,$413.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000214,73060,HC XRAY HUMERUS (2 V),320,1 ,$576.00 ,$374.40 ,$82.24 ,$576.00 ,$429.12 ,$377.28 ,$82.24 ,$303.55 ,$82.24 ,$363.46 ,$363.46 ,$363.46 ,$363.46 ,$518.40 ,$432.00 ,$82.24 ,$506.88 ,$82.24 ,$432.00 ,$432.00 ,$489.60 ,$489.60 ,$82.24 ,$489.60 ,$82.24 ,$455.04 ,$455.04 ,$455.04 ,$518.40 ,$197.42 ,$518.40 ,$82.24 ,$576.00 ,$377.28 ,$82.24 ,$249.98 , N/A ,$86.08 ,$518.40 ,$178.23 ,$363.46 ,$345.60 ,$518.40 ,$82.24 ,$518.40 ,$518.40 ,$82.24 ,$374.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000214,73060,HC XRAY HUMERUS (2 V),320,1 ,$863.00 ,$560.95 ,$82.24 ,$863.00 ,$642.94 ,$565.27 ,$82.24 ,$454.80 ,$82.24 ,$544.55 ,$544.55 ,$544.55 ,$544.55 ,$776.70 ,$647.25 ,$82.24 ,$759.44 ,$82.24 ,$647.25 ,$647.25 ,$733.55 ,$733.55 ,$82.24 ,$733.55 ,$82.24 ,$681.77 ,$681.77 ,$681.77 ,$776.70 ,$197.42 ,$776.70 ,$82.24 ,$863.00 ,$565.27 ,$82.24 ,$374.54 , N/A ,$86.08 ,$776.70 ,$178.23 ,$544.55 ,$517.80 ,$776.70 ,$82.24 ,$776.70 ,$776.70 ,$82.24 ,$560.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000217,73070,HC XRAY ELBOW (2 V),320,1 ,$385.00 ,$250.25 ,$82.24 ,$385.00 ,$286.83 ,$252.18 ,$82.24 ,$202.90 ,$82.24 ,$242.94 ,$242.94 ,$242.94 ,$242.94 ,$346.50 ,$288.75 ,$82.24 ,$338.80 ,$82.24 ,$288.75 ,$288.75 ,$327.25 ,$327.25 ,$82.24 ,$327.25 ,$82.24 ,$304.15 ,$304.15 ,$304.15 ,$346.50 ,$197.42 ,$346.50 ,$82.24 ,$385.00 ,$252.18 ,$82.24 ,$167.09 , N/A ,$86.08 ,$346.50 ,$178.23 ,$242.94 ,$231.00 ,$346.50 ,$82.24 ,$346.50 ,$346.50 ,$82.24 ,$250.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000217,73070,HC XRAY ELBOW (2 V),320,1 ,$577.00 ,$375.05 ,$82.24 ,$577.00 ,$429.87 ,$377.94 ,$82.24 ,$304.08 ,$82.24 ,$364.09 ,$364.09 ,$364.09 ,$364.09 ,$519.30 ,$432.75 ,$82.24 ,$507.76 ,$82.24 ,$432.75 ,$432.75 ,$490.45 ,$490.45 ,$82.24 ,$490.45 ,$82.24 ,$455.83 ,$455.83 ,$455.83 ,$519.30 ,$197.42 ,$519.30 ,$82.24 ,$577.00 ,$377.94 ,$82.24 ,$250.42 , N/A ,$86.08 ,$519.30 ,$178.23 ,$364.09 ,$346.20 ,$519.30 ,$82.24 ,$519.30 ,$519.30 ,$82.24 ,$375.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000220,73080,HC XRAY ELBOW (MIN 3 V),320,1 ,$557.00 ,$362.05 ,$82.24 ,$557.00 ,$414.97 ,$364.84 ,$82.24 ,$293.54 ,$82.24 ,$351.47 ,$351.47 ,$351.47 ,$351.47 ,$501.30 ,$417.75 ,$82.24 ,$490.16 ,$82.24 ,$417.75 ,$417.75 ,$473.45 ,$473.45 ,$82.24 ,$473.45 ,$82.24 ,$440.03 ,$440.03 ,$440.03 ,$501.30 ,$197.42 ,$501.30 ,$82.24 ,$557.00 ,$364.84 ,$82.24 ,$241.74 , N/A ,$86.08 ,$501.30 ,$178.23 ,$351.47 ,$334.20 ,$501.30 ,$82.24 ,$501.30 ,$501.30 ,$82.24 ,$362.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000220,73080,HC XRAY ELBOW (MIN 3 V),320,1 ,$835.00 ,$542.75 ,$82.24 ,$835.00 ,$622.08 ,$546.93 ,$82.24 ,$440.05 ,$82.24 ,$526.89 ,$526.89 ,$526.89 ,$526.89 ,$751.50 ,$626.25 ,$82.24 ,$734.80 ,$82.24 ,$626.25 ,$626.25 ,$709.75 ,$709.75 ,$82.24 ,$709.75 ,$82.24 ,$659.65 ,$659.65 ,$659.65 ,$751.50 ,$197.42 ,$751.50 ,$82.24 ,$835.00 ,$546.93 ,$82.24 ,$362.39 , N/A ,$86.08 ,$751.50 ,$178.23 ,$526.89 ,$501.00 ,$751.50 ,$82.24 ,$751.50 ,$751.50 ,$82.24 ,$542.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000222,73085,HC XRAY ELBOW ARTHRO,320,1 ,$471.00 ,$306.15 ,$204.41 ,$810.99 ,$350.90 ,$308.51 ,$374.22 ,$248.22 ,$374.22 ,$297.20 ,$297.20 ,$297.20 ,$297.20 ,$423.90 ,$353.25 ,$374.22 ,$414.48 ,$374.22 ,$353.25 ,$353.25 ,$400.35 ,$400.35 ,$374.22 ,$400.35 ,$374.22 ,$372.09 ,$372.09 ,$372.09 ,$423.90 ,$471.00 ,$423.90 ,$374.22 ,$471.00 ,$308.51 ,$374.22 ,$204.41 , N/A ,$391.69 ,$423.90 ,$810.99 ,$297.20 ,$282.60 ,$423.90 ,$374.22 ,$423.90 ,$423.90 ,$374.22 ,$306.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000223,73090,HC XRAY FOREARM (2 V),320,1 ,$440.00 ,$286.00 ,$82.24 ,$440.00 ,$327.80 ,$288.20 ,$82.24 ,$231.88 ,$82.24 ,$277.64 ,$277.64 ,$277.64 ,$277.64 ,$396.00 ,$330.00 ,$82.24 ,$387.20 ,$82.24 ,$330.00 ,$330.00 ,$374.00 ,$374.00 ,$82.24 ,$374.00 ,$82.24 ,$347.60 ,$347.60 ,$347.60 ,$396.00 ,$197.42 ,$396.00 ,$82.24 ,$440.00 ,$288.20 ,$82.24 ,$190.96 , N/A ,$86.08 ,$396.00 ,$178.23 ,$277.64 ,$264.00 ,$396.00 ,$82.24 ,$396.00 ,$396.00 ,$82.24 ,$286.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000223,73090,HC XRAY FOREARM (2 V),320,1 ,$660.00 ,$429.00 ,$82.24 ,$660.00 ,$491.70 ,$432.30 ,$82.24 ,$347.82 ,$82.24 ,$416.46 ,$416.46 ,$416.46 ,$416.46 ,$594.00 ,$495.00 ,$82.24 ,$580.80 ,$82.24 ,$495.00 ,$495.00 ,$561.00 ,$561.00 ,$82.24 ,$561.00 ,$82.24 ,$521.40 ,$521.40 ,$521.40 ,$594.00 ,$197.42 ,$594.00 ,$82.24 ,$660.00 ,$432.30 ,$82.24 ,$286.44 , N/A ,$86.08 ,$594.00 ,$178.23 ,$416.46 ,$396.00 ,$594.00 ,$82.24 ,$594.00 ,$594.00 ,$82.24 ,$429.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000226,73092,HC XRAY INFANT UP EXTRM MIN 2V,320,1 ,$279.00 ,$181.35 ,$110.78 ,$279.00 ,$207.86 ,$182.75 ,$110.78 ,$147.03 ,$110.78 ,$176.05 ,$176.05 ,$176.05 ,$176.05 ,$251.10 ,$209.25 ,$110.78 ,$245.52 ,$110.78 ,$209.25 ,$209.25 ,$237.15 ,$237.15 ,$110.78 ,$237.15 ,$110.78 ,$220.41 ,$220.41 ,$220.41 ,$251.10 ,$265.92 ,$251.10 ,$110.78 ,$279.00 ,$182.75 ,$110.78 ,$121.09 , N/A ,$115.95 ,$251.10 ,$240.07 ,$176.05 ,$167.40 ,$251.10 ,$110.78 ,$251.10 ,$251.10 ,$110.78 ,$181.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000226,73092,HC XRAY INFANT UP EXTRM MIN 2V,320,1 ,$419.00 ,$272.35 ,$110.78 ,$419.00 ,$312.16 ,$274.45 ,$110.78 ,$220.81 ,$110.78 ,$264.39 ,$264.39 ,$264.39 ,$264.39 ,$377.10 ,$314.25 ,$110.78 ,$368.72 ,$110.78 ,$314.25 ,$314.25 ,$356.15 ,$356.15 ,$110.78 ,$356.15 ,$110.78 ,$331.01 ,$331.01 ,$331.01 ,$377.10 ,$265.92 ,$377.10 ,$110.78 ,$419.00 ,$274.45 ,$110.78 ,$181.85 , N/A ,$115.95 ,$377.10 ,$240.07 ,$264.39 ,$251.40 ,$377.10 ,$110.78 ,$377.10 ,$377.10 ,$110.78 ,$272.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000229,73100,HC XRAY WRIST 2 VIEWS,320,1 ,$374.00 ,$243.10 ,$82.24 ,$374.00 ,$278.63 ,$244.97 ,$82.24 ,$197.10 ,$82.24 ,$235.99 ,$235.99 ,$235.99 ,$235.99 ,$336.60 ,$280.50 ,$82.24 ,$329.12 ,$82.24 ,$280.50 ,$280.50 ,$317.90 ,$317.90 ,$82.24 ,$317.90 ,$82.24 ,$295.46 ,$295.46 ,$295.46 ,$336.60 ,$197.42 ,$336.60 ,$82.24 ,$374.00 ,$244.97 ,$82.24 ,$162.32 , N/A ,$86.08 ,$336.60 ,$178.23 ,$235.99 ,$224.40 ,$336.60 ,$82.24 ,$336.60 ,$336.60 ,$82.24 ,$243.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000229,73100,HC XRAY WRIST 2 VIEWS,320,1 ,$561.00 ,$364.65 ,$82.24 ,$561.00 ,$417.95 ,$367.46 ,$82.24 ,$295.65 ,$82.24 ,$353.99 ,$353.99 ,$353.99 ,$353.99 ,$504.90 ,$420.75 ,$82.24 ,$493.68 ,$82.24 ,$420.75 ,$420.75 ,$476.85 ,$476.85 ,$82.24 ,$476.85 ,$82.24 ,$443.19 ,$443.19 ,$443.19 ,$504.90 ,$197.42 ,$504.90 ,$82.24 ,$561.00 ,$367.46 ,$82.24 ,$243.47 , N/A ,$86.08 ,$504.90 ,$178.23 ,$353.99 ,$336.60 ,$504.90 ,$82.24 ,$504.90 ,$504.90 ,$82.24 ,$364.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$576.00 ,$374.40 ,$82.24 ,$576.00 ,$429.12 ,$377.28 ,$82.24 ,$303.55 ,$82.24 ,$363.46 ,$363.46 ,$363.46 ,$363.46 ,$518.40 ,$432.00 ,$82.24 ,$506.88 ,$82.24 ,$432.00 ,$432.00 ,$489.60 ,$489.60 ,$82.24 ,$489.60 ,$82.24 ,$455.04 ,$455.04 ,$455.04 ,$518.40 ,$197.42 ,$518.40 ,$82.24 ,$576.00 ,$377.28 ,$82.24 ,$249.98 , N/A ,$86.08 ,$518.40 ,$178.23 ,$363.46 ,$345.60 ,$518.40 ,$82.24 ,$518.40 ,$518.40 ,$82.24 ,$374.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000233,73110,HC XRAY WRIST COMP MIN 3 V,320,1 ,$863.00 ,$560.95 ,$82.24 ,$863.00 ,$642.94 ,$565.27 ,$82.24 ,$454.80 ,$82.24 ,$544.55 ,$544.55 ,$544.55 ,$544.55 ,$776.70 ,$647.25 ,$82.24 ,$759.44 ,$82.24 ,$647.25 ,$647.25 ,$733.55 ,$733.55 ,$82.24 ,$733.55 ,$82.24 ,$681.77 ,$681.77 ,$681.77 ,$776.70 ,$197.42 ,$776.70 ,$82.24 ,$863.00 ,$565.27 ,$82.24 ,$374.54 , N/A ,$86.08 ,$776.70 ,$178.23 ,$544.55 ,$517.80 ,$776.70 ,$82.24 ,$776.70 ,$776.70 ,$82.24 ,$560.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000236,73115,HC XRAY WRIST ARTHRO,320,1 ,$616.00 ,$400.40 ,$267.34 ,$810.99 ,$458.92 ,$403.48 ,$374.22 ,$324.63 ,$374.22 ,$388.70 ,$388.70 ,$388.70 ,$388.70 ,$554.40 ,$462.00 ,$374.22 ,$542.08 ,$374.22 ,$462.00 ,$462.00 ,$523.60 ,$523.60 ,$374.22 ,$523.60 ,$374.22 ,$486.64 ,$486.64 ,$486.64 ,$554.40 ,$616.00 ,$554.40 ,$374.22 ,$616.00 ,$403.48 ,$374.22 ,$267.34 , N/A ,$391.69 ,$554.40 ,$810.99 ,$388.70 ,$369.60 ,$554.40 ,$374.22 ,$554.40 ,$554.40 ,$374.22 ,$400.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000237,73120,HC XRAY HAND 2 VIEW,320,1 ,$279.00 ,$181.35 ,$110.78 ,$279.00 ,$207.86 ,$182.75 ,$110.78 ,$147.03 ,$110.78 ,$176.05 ,$176.05 ,$176.05 ,$176.05 ,$251.10 ,$209.25 ,$110.78 ,$245.52 ,$110.78 ,$209.25 ,$209.25 ,$237.15 ,$237.15 ,$110.78 ,$237.15 ,$110.78 ,$220.41 ,$220.41 ,$220.41 ,$251.10 ,$265.92 ,$251.10 ,$110.78 ,$279.00 ,$182.75 ,$110.78 ,$121.09 , N/A ,$115.95 ,$251.10 ,$240.07 ,$176.05 ,$167.40 ,$251.10 ,$110.78 ,$251.10 ,$251.10 ,$110.78 ,$181.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000237,73120,HC XRAY HAND 2 VIEW,320,1 ,$419.00 ,$272.35 ,$110.78 ,$419.00 ,$312.16 ,$274.45 ,$110.78 ,$220.81 ,$110.78 ,$264.39 ,$264.39 ,$264.39 ,$264.39 ,$377.10 ,$314.25 ,$110.78 ,$368.72 ,$110.78 ,$314.25 ,$314.25 ,$356.15 ,$356.15 ,$110.78 ,$356.15 ,$110.78 ,$331.01 ,$331.01 ,$331.01 ,$377.10 ,$265.92 ,$377.10 ,$110.78 ,$419.00 ,$274.45 ,$110.78 ,$181.85 , N/A ,$115.95 ,$377.10 ,$240.07 ,$264.39 ,$251.40 ,$377.10 ,$110.78 ,$377.10 ,$377.10 ,$110.78 ,$272.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000239,73130,HC XRAY HAND MIN 3 VIEW,320,1 ,$576.00 ,$374.40 ,$82.24 ,$576.00 ,$429.12 ,$377.28 ,$82.24 ,$303.55 ,$82.24 ,$363.46 ,$363.46 ,$363.46 ,$363.46 ,$518.40 ,$432.00 ,$82.24 ,$506.88 ,$82.24 ,$432.00 ,$432.00 ,$489.60 ,$489.60 ,$82.24 ,$489.60 ,$82.24 ,$455.04 ,$455.04 ,$455.04 ,$518.40 ,$197.42 ,$518.40 ,$82.24 ,$576.00 ,$377.28 ,$82.24 ,$249.98 , N/A ,$86.08 ,$518.40 ,$178.23 ,$363.46 ,$345.60 ,$518.40 ,$82.24 ,$518.40 ,$518.40 ,$82.24 ,$374.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000239,73130,HC XRAY HAND MIN 3 VIEW,320,1 ,$863.00 ,$560.95 ,$82.24 ,$863.00 ,$642.94 ,$565.27 ,$82.24 ,$454.80 ,$82.24 ,$544.55 ,$544.55 ,$544.55 ,$544.55 ,$776.70 ,$647.25 ,$82.24 ,$759.44 ,$82.24 ,$647.25 ,$647.25 ,$733.55 ,$733.55 ,$82.24 ,$733.55 ,$82.24 ,$681.77 ,$681.77 ,$681.77 ,$776.70 ,$197.42 ,$776.70 ,$82.24 ,$863.00 ,$565.27 ,$82.24 ,$374.54 , N/A ,$86.08 ,$776.70 ,$178.23 ,$544.55 ,$517.80 ,$776.70 ,$82.24 ,$776.70 ,$776.70 ,$82.24 ,$560.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000241,73140,HC XRAY FINGER MIN 2 VIEWS,320,1 ,$385.00 ,$250.25 ,$82.24 ,$385.00 ,$286.83 ,$252.18 ,$82.24 ,$202.90 ,$82.24 ,$242.94 ,$242.94 ,$242.94 ,$242.94 ,$346.50 ,$288.75 ,$82.24 ,$338.80 ,$82.24 ,$288.75 ,$288.75 ,$327.25 ,$327.25 ,$82.24 ,$327.25 ,$82.24 ,$304.15 ,$304.15 ,$304.15 ,$346.50 ,$197.42 ,$346.50 ,$82.24 ,$385.00 ,$252.18 ,$82.24 ,$167.09 , N/A ,$86.08 ,$346.50 ,$178.23 ,$242.94 ,$231.00 ,$346.50 ,$82.24 ,$346.50 ,$346.50 ,$82.24 ,$250.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000252,73525,HC XRAY HIP ARTHRGRPHY,320,1 ,$850.00 ,$552.50 ,$368.90 ,$850.00 ,$633.25 ,$556.75 ,$374.22 ,$447.95 ,$374.22 ,$536.35 ,$536.35 ,$536.35 ,$536.35 ,$765.00 ,$637.50 ,$374.22 ,$748.00 ,$374.22 ,$637.50 ,$637.50 ,$722.50 ,$722.50 ,$374.22 ,$722.50 ,$374.22 ,$671.50 ,$671.50 ,$671.50 ,$765.00 ,$850.00 ,$765.00 ,$374.22 ,$850.00 ,$556.75 ,$374.22 ,$368.90 , N/A ,$391.69 ,$765.00 ,$810.99 ,$536.35 ,$510.00 ,$765.00 ,$374.22 ,$765.00 ,$765.00 ,$374.22 ,$552.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000260,73560,HC XRAY KNEE (1 OR 2 V),320,1 ,$296.00 ,$192.40 ,$82.24 ,$296.00 ,$220.52 ,$193.88 ,$82.24 ,$155.99 ,$82.24 ,$186.78 ,$186.78 ,$186.78 ,$186.78 ,$266.40 ,$222.00 ,$82.24 ,$260.48 ,$82.24 ,$222.00 ,$222.00 ,$251.60 ,$251.60 ,$82.24 ,$251.60 ,$82.24 ,$233.84 ,$233.84 ,$233.84 ,$266.40 ,$197.42 ,$266.40 ,$82.24 ,$296.00 ,$193.88 ,$82.24 ,$128.46 , N/A ,$86.08 ,$266.40 ,$178.23 ,$186.78 ,$177.60 ,$266.40 ,$82.24 ,$266.40 ,$266.40 ,$82.24 ,$192.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000260,73560,HC XRAY KNEE (1 OR 2 V),320,1 ,$445.00 ,$289.25 ,$82.24 ,$445.00 ,$331.53 ,$291.48 ,$82.24 ,$234.52 ,$82.24 ,$280.80 ,$280.80 ,$280.80 ,$280.80 ,$400.50 ,$333.75 ,$82.24 ,$391.60 ,$82.24 ,$333.75 ,$333.75 ,$378.25 ,$378.25 ,$82.24 ,$378.25 ,$82.24 ,$351.55 ,$351.55 ,$351.55 ,$400.50 ,$197.42 ,$400.50 ,$82.24 ,$445.00 ,$291.48 ,$82.24 ,$193.13 , N/A ,$86.08 ,$400.50 ,$178.23 ,$280.80 ,$267.00 ,$400.50 ,$82.24 ,$400.50 ,$400.50 ,$82.24 ,$289.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000263,73562,HC XRAY KNEE (3 V),320,1 ,$557.00 ,$362.05 ,$82.24 ,$557.00 ,$414.97 ,$364.84 ,$82.24 ,$293.54 ,$82.24 ,$351.47 ,$351.47 ,$351.47 ,$351.47 ,$501.30 ,$417.75 ,$82.24 ,$490.16 ,$82.24 ,$417.75 ,$417.75 ,$473.45 ,$473.45 ,$82.24 ,$473.45 ,$82.24 ,$440.03 ,$440.03 ,$440.03 ,$501.30 ,$197.42 ,$501.30 ,$82.24 ,$557.00 ,$364.84 ,$82.24 ,$241.74 , N/A ,$86.08 ,$501.30 ,$178.23 ,$351.47 ,$334.20 ,$501.30 ,$82.24 ,$501.30 ,$501.30 ,$82.24 ,$362.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000263,73562,HC XRAY KNEE (3 V),320,1 ,$835.00 ,$542.75 ,$82.24 ,$835.00 ,$622.08 ,$546.93 ,$82.24 ,$440.05 ,$82.24 ,$526.89 ,$526.89 ,$526.89 ,$526.89 ,$751.50 ,$626.25 ,$82.24 ,$734.80 ,$82.24 ,$626.25 ,$626.25 ,$709.75 ,$709.75 ,$82.24 ,$709.75 ,$82.24 ,$659.65 ,$659.65 ,$659.65 ,$751.50 ,$197.42 ,$751.50 ,$82.24 ,$835.00 ,$546.93 ,$82.24 ,$362.39 , N/A ,$86.08 ,$751.50 ,$178.23 ,$526.89 ,$501.00 ,$751.50 ,$82.24 ,$751.50 ,$751.50 ,$82.24 ,$542.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000265,73564,HC XRAY KNEE (MIN 4 V),320,1 ,$576.00 ,$374.40 ,$110.78 ,$576.00 ,$429.12 ,$377.28 ,$110.78 ,$303.55 ,$110.78 ,$363.46 ,$363.46 ,$363.46 ,$363.46 ,$518.40 ,$432.00 ,$110.78 ,$506.88 ,$110.78 ,$432.00 ,$432.00 ,$489.60 ,$489.60 ,$110.78 ,$489.60 ,$110.78 ,$455.04 ,$455.04 ,$455.04 ,$518.40 ,$265.92 ,$518.40 ,$110.78 ,$576.00 ,$377.28 ,$110.78 ,$249.98 , N/A ,$115.95 ,$518.40 ,$240.07 ,$363.46 ,$345.60 ,$518.40 ,$110.78 ,$518.40 ,$518.40 ,$110.78 ,$374.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000265,73564,HC XRAY KNEE (MIN 4 V),320,1 ,$863.00 ,$560.95 ,$110.78 ,$863.00 ,$642.94 ,$565.27 ,$110.78 ,$454.80 ,$110.78 ,$544.55 ,$544.55 ,$544.55 ,$544.55 ,$776.70 ,$647.25 ,$110.78 ,$759.44 ,$110.78 ,$647.25 ,$647.25 ,$733.55 ,$733.55 ,$110.78 ,$733.55 ,$110.78 ,$681.77 ,$681.77 ,$681.77 ,$776.70 ,$265.92 ,$776.70 ,$110.78 ,$863.00 ,$565.27 ,$110.78 ,$374.54 , N/A ,$115.95 ,$776.70 ,$240.07 ,$544.55 ,$517.80 ,$776.70 ,$110.78 ,$776.70 ,$776.70 ,$110.78 ,$560.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000267,73565,HC XR KNEE STAND,320,1 ,$348.00 ,$226.20 ,$82.24 ,$348.00 ,$259.26 ,$227.94 ,$82.24 ,$183.40 ,$82.24 ,$219.59 ,$219.59 ,$219.59 ,$219.59 ,$313.20 ,$261.00 ,$82.24 ,$306.24 ,$82.24 ,$261.00 ,$261.00 ,$295.80 ,$295.80 ,$82.24 ,$295.80 ,$82.24 ,$274.92 ,$274.92 ,$274.92 ,$313.20 ,$197.42 ,$313.20 ,$82.24 ,$348.00 ,$227.94 ,$82.24 ,$151.03 , N/A ,$86.08 ,$313.20 ,$178.23 ,$219.59 ,$208.80 ,$313.20 ,$82.24 ,$313.20 ,$313.20 ,$82.24 ,$226.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000268,73580,HC XRAY KNEE ARTHRO,320,1 ,$871.00 ,$566.15 ,$374.22 ,$871.00 ,$648.90 ,$570.51 ,$374.22 ,$459.02 ,$374.22 ,$549.60 ,$549.60 ,$549.60 ,$549.60 ,$783.90 ,$653.25 ,$374.22 ,$766.48 ,$374.22 ,$653.25 ,$653.25 ,$740.35 ,$740.35 ,$374.22 ,$740.35 ,$374.22 ,$688.09 ,$688.09 ,$688.09 ,$783.90 ,$871.00 ,$783.90 ,$374.22 ,$871.00 ,$570.51 ,$374.22 ,$378.01 , N/A ,$391.69 ,$783.90 ,$810.99 ,$549.60 ,$522.60 ,$783.90 ,$374.22 ,$783.90 ,$783.90 ,$374.22 ,$566.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$465.00 ,$302.25 ,$82.24 ,$465.00 ,$346.43 ,$304.58 ,$82.24 ,$245.06 ,$82.24 ,$293.42 ,$293.42 ,$293.42 ,$293.42 ,$418.50 ,$348.75 ,$82.24 ,$409.20 ,$82.24 ,$348.75 ,$348.75 ,$395.25 ,$395.25 ,$82.24 ,$395.25 ,$82.24 ,$367.35 ,$367.35 ,$367.35 ,$418.50 ,$197.42 ,$418.50 ,$82.24 ,$465.00 ,$304.58 ,$82.24 ,$201.81 , N/A ,$86.08 ,$418.50 ,$178.23 ,$293.42 ,$279.00 ,$418.50 ,$82.24 ,$418.50 ,$418.50 ,$82.24 ,$302.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000269,73590,HC XRAY TIBIA/FIBULA 2 VIEW,320,1 ,$697.00 ,$453.05 ,$82.24 ,$697.00 ,$519.27 ,$456.54 ,$82.24 ,$367.32 ,$82.24 ,$439.81 ,$439.81 ,$439.81 ,$439.81 ,$627.30 ,$522.75 ,$82.24 ,$613.36 ,$82.24 ,$522.75 ,$522.75 ,$592.45 ,$592.45 ,$82.24 ,$592.45 ,$82.24 ,$550.63 ,$550.63 ,$550.63 ,$627.30 ,$197.42 ,$627.30 ,$82.24 ,$697.00 ,$456.54 ,$82.24 ,$302.50 , N/A ,$86.08 ,$627.30 ,$178.23 ,$439.81 ,$418.20 ,$627.30 ,$82.24 ,$627.30 ,$627.30 ,$82.24 ,$453.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000272,73592,HC XRAY INFANT LO EXTRM MIN 2V,320,1 ,$310.00 ,$201.50 ,$82.24 ,$310.00 ,$230.95 ,$203.05 ,$82.24 ,$163.37 ,$82.24 ,$195.61 ,$195.61 ,$195.61 ,$195.61 ,$279.00 ,$232.50 ,$82.24 ,$272.80 ,$82.24 ,$232.50 ,$232.50 ,$263.50 ,$263.50 ,$82.24 ,$263.50 ,$82.24 ,$244.90 ,$244.90 ,$244.90 ,$279.00 ,$197.42 ,$279.00 ,$82.24 ,$310.00 ,$203.05 ,$82.24 ,$134.54 , N/A ,$86.08 ,$279.00 ,$178.23 ,$195.61 ,$186.00 ,$279.00 ,$82.24 ,$279.00 ,$279.00 ,$82.24 ,$201.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000272,73592,HC XRAY INFANT LO EXTRM MIN 2V,320,1 ,$465.00 ,$302.25 ,$82.24 ,$465.00 ,$346.43 ,$304.58 ,$82.24 ,$245.06 ,$82.24 ,$293.42 ,$293.42 ,$293.42 ,$293.42 ,$418.50 ,$348.75 ,$82.24 ,$409.20 ,$82.24 ,$348.75 ,$348.75 ,$395.25 ,$395.25 ,$82.24 ,$395.25 ,$82.24 ,$367.35 ,$367.35 ,$367.35 ,$418.50 ,$197.42 ,$418.50 ,$82.24 ,$465.00 ,$304.58 ,$82.24 ,$201.81 , N/A ,$86.08 ,$418.50 ,$178.23 ,$293.42 ,$279.00 ,$418.50 ,$82.24 ,$418.50 ,$418.50 ,$82.24 ,$302.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000274,73600,HC XRAY ANKLE (2 V),320,1 ,$385.00 ,$250.25 ,$82.24 ,$385.00 ,$286.83 ,$252.18 ,$82.24 ,$202.90 ,$82.24 ,$242.94 ,$242.94 ,$242.94 ,$242.94 ,$346.50 ,$288.75 ,$82.24 ,$338.80 ,$82.24 ,$288.75 ,$288.75 ,$327.25 ,$327.25 ,$82.24 ,$327.25 ,$82.24 ,$304.15 ,$304.15 ,$304.15 ,$346.50 ,$197.42 ,$346.50 ,$82.24 ,$385.00 ,$252.18 ,$82.24 ,$167.09 , N/A ,$86.08 ,$346.50 ,$178.23 ,$242.94 ,$231.00 ,$346.50 ,$82.24 ,$346.50 ,$346.50 ,$82.24 ,$250.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000274,73600,HC XRAY ANKLE (2 V),320,1 ,$577.00 ,$375.05 ,$82.24 ,$577.00 ,$429.87 ,$377.94 ,$82.24 ,$304.08 ,$82.24 ,$364.09 ,$364.09 ,$364.09 ,$364.09 ,$519.30 ,$432.75 ,$82.24 ,$507.76 ,$82.24 ,$432.75 ,$432.75 ,$490.45 ,$490.45 ,$82.24 ,$490.45 ,$82.24 ,$455.83 ,$455.83 ,$455.83 ,$519.30 ,$197.42 ,$519.30 ,$82.24 ,$577.00 ,$377.94 ,$82.24 ,$250.42 , N/A ,$86.08 ,$519.30 ,$178.23 ,$364.09 ,$346.20 ,$519.30 ,$82.24 ,$519.30 ,$519.30 ,$82.24 ,$375.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000276,73610,HC XRAY ANKLE (MIN 3 V),320,1 ,$487.00 ,$316.55 ,$82.24 ,$487.00 ,$362.82 ,$318.99 ,$82.24 ,$256.65 ,$82.24 ,$307.30 ,$307.30 ,$307.30 ,$307.30 ,$438.30 ,$365.25 ,$82.24 ,$428.56 ,$82.24 ,$365.25 ,$365.25 ,$413.95 ,$413.95 ,$82.24 ,$413.95 ,$82.24 ,$384.73 ,$384.73 ,$384.73 ,$438.30 ,$197.42 ,$438.30 ,$82.24 ,$487.00 ,$318.99 ,$82.24 ,$211.36 , N/A ,$86.08 ,$438.30 ,$178.23 ,$307.30 ,$292.20 ,$438.30 ,$82.24 ,$438.30 ,$438.30 ,$82.24 ,$316.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000276,73610,HC XRAY ANKLE (MIN 3 V),320,1 ,$731.00 ,$475.15 ,$82.24 ,$731.00 ,$544.60 ,$478.81 ,$82.24 ,$385.24 ,$82.24 ,$461.26 ,$461.26 ,$461.26 ,$461.26 ,$657.90 ,$548.25 ,$82.24 ,$643.28 ,$82.24 ,$548.25 ,$548.25 ,$621.35 ,$621.35 ,$82.24 ,$621.35 ,$82.24 ,$577.49 ,$577.49 ,$577.49 ,$657.90 ,$197.42 ,$657.90 ,$82.24 ,$731.00 ,$478.81 ,$82.24 ,$317.25 , N/A ,$86.08 ,$657.90 ,$178.23 ,$461.26 ,$438.60 ,$657.90 ,$82.24 ,$657.90 ,$657.90 ,$82.24 ,$475.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000278,73615,HC XRAY ARTHRO ANKLE,320,1 ,$529.00 ,$343.85 ,$229.59 ,$810.99 ,$394.11 ,$346.50 ,$374.22 ,$278.78 ,$374.22 ,$333.80 ,$333.80 ,$333.80 ,$333.80 ,$476.10 ,$396.75 ,$374.22 ,$465.52 ,$374.22 ,$396.75 ,$396.75 ,$449.65 ,$449.65 ,$374.22 ,$449.65 ,$374.22 ,$417.91 ,$417.91 ,$417.91 ,$476.10 ,$529.00 ,$476.10 ,$374.22 ,$529.00 ,$346.50 ,$374.22 ,$229.59 , N/A ,$391.69 ,$476.10 ,$810.99 ,$333.80 ,$317.40 ,$476.10 ,$374.22 ,$476.10 ,$476.10 ,$374.22 ,$343.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000279,73620,HC XRAY FOOT (2 V),320,1 ,$352.00 ,$228.80 ,$82.24 ,$352.00 ,$262.24 ,$230.56 ,$82.24 ,$185.50 ,$82.24 ,$222.11 ,$222.11 ,$222.11 ,$222.11 ,$316.80 ,$264.00 ,$82.24 ,$309.76 ,$82.24 ,$264.00 ,$264.00 ,$299.20 ,$299.20 ,$82.24 ,$299.20 ,$82.24 ,$278.08 ,$278.08 ,$278.08 ,$316.80 ,$197.42 ,$316.80 ,$82.24 ,$352.00 ,$230.56 ,$82.24 ,$152.77 , N/A ,$86.08 ,$316.80 ,$178.23 ,$222.11 ,$211.20 ,$316.80 ,$82.24 ,$316.80 ,$316.80 ,$82.24 ,$228.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000279,73620,HC XRAY FOOT (2 V),320,1 ,$528.00 ,$343.20 ,$82.24 ,$528.00 ,$393.36 ,$345.84 ,$82.24 ,$278.26 ,$82.24 ,$333.17 ,$333.17 ,$333.17 ,$333.17 ,$475.20 ,$396.00 ,$82.24 ,$464.64 ,$82.24 ,$396.00 ,$396.00 ,$448.80 ,$448.80 ,$82.24 ,$448.80 ,$82.24 ,$417.12 ,$417.12 ,$417.12 ,$475.20 ,$197.42 ,$475.20 ,$82.24 ,$528.00 ,$345.84 ,$82.24 ,$229.15 , N/A ,$86.08 ,$475.20 ,$178.23 ,$333.17 ,$316.80 ,$475.20 ,$82.24 ,$475.20 ,$475.20 ,$82.24 ,$343.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000281,73630,HC XRAY FOOT (MIN 3 V),320,1 ,$557.00 ,$362.05 ,$82.24 ,$557.00 ,$414.97 ,$364.84 ,$82.24 ,$293.54 ,$82.24 ,$351.47 ,$351.47 ,$351.47 ,$351.47 ,$501.30 ,$417.75 ,$82.24 ,$490.16 ,$82.24 ,$417.75 ,$417.75 ,$473.45 ,$473.45 ,$82.24 ,$473.45 ,$82.24 ,$440.03 ,$440.03 ,$440.03 ,$501.30 ,$197.42 ,$501.30 ,$82.24 ,$557.00 ,$364.84 ,$82.24 ,$241.74 , N/A ,$86.08 ,$501.30 ,$178.23 ,$351.47 ,$334.20 ,$501.30 ,$82.24 ,$501.30 ,$501.30 ,$82.24 ,$362.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000281,73630,HC XRAY FOOT (MIN 3 V),320,1 ,$835.00 ,$542.75 ,$82.24 ,$835.00 ,$622.08 ,$546.93 ,$82.24 ,$440.05 ,$82.24 ,$526.89 ,$526.89 ,$526.89 ,$526.89 ,$751.50 ,$626.25 ,$82.24 ,$734.80 ,$82.24 ,$626.25 ,$626.25 ,$709.75 ,$709.75 ,$82.24 ,$709.75 ,$82.24 ,$659.65 ,$659.65 ,$659.65 ,$751.50 ,$197.42 ,$751.50 ,$82.24 ,$835.00 ,$546.93 ,$82.24 ,$362.39 , N/A ,$86.08 ,$751.50 ,$178.23 ,$526.89 ,$501.00 ,$751.50 ,$82.24 ,$751.50 ,$751.50 ,$82.24 ,$542.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000283,73650,HC XRAY OS CALCIS HEEL,320,1 ,$385.00 ,$250.25 ,$82.24 ,$385.00 ,$286.83 ,$252.18 ,$82.24 ,$202.90 ,$82.24 ,$242.94 ,$242.94 ,$242.94 ,$242.94 ,$346.50 ,$288.75 ,$82.24 ,$338.80 ,$82.24 ,$288.75 ,$288.75 ,$327.25 ,$327.25 ,$82.24 ,$327.25 ,$82.24 ,$304.15 ,$304.15 ,$304.15 ,$346.50 ,$197.42 ,$346.50 ,$82.24 ,$385.00 ,$252.18 ,$82.24 ,$167.09 , N/A ,$86.08 ,$346.50 ,$178.23 ,$242.94 ,$231.00 ,$346.50 ,$82.24 ,$346.50 ,$346.50 ,$82.24 ,$250.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000283,73650,HC XRAY OS CALCIS HEEL,320,1 ,$577.00 ,$375.05 ,$82.24 ,$577.00 ,$429.87 ,$377.94 ,$82.24 ,$304.08 ,$82.24 ,$364.09 ,$364.09 ,$364.09 ,$364.09 ,$519.30 ,$432.75 ,$82.24 ,$507.76 ,$82.24 ,$432.75 ,$432.75 ,$490.45 ,$490.45 ,$82.24 ,$490.45 ,$82.24 ,$455.83 ,$455.83 ,$455.83 ,$519.30 ,$197.42 ,$519.30 ,$82.24 ,$577.00 ,$377.94 ,$82.24 ,$250.42 , N/A ,$86.08 ,$519.30 ,$178.23 ,$364.09 ,$346.20 ,$519.30 ,$82.24 ,$519.30 ,$519.30 ,$82.24 ,$375.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000286,73660,HC XRAY TOE MIN 2 VIEW,320,1 ,$374.00 ,$243.10 ,$82.24 ,$374.00 ,$278.63 ,$244.97 ,$82.24 ,$197.10 ,$82.24 ,$235.99 ,$235.99 ,$235.99 ,$235.99 ,$336.60 ,$280.50 ,$82.24 ,$329.12 ,$82.24 ,$280.50 ,$280.50 ,$317.90 ,$317.90 ,$82.24 ,$317.90 ,$82.24 ,$295.46 ,$295.46 ,$295.46 ,$336.60 ,$197.42 ,$336.60 ,$82.24 ,$374.00 ,$244.97 ,$82.24 ,$162.32 , N/A ,$86.08 ,$336.60 ,$178.23 ,$235.99 ,$224.40 ,$336.60 ,$82.24 ,$336.60 ,$336.60 ,$82.24 ,$243.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000289,74018,HC XRAY ABDOMEN 1V,320,1 ,$544.00 ,$353.60 ,$82.24 ,$544.00 ,$405.28 ,$356.32 ,$82.24 ,$286.69 ,$82.24 ,$343.26 ,$343.26 ,$343.26 ,$343.26 ,$489.60 ,$408.00 ,$82.24 ,$478.72 ,$82.24 ,$408.00 ,$408.00 ,$462.40 ,$462.40 ,$82.24 ,$462.40 ,$82.24 ,$429.76 ,$429.76 ,$429.76 ,$489.60 ,$197.42 ,$489.60 ,$82.24 ,$544.00 ,$356.32 ,$82.24 ,$236.10 , N/A ,$86.08 ,$489.60 ,$178.23 ,$343.26 ,$326.40 ,$489.60 ,$82.24 ,$489.60 ,$489.60 ,$82.24 ,$353.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000294,74019,HC XRAY ABDOMEN AP AND LAT (2 V OR 3 V),320,1 ,$574.00 ,$373.10 ,$110.78 ,$574.00 ,$427.63 ,$375.97 ,$110.78 ,$302.50 ,$110.78 ,$362.19 ,$362.19 ,$362.19 ,$362.19 ,$516.60 ,$430.50 ,$110.78 ,$505.12 ,$110.78 ,$430.50 ,$430.50 ,$487.90 ,$487.90 ,$110.78 ,$487.90 ,$110.78 ,$453.46 ,$453.46 ,$453.46 ,$516.60 ,$265.92 ,$516.60 ,$110.78 ,$574.00 ,$375.97 ,$110.78 ,$249.12 , N/A ,$115.95 ,$516.60 ,$240.07 ,$362.19 ,$344.40 ,$516.60 ,$110.78 ,$516.60 ,$516.60 ,$110.78 ,$373.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000298,74022,HC XRAY ABDOMEN AP/DECUB/ERECT/CXR,320,1 ,"$1,155.00 ",$750.75 ,$110.78 ,"$1,155.00 ",$860.48 ,$756.53 ,$110.78 ,$608.69 ,$110.78 ,$728.81 ,$728.81 ,$728.81 ,$728.81 ,"$1,039.50 ",$866.25 ,$110.78 ,"$1,016.40 ",$110.78 ,$866.25 ,$866.25 ,$981.75 ,$981.75 ,$110.78 ,$981.75 ,$110.78 ,$912.45 ,$912.45 ,$912.45 ,"$1,039.50 ",$265.92 ,"$1,039.50 ",$110.78 ,"$1,155.00 ",$756.53 ,$110.78 ,$501.27 , N/A ,$115.95 ,"$1,039.50 ",$240.07 ,$728.81 ,$693.00 ,"$1,039.50 ",$110.78 ,"$1,039.50 ","$1,039.50 ",$110.78 ,$750.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000300,74220,HC XRAY ESOPHAGUS,320,1 ,$862.00 ,$560.30 ,$181.51 ,$862.00 ,$642.19 ,$564.61 ,$181.51 ,$454.27 ,$181.51 ,$543.92 ,$543.92 ,$543.92 ,$543.92 ,$775.80 ,$646.50 ,$181.51 ,$758.56 ,$181.51 ,$646.50 ,$646.50 ,$732.70 ,$732.70 ,$181.51 ,$732.70 ,$181.51 ,$680.98 ,$680.98 ,$680.98 ,$775.80 ,$435.72 ,$775.80 ,$181.51 ,$862.00 ,$564.61 ,$181.51 ,$374.11 , N/A ,$189.98 ,$775.80 ,$393.35 ,$543.92 ,$517.20 ,$775.80 ,$181.51 ,$775.80 ,$775.80 ,$181.51 ,$560.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000301,74230,HC VIDEO FLUORO SWALLOWING,320,1 ,"$1,209.00 ",$785.85 ,$181.51 ,"$1,209.00 ",$900.71 ,$791.90 ,$181.51 ,$637.14 ,$181.51 ,$762.88 ,$762.88 ,$762.88 ,$762.88 ,"$1,088.10 ",$906.75 ,$181.51 ,"$1,063.92 ",$181.51 ,$906.75 ,$906.75 ,"$1,027.65 ","$1,027.65 ",$181.51 ,"$1,027.65 ",$181.51 ,$955.11 ,$955.11 ,$955.11 ,"$1,088.10 ",$435.72 ,"$1,088.10 ",$181.51 ,"$1,209.00 ",$791.90 ,$181.51 ,$524.71 , N/A ,$189.98 ,"$1,088.10 ",$393.35 ,$762.88 ,$725.40 ,"$1,088.10 ",$181.51 ,"$1,088.10 ","$1,088.10 ",$181.51 ,$785.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000302,74240,HC XRAY UPPER GI TRACT,320,1 ,"$1,575.00 ","$1,023.75 ",$181.51 ,"$1,575.00 ","$1,173.38 ","$1,031.63 ",$181.51 ,$830.03 ,$181.51 ,$993.83 ,$993.83 ,$993.83 ,$993.83 ,"$1,417.50 ","$1,181.25 ",$181.51 ,"$1,386.00 ",$181.51 ,"$1,181.25 ","$1,181.25 ","$1,338.75 ","$1,338.75 ",$181.51 ,"$1,338.75 ",$181.51 ,"$1,244.25 ","$1,244.25 ","$1,244.25 ","$1,417.50 ",$435.72 ,"$1,417.50 ",$181.51 ,"$1,575.00 ","$1,031.63 ",$181.51 ,$683.55 , N/A ,$189.98 ,"$1,417.50 ",$393.35 ,$993.83 ,$945.00 ,"$1,417.50 ",$181.51 ,"$1,417.50 ","$1,417.50 ",$181.51 ,"$1,023.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000303,74241,HC SINGLE CONTRAST UPPER GI W/KUB,320,1 ,"$1,827.00 ","$1,187.55 ",$792.92 ,"$1,827.00 ","$1,361.12 ","$1,196.69 ", N/A ,$962.83 , N/A ,"$1,152.84 ","$1,152.84 ","$1,152.84 ","$1,152.84 ","$1,644.30 ","$1,370.25 ", N/A ,"$1,607.76 ", N/A ,"$1,370.25 ","$1,370.25 ","$1,552.95 ","$1,552.95 ", N/A ,"$1,552.95 ", N/A ,"$1,443.33 ","$1,443.33 ","$1,443.33 ","$1,644.30 ", N/A ,"$1,644.30 ", N/A ,"$1,827.00 ","$1,196.69 ", N/A ,$792.92 , N/A , N/A ,"$1,644.30 ", N/A ,"$1,152.84 ","$1,096.20 ","$1,644.30 ", N/A ,"$1,644.30 ","$1,644.30 ", N/A ,"$1,187.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000304,74245,HC UPPER GI\SMALL BOWEL SGL,320,1 ,"$2,211.00 ","$1,437.15 ",$959.57 ,"$2,211.00 ","$1,647.20 ","$1,448.21 ", N/A ,"$1,165.20 ", N/A ,"$1,395.14 ","$1,395.14 ","$1,395.14 ","$1,395.14 ","$1,989.90 ","$1,658.25 ", N/A ,"$1,945.68 ", N/A ,"$1,658.25 ","$1,658.25 ","$1,879.35 ","$1,879.35 ", N/A ,"$1,879.35 ", N/A ,"$1,746.69 ","$1,746.69 ","$1,746.69 ","$1,989.90 ", N/A ,"$1,989.90 ", N/A ,"$2,211.00 ","$1,448.21 ", N/A ,$959.57 , N/A , N/A ,"$1,989.90 ", N/A ,"$1,395.14 ","$1,326.60 ","$1,989.90 ", N/A ,"$1,989.90 ","$1,989.90 ", N/A ,"$1,437.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000306,74246,HC UPPER GI TRACT - NO KUB,320,1 ,"$2,258.00 ","$1,467.70 ",$181.51 ,"$2,258.00 ","$1,682.21 ","$1,478.99 ",$181.51 ,"$1,189.97 ",$181.51 ,"$1,424.80 ","$1,424.80 ","$1,424.80 ","$1,424.80 ","$2,032.20 ","$1,693.50 ",$181.51 ,"$1,987.04 ",$181.51 ,"$1,693.50 ","$1,693.50 ","$1,919.30 ","$1,919.30 ",$181.51 ,"$1,919.30 ",$181.51 ,"$1,783.82 ","$1,783.82 ","$1,783.82 ","$2,032.20 ",$435.72 ,"$2,032.20 ",$181.51 ,"$2,258.00 ","$1,478.99 ",$181.51 ,$979.97 , N/A ,$189.98 ,"$2,032.20 ",$393.35 ,"$1,424.80 ","$1,354.80 ","$2,032.20 ",$181.51 ,"$2,032.20 ","$2,032.20 ",$181.51 ,"$1,467.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000307,74246,HC XRAY ESOPHAGUS/UGI W AIR,320,1 ,$637.00 ,$414.05 ,$181.51 ,$637.00 ,$474.57 ,$417.24 ,$181.51 ,$335.70 ,$181.51 ,$401.95 ,$401.95 ,$401.95 ,$401.95 ,$573.30 ,$477.75 ,$181.51 ,$560.56 ,$181.51 ,$477.75 ,$477.75 ,$541.45 ,$541.45 ,$181.51 ,$541.45 ,$181.51 ,$503.23 ,$503.23 ,$503.23 ,$573.30 ,$435.72 ,$573.30 ,$181.51 ,$637.00 ,$417.24 ,$181.51 ,$276.46 , N/A ,$189.98 ,$573.30 ,$393.35 ,$401.95 ,$382.20 ,$573.30 ,$181.51 ,$573.30 ,$573.30 ,$181.51 ,$414.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000308,74247,HC UPPER GI W/KUB DBL CONTRAST,320,1 ,"$2,455.00 ","$1,595.75 ","$1,065.47 ","$2,455.00 ","$1,828.98 ","$1,608.03 ", N/A ,"$1,293.79 ", N/A ,"$1,549.11 ","$1,549.11 ","$1,549.11 ","$1,549.11 ","$2,209.50 ","$1,841.25 ", N/A ,"$2,160.40 ", N/A ,"$1,841.25 ","$1,841.25 ","$2,086.75 ","$2,086.75 ", N/A ,"$2,086.75 ", N/A ,"$1,939.45 ","$1,939.45 ","$1,939.45 ","$2,209.50 ", N/A ,"$2,209.50 ", N/A ,"$2,455.00 ","$1,608.03 ", N/A ,"$1,065.47 ", N/A , N/A ,"$2,209.50 ", N/A ,"$1,549.11 ","$1,473.00 ","$2,209.50 ", N/A ,"$2,209.50 ","$2,209.50 ", N/A ,"$1,595.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000309,74249,HC UGI/SM BOWEL W AIR CONT,320,1 ,"$2,658.00 ","$1,727.70 ","$1,153.57 ","$2,658.00 ","$1,980.21 ","$1,740.99 ", N/A ,"$1,400.77 ", N/A ,"$1,677.20 ","$1,677.20 ","$1,677.20 ","$1,677.20 ","$2,392.20 ","$1,993.50 ", N/A ,"$2,339.04 ", N/A ,"$1,993.50 ","$1,993.50 ","$2,259.30 ","$2,259.30 ", N/A ,"$2,259.30 ", N/A ,"$2,099.82 ","$2,099.82 ","$2,099.82 ","$2,392.20 ", N/A ,"$2,392.20 ", N/A ,"$2,658.00 ","$1,740.99 ", N/A ,"$1,153.57 ", N/A , N/A ,"$2,392.20 ", N/A ,"$1,677.20 ","$1,594.80 ","$2,392.20 ", N/A ,"$2,392.20 ","$2,392.20 ", N/A ,"$1,727.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000311,74250,HC XRAY SMALL BOWEL,320,1 ,$915.00 ,$594.75 ,$181.51 ,$915.00 ,$681.68 ,$599.33 ,$181.51 ,$482.21 ,$181.51 ,$577.37 ,$577.37 ,$577.37 ,$577.37 ,$823.50 ,$686.25 ,$181.51 ,$805.20 ,$181.51 ,$686.25 ,$686.25 ,$777.75 ,$777.75 ,$181.51 ,$777.75 ,$181.51 ,$722.85 ,$722.85 ,$722.85 ,$823.50 ,$435.72 ,$823.50 ,$181.51 ,$915.00 ,$599.33 ,$181.51 ,$397.11 , N/A ,$189.98 ,$823.50 ,$393.35 ,$577.37 ,$549.00 ,$823.50 ,$181.51 ,$823.50 ,$823.50 ,$181.51 ,$594.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000312,74018,HC SITZ MARKER STUDY,320,1 ,$544.00 ,$353.60 ,$82.24 ,$544.00 ,$405.28 ,$356.32 ,$82.24 ,$286.69 ,$82.24 ,$343.26 ,$343.26 ,$343.26 ,$343.26 ,$489.60 ,$408.00 ,$82.24 ,$478.72 ,$82.24 ,$408.00 ,$408.00 ,$462.40 ,$462.40 ,$82.24 ,$462.40 ,$82.24 ,$429.76 ,$429.76 ,$429.76 ,$489.60 ,$197.42 ,$489.60 ,$82.24 ,$544.00 ,$356.32 ,$82.24 ,$236.10 , N/A ,$86.08 ,$489.60 ,$178.23 ,$343.26 ,$326.40 ,$489.60 ,$82.24 ,$489.60 ,$489.60 ,$82.24 ,$353.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000315,74270,HC XRAY COLON BARIUM,320,1 ,"$1,357.00 ",$882.05 ,$181.51 ,"$1,357.00 ","$1,010.97 ",$888.84 ,$181.51 ,$715.14 ,$181.51 ,$856.27 ,$856.27 ,$856.27 ,$856.27 ,"$1,221.30 ","$1,017.75 ",$181.51 ,"$1,194.16 ",$181.51 ,"$1,017.75 ","$1,017.75 ","$1,153.45 ","$1,153.45 ",$181.51 ,"$1,153.45 ",$181.51 ,"$1,072.03 ","$1,072.03 ","$1,072.03 ","$1,221.30 ",$435.72 ,"$1,221.30 ",$181.51 ,"$1,357.00 ",$888.84 ,$181.51 ,$588.94 , N/A ,$189.98 ,"$1,221.30 ",$393.35 ,$856.27 ,$814.20 ,"$1,221.30 ",$181.51 ,"$1,221.30 ","$1,221.30 ",$181.51 ,$882.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000318,74270,HC XRAY BARM ENEMA/COLSTMY,320,1 ,"$1,357.00 ",$882.05 ,$181.51 ,"$1,357.00 ","$1,010.97 ",$888.84 ,$181.51 ,$715.14 ,$181.51 ,$856.27 ,$856.27 ,$856.27 ,$856.27 ,"$1,221.30 ","$1,017.75 ",$181.51 ,"$1,194.16 ",$181.51 ,"$1,017.75 ","$1,017.75 ","$1,153.45 ","$1,153.45 ",$181.51 ,"$1,153.45 ",$181.51 ,"$1,072.03 ","$1,072.03 ","$1,072.03 ","$1,221.30 ",$435.72 ,"$1,221.30 ",$181.51 ,"$1,357.00 ",$888.84 ,$181.51 ,$588.94 , N/A ,$189.98 ,"$1,221.30 ",$393.35 ,$856.27 ,$814.20 ,"$1,221.30 ",$181.51 ,"$1,221.30 ","$1,221.30 ",$181.51 ,$882.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000319,74270,HC XRAY BARM ENEMA WATER SOL,320,1 ,"$1,357.00 ",$882.05 ,$181.51 ,"$1,357.00 ","$1,010.97 ",$888.84 ,$181.51 ,$715.14 ,$181.51 ,$856.27 ,$856.27 ,$856.27 ,$856.27 ,"$1,221.30 ","$1,017.75 ",$181.51 ,"$1,194.16 ",$181.51 ,"$1,017.75 ","$1,017.75 ","$1,153.45 ","$1,153.45 ",$181.51 ,"$1,153.45 ",$181.51 ,"$1,072.03 ","$1,072.03 ","$1,072.03 ","$1,221.30 ",$435.72 ,"$1,221.30 ",$181.51 ,"$1,357.00 ",$888.84 ,$181.51 ,$588.94 , N/A ,$189.98 ,"$1,221.30 ",$393.35 ,$856.27 ,$814.20 ,"$1,221.30 ",$181.51 ,"$1,221.30 ","$1,221.30 ",$181.51 ,$882.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000320,74280,HC XRAY COLON BARIUM AIR CONTRAST,320,1 ,"$1,489.00 ",$967.85 ,$181.51 ,"$1,489.00 ","$1,109.31 ",$975.30 ,$181.51 ,$784.70 ,$181.51 ,$939.56 ,$939.56 ,$939.56 ,$939.56 ,"$1,340.10 ","$1,116.75 ",$181.51 ,"$1,310.32 ",$181.51 ,"$1,116.75 ","$1,116.75 ","$1,265.65 ","$1,265.65 ",$181.51 ,"$1,265.65 ",$181.51 ,"$1,176.31 ","$1,176.31 ","$1,176.31 ","$1,340.10 ",$435.72 ,"$1,340.10 ",$181.51 ,"$1,489.00 ",$975.30 ,$181.51 ,$646.23 , N/A ,$189.98 ,"$1,340.10 ",$393.35 ,$939.56 ,$893.40 ,"$1,340.10 ",$181.51 ,"$1,340.10 ","$1,340.10 ",$181.51 ,$967.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000323,74300,HC CHOLANGIOGRAPHY OPERATIVE,320,1 ,"$1,342.00 ",$872.30 ,$582.43 ,"$1,342.00 ",$999.79 ,$879.01 , N/A ,$707.23 , N/A ,$846.80 ,$846.80 ,$846.80 ,$846.80 ,"$1,207.80 ","$1,006.50 ", N/A ,"$1,180.96 ", N/A ,"$1,006.50 ","$1,006.50 ","$1,140.70 ","$1,140.70 ", N/A ,"$1,140.70 ", N/A ,"$1,060.18 ","$1,060.18 ","$1,060.18 ","$1,207.80 ", N/A ,"$1,207.80 ", N/A ,"$1,342.00 ",$879.01 , N/A ,$582.43 , N/A , N/A ,"$1,207.80 ", N/A ,$846.80 ,$805.20 ,"$1,207.80 ", N/A ,"$1,207.80 ","$1,207.80 ", N/A ,$872.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000331,74340,HC INTRODUCTION LONG GI TUBE,320,1 ,$854.00 ,$555.10 ,$370.64 ,$854.00 ,$636.23 ,$559.37 , N/A ,$450.06 , N/A ,$538.87 ,$538.87 ,$538.87 ,$538.87 ,$768.60 ,$640.50 , N/A ,$751.52 , N/A ,$640.50 ,$640.50 ,$725.90 ,$725.90 , N/A ,$725.90 , N/A ,$674.66 ,$674.66 ,$674.66 ,$768.60 , N/A ,$768.60 , N/A ,$854.00 ,$559.37 , N/A ,$370.64 , N/A , N/A ,$768.60 , N/A ,$538.87 ,$512.40 ,$768.60 , N/A ,$768.60 ,$768.60 , N/A ,$555.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000339,74420,HC XRAY UROGRAM RETROGRADE,320,1 ,"$1,242.00 ",$807.30 ,$374.22 ,"$1,242.00 ",$925.29 ,$813.51 ,$374.22 ,$654.53 ,$374.22 ,$783.70 ,$783.70 ,$783.70 ,$783.70 ,"$1,117.80 ",$931.50 ,$374.22 ,"$1,092.96 ",$374.22 ,$931.50 ,$931.50 ,"$1,055.70 ","$1,055.70 ",$374.22 ,"$1,055.70 ",$374.22 ,$981.18 ,$981.18 ,$981.18 ,"$1,117.80 ",$898.34 ,"$1,117.80 ",$374.22 ,"$1,242.00 ",$813.51 ,$374.22 ,$539.03 , N/A ,$391.69 ,"$1,117.80 ",$810.99 ,$783.70 ,$745.20 ,"$1,117.80 ",$374.22 ,"$1,117.80 ","$1,117.80 ",$374.22 ,$807.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000340,74425,HC XRAY UROGRAM ANTEGRADE,320,1 ,$987.00 ,$641.55 ,$374.22 ,$987.00 ,$735.32 ,$646.49 ,$374.22 ,$520.15 ,$374.22 ,$622.80 ,$622.80 ,$622.80 ,$622.80 ,$888.30 ,$740.25 ,$374.22 ,$868.56 ,$374.22 ,$740.25 ,$740.25 ,$838.95 ,$838.95 ,$374.22 ,$838.95 ,$374.22 ,$779.73 ,$779.73 ,$779.73 ,$888.30 ,$898.34 ,$888.30 ,$374.22 ,$987.00 ,$646.49 ,$374.22 ,$428.36 , N/A ,$391.69 ,$888.30 ,$810.99 ,$622.80 ,$592.20 ,$888.30 ,$374.22 ,$888.30 ,$888.30 ,$374.22 ,$641.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000341,50431,HC ANGIO NEPHROSTGRAM,320,1 ,"$4,889.00 ","$3,177.85 ",$584.29 ,"$4,889.00 ","$3,642.31 ","$3,202.30 ",$584.29 ,"$2,576.50 ",$584.29 ,"$3,084.96 ","$3,084.96 ","$3,084.96 ","$3,084.96 ","$4,400.10 ","$3,666.75 ",$584.29 ,"$4,302.32 ",$584.29 ,"$3,666.75 ","$3,666.75 ","$4,155.65 ","$4,155.65 ",$584.29 ,"$4,155.65 ",$584.29 ,"$3,862.31 ","$3,862.31 ","$3,862.31 ","$4,400.10 ","$1,402.64 ","$4,400.10 ",$584.29 ,"$4,889.00 ","$3,202.30 ",$584.29 ,"$2,121.83 ", N/A ,$611.57 ,"$4,400.10 ","$1,266.25 ","$3,084.96 ","$2,933.40 ","$4,400.10 ",$584.29 ,"$4,400.10 ","$4,400.10 ",$584.29 ,"$3,177.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000341,50431,HC ANGIO NEPHROSTGRAM,320,1 ,"$7,332.00 ","$4,765.80 ",$584.29 ,"$7,332.00 ","$5,462.34 ","$4,802.46 ",$584.29 ,"$3,863.96 ",$584.29 ,"$4,626.49 ","$4,626.49 ","$4,626.49 ","$4,626.49 ","$6,598.80 ","$5,499.00 ",$584.29 ,"$6,452.16 ",$584.29 ,"$5,499.00 ","$5,499.00 ","$6,232.20 ","$6,232.20 ",$584.29 ,"$6,232.20 ",$584.29 ,"$5,792.28 ","$5,792.28 ","$5,792.28 ","$6,598.80 ","$1,402.64 ","$6,598.80 ",$584.29 ,"$7,332.00 ","$4,802.46 ",$584.29 ,"$3,182.09 ", N/A ,$611.57 ,"$6,598.80 ","$1,266.25 ","$4,626.49 ","$4,399.20 ","$6,598.80 ",$584.29 ,"$6,598.80 ","$6,598.80 ",$584.29 ,"$4,765.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000343,74430,HC CYSTOGRAM 3+ VIEWS,320,1 ,$809.00 ,$525.85 ,$351.11 ,$810.99 ,$602.71 ,$529.90 ,$374.22 ,$426.34 ,$374.22 ,$510.48 ,$510.48 ,$510.48 ,$510.48 ,$728.10 ,$606.75 ,$374.22 ,$711.92 ,$374.22 ,$606.75 ,$606.75 ,$687.65 ,$687.65 ,$374.22 ,$687.65 ,$374.22 ,$639.11 ,$639.11 ,$639.11 ,$728.10 ,$809.00 ,$728.10 ,$374.22 ,$809.00 ,$529.90 ,$374.22 ,$351.11 , N/A ,$391.69 ,$728.10 ,$810.99 ,$510.48 ,$485.40 ,$728.10 ,$374.22 ,$728.10 ,$728.10 ,$374.22 ,$525.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000344,74450,HC CYSTOURETHROGRAM RETROGRADE,320,1 ,$871.00 ,$566.15 ,$233.94 ,$871.00 ,$648.90 ,$570.51 ,$233.94 ,$459.02 ,$233.94 ,$549.60 ,$549.60 ,$549.60 ,$549.60 ,$783.90 ,$653.25 ,$233.94 ,$766.48 ,$233.94 ,$653.25 ,$653.25 ,$740.35 ,$740.35 ,$233.94 ,$740.35 ,$233.94 ,$688.09 ,$688.09 ,$688.09 ,$783.90 ,$561.60 ,$783.90 ,$233.94 ,$871.00 ,$570.51 ,$233.94 ,$378.01 , N/A ,$244.87 ,$783.90 ,$506.99 ,$549.60 ,$522.60 ,$783.90 ,$233.94 ,$783.90 ,$783.90 ,$233.94 ,$566.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000346,74455,HC XRAY VOID CYSTOURETHGRAM,320,1 ,"$1,495.00 ",$971.75 ,$233.94 ,"$1,495.00 ","$1,113.78 ",$979.23 ,$233.94 ,$787.87 ,$233.94 ,$943.35 ,$943.35 ,$943.35 ,$943.35 ,"$1,345.50 ","$1,121.25 ",$233.94 ,"$1,315.60 ",$233.94 ,"$1,121.25 ","$1,121.25 ","$1,270.75 ","$1,270.75 ",$233.94 ,"$1,270.75 ",$233.94 ,"$1,181.05 ","$1,181.05 ","$1,181.05 ","$1,345.50 ",$561.60 ,"$1,345.50 ",$233.94 ,"$1,495.00 ",$979.23 ,$233.94 ,$648.83 , N/A ,$244.87 ,"$1,345.50 ",$506.99 ,$943.35 ,$897.00 ,"$1,345.50 ",$233.94 ,"$1,345.50 ","$1,345.50 ",$233.94 ,$971.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000349,50432,HC PERCUTANEOUS NEPHRO CATH PLCMT,320,1 ,"$4,251.00 ","$2,763.15 ","$1,822.70 ","$4,251.00 ","$3,167.00 ","$2,784.41 ","$1,822.70 ","$2,240.28 ","$1,822.70 ","$2,682.38 ","$2,682.38 ","$2,682.38 ","$2,682.38 ","$3,825.90 ","$3,188.25 ","$1,822.70 ","$3,740.88 ","$1,822.70 ","$3,188.25 ","$3,188.25 ","$3,613.35 ","$3,613.35 ","$1,822.70 ","$3,613.35 ","$1,822.70 ","$3,358.29 ","$3,358.29 ","$3,358.29 ","$3,825.90 ","$4,251.00 ","$3,825.90 ","$1,822.70 ","$4,251.00 ","$2,784.41 ","$1,822.70 ","$1,844.93 ", N/A ,"$1,907.80 ","$3,825.90 ","$3,950.04 ","$2,682.38 ","$2,550.60 ","$3,825.90 ","$1,822.70 ","$3,825.90 ","$3,825.90 ","$1,822.70 ","$2,763.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000349,50432,HC PERCUTANEOUS NEPHRO CATH PLCMT,320,1 ,"$6,376.00 ","$4,144.40 ","$2,767.18 ","$6,777.32 ","$4,750.12 ","$4,176.28 ","$3,127.32 ","$3,360.15 ","$3,127.32 ","$4,023.26 ","$4,023.26 ","$4,023.26 ","$4,023.26 ","$5,738.40 ","$4,782.00 ","$3,127.32 ","$5,610.88 ","$3,127.32 ","$4,782.00 ","$4,782.00 ","$5,419.60 ","$5,419.60 ","$3,127.32 ","$5,419.60 ","$3,127.32 ","$5,037.04 ","$5,037.04 ","$5,037.04 ","$5,738.40 ","$6,376.00 ","$5,738.40 ","$3,127.32 ","$6,376.00 ","$4,176.28 ","$3,127.32 ","$2,767.18 ", N/A ,"$3,273.32 ","$5,738.40 ","$6,777.32 ","$4,023.26 ","$3,825.60 ","$5,738.40 ","$3,127.32 ","$5,738.40 ","$5,738.40 ","$3,127.32 ","$4,144.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000352,74485,"HC DILITATN NEPHRO,URETER,URETHRA",320,1 ,"$3,543.00 ","$2,302.95 ","$1,537.66 ","$3,950.04 ","$2,639.54 ","$2,320.67 ","$1,822.70 ","$1,867.16 ","$1,822.70 ","$2,235.63 ","$2,235.63 ","$2,235.63 ","$2,235.63 ","$3,188.70 ","$2,657.25 ","$1,822.70 ","$3,117.84 ","$1,822.70 ","$2,657.25 ","$2,657.25 ","$3,011.55 ","$3,011.55 ","$1,822.70 ","$3,011.55 ","$1,822.70 ","$2,798.97 ","$2,798.97 ","$2,798.97 ","$3,188.70 ","$3,543.00 ","$3,188.70 ","$1,822.70 ","$3,543.00 ","$2,320.67 ","$1,822.70 ","$1,537.66 ", N/A ,"$1,907.80 ","$3,188.70 ","$3,950.04 ","$2,235.63 ","$2,125.80 ","$3,188.70 ","$1,822.70 ","$3,188.70 ","$3,188.70 ","$1,822.70 ","$2,302.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000354,74740,HC XRAY HYSTEROSALPINGOGRAP,320,1 ,"$1,375.00 ",$893.75 ,$233.94 ,"$1,375.00 ","$1,024.38 ",$900.63 ,$233.94 ,$724.63 ,$233.94 ,$867.63 ,$867.63 ,$867.63 ,$867.63 ,"$1,237.50 ","$1,031.25 ",$233.94 ,"$1,210.00 ",$233.94 ,"$1,031.25 ","$1,031.25 ","$1,168.75 ","$1,168.75 ",$233.94 ,"$1,168.75 ",$233.94 ,"$1,086.25 ","$1,086.25 ","$1,086.25 ","$1,237.50 ",$561.60 ,"$1,237.50 ",$233.94 ,"$1,375.00 ",$900.63 ,$233.94 ,$596.75 , N/A ,$244.87 ,"$1,237.50 ",$506.99 ,$867.63 ,$825.00 ,"$1,237.50 ",$233.94 ,"$1,237.50 ","$1,237.50 ",$233.94 ,$893.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000355,75605,HC THORACIC AORTA,320,1 ,"$4,824.00 ","$3,135.60 ","$2,093.62 ","$10,509.35 ","$3,593.88 ","$3,159.72 ","$4,824.00 ","$2,542.25 ","$4,824.00 ","$3,043.94 ","$3,043.94 ","$3,043.94 ","$3,043.94 ","$4,341.60 ","$3,618.00 ","$4,824.00 ","$4,245.12 ","$4,824.00 ","$3,618.00 ","$3,618.00 ","$4,100.40 ","$4,100.40 ","$4,824.00 ","$4,100.40 ","$4,824.00 ","$3,810.96 ","$3,810.96 ","$3,810.96 ","$4,341.60 ","$4,824.00 ","$4,341.60 ","$4,824.00 ","$4,824.00 ","$3,159.72 ","$4,824.00 ","$2,093.62 ", N/A ,"$4,824.00 ","$4,341.60 ","$10,509.35 ","$3,043.94 ","$2,894.40 ","$4,341.60 ","$4,824.00 ","$4,341.60 ","$4,341.60 ","$4,824.00 ","$3,135.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000356,75625,HC ABDOMINAL AORTAGRAM 75625,320,1 ,"$4,986.00 ","$3,240.90 ","$2,163.92 ","$6,304.37 ","$3,714.57 ","$3,265.83 ","$2,909.08 ","$2,627.62 ","$2,909.08 ","$3,146.17 ","$3,146.17 ","$3,146.17 ","$3,146.17 ","$4,487.40 ","$3,739.50 ","$2,909.08 ","$4,387.68 ","$2,909.08 ","$3,739.50 ","$3,739.50 ","$4,238.10 ","$4,238.10 ","$2,909.08 ","$4,238.10 ","$2,909.08 ","$3,938.94 ","$3,938.94 ","$3,938.94 ","$4,487.40 ","$4,986.00 ","$4,487.40 ","$2,909.08 ","$4,986.00 ","$3,265.83 ","$2,909.08 ","$2,163.92 ", N/A ,"$3,044.89 ","$4,487.40 ","$6,304.37 ","$3,146.17 ","$2,991.60 ","$4,487.40 ","$2,909.08 ","$4,487.40 ","$4,487.40 ","$2,909.08 ","$3,240.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000357,75630,HC AORTA WITH RUNOFF 75630,320,1 ,"$5,599.00 ","$3,639.35 ","$2,429.97 ","$6,304.37 ","$4,171.26 ","$3,667.35 ","$2,909.08 ","$2,950.67 ","$2,909.08 ","$3,532.97 ","$3,532.97 ","$3,532.97 ","$3,532.97 ","$5,039.10 ","$4,199.25 ","$2,909.08 ","$4,927.12 ","$2,909.08 ","$4,199.25 ","$4,199.25 ","$4,759.15 ","$4,759.15 ","$2,909.08 ","$4,759.15 ","$2,909.08 ","$4,423.21 ","$4,423.21 ","$4,423.21 ","$5,039.10 ","$5,599.00 ","$5,039.10 ","$2,909.08 ","$5,599.00 ","$3,667.35 ","$2,909.08 ","$2,429.97 ", N/A ,"$3,044.89 ","$5,039.10 ","$6,304.37 ","$3,532.97 ","$3,359.40 ","$5,039.10 ","$2,909.08 ","$5,039.10 ","$5,039.10 ","$2,909.08 ","$3,639.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000371,75710,HC ANGIO EXTREMITY UNI 75710,320,1 ,"$4,810.00 ","$3,126.50 ","$2,087.54 ","$6,304.37 ","$3,583.45 ","$3,150.55 ","$2,909.08 ","$2,534.87 ","$2,909.08 ","$3,035.11 ","$3,035.11 ","$3,035.11 ","$3,035.11 ","$4,329.00 ","$3,607.50 ","$2,909.08 ","$4,232.80 ","$2,909.08 ","$3,607.50 ","$3,607.50 ","$4,088.50 ","$4,088.50 ","$2,909.08 ","$4,088.50 ","$2,909.08 ","$3,799.90 ","$3,799.90 ","$3,799.90 ","$4,329.00 ","$4,810.00 ","$4,329.00 ","$2,909.08 ","$4,810.00 ","$3,150.55 ","$2,909.08 ","$2,087.54 ", N/A ,"$3,044.89 ","$4,329.00 ","$6,304.37 ","$3,035.11 ","$2,886.00 ","$4,329.00 ","$2,909.08 ","$4,329.00 ","$4,329.00 ","$2,909.08 ","$3,126.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000373,75716,HC ANGIO EXTREMITY BILAT 75716,320,1 ,"$5,376.00 ","$3,494.40 ","$2,333.18 ","$6,304.37 ","$4,005.12 ","$3,521.28 ","$2,909.08 ","$2,833.15 ","$2,909.08 ","$3,392.26 ","$3,392.26 ","$3,392.26 ","$3,392.26 ","$4,838.40 ","$4,032.00 ","$2,909.08 ","$4,730.88 ","$2,909.08 ","$4,032.00 ","$4,032.00 ","$4,569.60 ","$4,569.60 ","$2,909.08 ","$4,569.60 ","$2,909.08 ","$4,247.04 ","$4,247.04 ","$4,247.04 ","$4,838.40 ","$5,376.00 ","$4,838.40 ","$2,909.08 ","$5,376.00 ","$3,521.28 ","$2,909.08 ","$2,333.18 ", N/A ,"$3,044.89 ","$4,838.40 ","$6,304.37 ","$3,392.26 ","$3,225.60 ","$4,838.40 ","$2,909.08 ","$4,838.40 ","$4,838.40 ","$2,909.08 ","$3,494.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000375,36251,HC ANGIO SEL RENAL UNILA 36251,320,1 ,"$3,514.00 ","$2,284.10 ","$1,525.08 ","$6,304.37 ","$2,617.93 ","$2,301.67 ","$2,909.08 ","$1,851.88 ","$2,909.08 ","$2,217.33 ","$2,217.33 ","$2,217.33 ","$2,217.33 ","$3,162.60 ","$2,635.50 ","$2,909.08 ","$3,092.32 ","$2,909.08 ","$2,635.50 ","$2,635.50 ","$2,986.90 ","$2,986.90 ","$2,909.08 ","$2,986.90 ","$2,909.08 ","$2,776.06 ","$2,776.06 ","$2,776.06 ","$3,162.60 ","$3,514.00 ","$3,162.60 ","$2,909.08 ","$3,514.00 ","$2,301.67 ","$2,909.08 ","$1,525.08 ", N/A ,"$3,044.89 ","$3,162.60 ","$6,304.37 ","$2,217.33 ","$2,108.40 ","$3,162.60 ","$2,909.08 ","$3,162.60 ","$3,162.60 ","$2,909.08 ","$2,284.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000376,36252,HC ANGIO SEL RENAL BILAT 36252,320,1 ,"$4,917.00 ","$3,196.05 ","$2,133.98 ","$6,304.37 ","$3,663.17 ","$3,220.64 ","$2,909.08 ","$2,591.26 ","$2,909.08 ","$3,102.63 ","$3,102.63 ","$3,102.63 ","$3,102.63 ","$4,425.30 ","$3,687.75 ","$2,909.08 ","$4,326.96 ","$2,909.08 ","$3,687.75 ","$3,687.75 ","$4,179.45 ","$4,179.45 ","$2,909.08 ","$4,179.45 ","$2,909.08 ","$3,884.43 ","$3,884.43 ","$3,884.43 ","$4,425.30 ","$4,917.00 ","$4,425.30 ","$2,909.08 ","$4,917.00 ","$3,220.64 ","$2,909.08 ","$2,133.98 ", N/A ,"$3,044.89 ","$4,425.30 ","$6,304.37 ","$3,102.63 ","$2,950.20 ","$4,425.30 ","$2,909.08 ","$4,425.30 ","$4,425.30 ","$2,909.08 ","$3,196.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000378,75726,"HC ANGIO VISERAL, SEL, OR SUPRASEL 75726",320,1 ,"$5,712.00 ","$3,712.80 ","$2,479.01 ","$10,509.35 ","$4,255.44 ","$3,741.36 ","$4,849.42 ","$3,010.22 ","$4,849.42 ","$3,604.27 ","$3,604.27 ","$3,604.27 ","$3,604.27 ","$5,140.80 ","$4,284.00 ","$4,849.42 ","$5,026.56 ","$4,849.42 ","$4,284.00 ","$4,284.00 ","$4,855.20 ","$4,855.20 ","$4,849.42 ","$4,855.20 ","$4,849.42 ","$4,512.48 ","$4,512.48 ","$4,512.48 ","$5,140.80 ","$5,712.00 ","$5,140.80 ","$4,849.42 ","$5,712.00 ","$3,741.36 ","$4,849.42 ","$2,479.01 ", N/A ,"$5,075.82 ","$5,140.80 ","$10,509.35 ","$3,604.27 ","$3,427.20 ","$5,140.80 ","$4,849.42 ","$5,140.80 ","$5,140.80 ","$4,849.42 ","$3,712.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000384,75736,HC ANGIO PELVIC SELECT,320,1 ,"$4,955.00 ","$3,220.75 ","$2,150.47 ","$10,509.35 ","$3,691.48 ","$3,245.53 ","$4,849.42 ","$2,611.29 ","$4,849.42 ","$3,126.61 ","$3,126.61 ","$3,126.61 ","$3,126.61 ","$4,459.50 ","$3,716.25 ","$4,849.42 ","$4,360.40 ","$4,849.42 ","$3,716.25 ","$3,716.25 ","$4,211.75 ","$4,211.75 ","$4,849.42 ","$4,211.75 ","$4,849.42 ","$3,914.45 ","$3,914.45 ","$3,914.45 ","$4,459.50 ","$4,955.00 ","$4,459.50 ","$4,849.42 ","$4,955.00 ","$3,245.53 ","$4,849.42 ","$2,150.47 ", N/A ,"$4,955.00 ","$4,459.50 ","$10,509.35 ","$3,126.61 ","$2,973.00 ","$4,459.50 ","$4,849.42 ","$4,459.50 ","$4,459.50 ","$4,849.42 ","$3,220.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000389,75774,HC ANGIO EA VESSEL ADDL 75774,320,1 ,"$2,300.00 ","$1,495.00 ",$998.20 ,"$2,300.00 ","$1,713.50 ","$1,506.50 ", N/A ,"$1,212.10 ", N/A ,"$1,451.30 ","$1,451.30 ","$1,451.30 ","$1,451.30 ","$2,070.00 ","$1,725.00 ", N/A ,"$2,024.00 ", N/A ,"$1,725.00 ","$1,725.00 ","$1,955.00 ","$1,955.00 ", N/A ,"$1,955.00 ", N/A ,"$1,817.00 ","$1,817.00 ","$1,817.00 ","$2,070.00 ", N/A ,"$2,070.00 ", N/A ,"$2,300.00 ","$1,506.50 ", N/A ,$998.20 , N/A , N/A ,"$2,070.00 ", N/A ,"$1,451.30 ","$1,380.00 ","$2,070.00 ", N/A ,"$2,070.00 ","$2,070.00 ", N/A ,"$1,495.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000395,75820,HC VENOGRAM EXTREMITY UNI 75820,320,1 ,"$1,851.00 ","$1,203.15 ",$803.33 ,"$3,097.79 ","$1,379.00 ","$1,212.41 ","$1,429.44 ",$975.48 ,"$1,429.44 ","$1,167.98 ","$1,167.98 ","$1,167.98 ","$1,167.98 ","$1,665.90 ","$1,388.25 ","$1,429.44 ","$1,628.88 ","$1,429.44 ","$1,388.25 ","$1,388.25 ","$1,573.35 ","$1,573.35 ","$1,429.44 ","$1,573.35 ","$1,429.44 ","$1,462.29 ","$1,462.29 ","$1,462.29 ","$1,665.90 ","$1,851.00 ","$1,665.90 ","$1,429.44 ","$1,851.00 ","$1,212.41 ","$1,429.44 ",$803.33 , N/A ,"$1,496.18 ","$1,665.90 ","$3,097.79 ","$1,167.98 ","$1,110.60 ","$1,665.90 ","$1,429.44 ","$1,665.90 ","$1,665.90 ","$1,429.44 ","$1,203.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000397,75822,HC VENOGRAM EXTREMITY BILAT,320,1 ,"$2,272.00 ","$1,476.80 ",$986.05 ,"$3,097.79 ","$1,692.64 ","$1,488.16 ","$1,429.44 ","$1,197.34 ","$1,429.44 ","$1,433.63 ","$1,433.63 ","$1,433.63 ","$1,433.63 ","$2,044.80 ","$1,704.00 ","$1,429.44 ","$1,999.36 ","$1,429.44 ","$1,704.00 ","$1,704.00 ","$1,931.20 ","$1,931.20 ","$1,429.44 ","$1,931.20 ","$1,429.44 ","$1,794.88 ","$1,794.88 ","$1,794.88 ","$2,044.80 ","$2,272.00 ","$2,044.80 ","$1,429.44 ","$2,272.00 ","$1,488.16 ","$1,429.44 ",$986.05 , N/A ,"$1,496.18 ","$2,044.80 ","$3,097.79 ","$1,433.63 ","$1,363.20 ","$2,044.80 ","$1,429.44 ","$2,044.80 ","$2,044.80 ","$1,429.44 ","$1,476.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000398,75825,HC VENOGRAPHY CAVAL INFERIOR,320,1 ,"$3,547.00 ","$2,305.55 ","$1,539.40 ","$6,304.37 ","$2,642.52 ","$2,323.29 ","$2,909.08 ","$1,869.27 ","$2,909.08 ","$2,238.16 ","$2,238.16 ","$2,238.16 ","$2,238.16 ","$3,192.30 ","$2,660.25 ","$2,909.08 ","$3,121.36 ","$2,909.08 ","$2,660.25 ","$2,660.25 ","$3,014.95 ","$3,014.95 ","$2,909.08 ","$3,014.95 ","$2,909.08 ","$2,802.13 ","$2,802.13 ","$2,802.13 ","$3,192.30 ","$3,547.00 ","$3,192.30 ","$2,909.08 ","$3,547.00 ","$2,323.29 ","$2,909.08 ","$1,539.40 ", N/A ,"$3,044.89 ","$3,192.30 ","$6,304.37 ","$2,238.16 ","$2,128.20 ","$3,192.30 ","$2,909.08 ","$3,192.30 ","$3,192.30 ","$2,909.08 ","$2,305.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000399,75827,HC VENOGRAPHY CAVAL SUPERIOR,320,1 ,"$2,399.00 ","$1,559.35 ","$1,041.17 ","$3,097.79 ","$1,787.26 ","$1,571.35 ","$1,429.44 ","$1,264.27 ","$1,429.44 ","$1,513.77 ","$1,513.77 ","$1,513.77 ","$1,513.77 ","$2,159.10 ","$1,799.25 ","$1,429.44 ","$2,111.12 ","$1,429.44 ","$1,799.25 ","$1,799.25 ","$2,039.15 ","$2,039.15 ","$1,429.44 ","$2,039.15 ","$1,429.44 ","$1,895.21 ","$1,895.21 ","$1,895.21 ","$2,159.10 ","$2,399.00 ","$2,159.10 ","$1,429.44 ","$2,399.00 ","$1,571.35 ","$1,429.44 ","$1,041.17 ", N/A ,"$1,496.18 ","$2,159.10 ","$3,097.79 ","$1,513.77 ","$1,439.40 ","$2,159.10 ","$1,429.44 ","$2,159.10 ","$2,159.10 ","$1,429.44 ","$1,559.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000411,75889,HC VENOGRAM HEPATIC W/HEMO,320,1 ,"$4,539.00 ","$2,950.35 ","$1,969.93 ","$6,304.37 ","$3,381.56 ","$2,973.05 ","$2,909.08 ","$2,392.05 ","$2,909.08 ","$2,864.11 ","$2,864.11 ","$2,864.11 ","$2,864.11 ","$4,085.10 ","$3,404.25 ","$2,909.08 ","$3,994.32 ","$2,909.08 ","$3,404.25 ","$3,404.25 ","$3,858.15 ","$3,858.15 ","$2,909.08 ","$3,858.15 ","$2,909.08 ","$3,585.81 ","$3,585.81 ","$3,585.81 ","$4,085.10 ","$4,539.00 ","$4,085.10 ","$2,909.08 ","$4,539.00 ","$2,973.05 ","$2,909.08 ","$1,969.93 ", N/A ,"$3,044.89 ","$4,085.10 ","$6,304.37 ","$2,864.11 ","$2,723.40 ","$4,085.10 ","$2,909.08 ","$4,085.10 ","$4,085.10 ","$2,909.08 ","$2,950.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000413,75893,HC VENOGRAM SAMPLING CATH,320,1 ,"$3,684.00 ","$2,394.60 ","$1,598.86 ","$10,509.35 ","$2,744.58 ","$2,413.02 ","$3,684.00 ","$1,941.47 ","$3,684.00 ","$2,324.60 ","$2,324.60 ","$2,324.60 ","$2,324.60 ","$3,315.60 ","$2,763.00 ","$3,684.00 ","$3,241.92 ","$3,684.00 ","$2,763.00 ","$2,763.00 ","$3,131.40 ","$3,131.40 ","$3,684.00 ","$3,131.40 ","$3,684.00 ","$2,910.36 ","$2,910.36 ","$2,910.36 ","$3,315.60 ","$3,684.00 ","$3,315.60 ","$3,684.00 ","$3,684.00 ","$2,413.02 ","$3,684.00 ","$1,598.86 ", N/A ,"$3,684.00 ","$3,315.60 ","$10,509.35 ","$2,324.60 ","$2,210.40 ","$3,315.60 ","$3,684.00 ","$3,315.60 ","$3,315.60 ","$3,684.00 ","$2,394.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000414,75894,HC TRANSCATH EMBOLIZATION 75894,320,1 ,"$8,718.09 ","$5,666.76 ","$3,783.65 ","$8,718.09 ","$6,494.98 ","$5,710.35 ", N/A ,"$4,594.43 ", N/A ,"$5,501.11 ","$5,501.11 ","$5,501.11 ","$5,501.11 ","$7,846.28 ","$6,538.57 ", N/A ,"$7,671.92 ", N/A ,"$6,538.57 ","$6,538.57 ","$7,410.38 ","$7,410.38 ", N/A ,"$7,410.38 ", N/A ,"$6,887.29 ","$6,887.29 ","$6,887.29 ","$7,846.28 ", N/A ,"$7,846.28 ", N/A ,"$8,718.09 ","$5,710.35 ", N/A ,"$3,783.65 ", N/A , N/A ,"$7,846.28 ", N/A ,"$5,501.11 ","$5,230.85 ","$7,846.28 ", N/A ,"$7,846.28 ","$7,846.28 ", N/A ,"$5,666.76 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000421,75901,HC REMOVE PERICATH OBST CV CATH,320,1 ,"$1,147.00 ",$745.55 ,$497.80 ,"$1,147.00 ",$854.52 ,$751.29 , N/A ,$604.47 , N/A ,$723.76 ,$723.76 ,$723.76 ,$723.76 ,"$1,032.30 ",$860.25 , N/A ,"$1,009.36 ", N/A ,$860.25 ,$860.25 ,$974.95 ,$974.95 , N/A ,$974.95 , N/A ,$906.13 ,$906.13 ,$906.13 ,"$1,032.30 ", N/A ,"$1,032.30 ", N/A ,"$1,147.00 ",$751.29 , N/A ,$497.80 , N/A , N/A ,"$1,032.30 ", N/A ,$723.76 ,$688.20 ,"$1,032.30 ", N/A ,"$1,032.30 ","$1,032.30 ", N/A ,$745.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000435,75970,HC TRANSCATH BX,320,1 ,"$5,733.00 ","$3,726.45 ","$2,488.12 ","$5,733.00 ","$4,271.09 ","$3,755.12 ", N/A ,"$3,021.29 ", N/A ,"$3,617.52 ","$3,617.52 ","$3,617.52 ","$3,617.52 ","$5,159.70 ","$4,299.75 ", N/A ,"$5,045.04 ", N/A ,"$4,299.75 ","$4,299.75 ","$4,873.05 ","$4,873.05 ", N/A ,"$4,873.05 ", N/A ,"$4,529.07 ","$4,529.07 ","$4,529.07 ","$5,159.70 ", N/A ,"$5,159.70 ", N/A ,"$5,733.00 ","$3,755.12 ", N/A ,"$2,488.12 ", N/A , N/A ,"$5,159.70 ", N/A ,"$3,617.52 ","$3,439.80 ","$5,159.70 ", N/A ,"$5,159.70 ","$5,159.70 ", N/A ,"$3,726.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000440,75984,HC CHANGE PERC DRAINAGE TUBE OR CATH,320,1 ,"$1,973.00 ","$1,282.45 ",$856.28 ,"$1,973.00 ","$1,469.89 ","$1,292.32 ", N/A ,"$1,039.77 ", N/A ,"$1,244.96 ","$1,244.96 ","$1,244.96 ","$1,244.96 ","$1,775.70 ","$1,479.75 ", N/A ,"$1,736.24 ", N/A ,"$1,479.75 ","$1,479.75 ","$1,677.05 ","$1,677.05 ", N/A ,"$1,677.05 ", N/A ,"$1,558.67 ","$1,558.67 ","$1,558.67 ","$1,775.70 ", N/A ,"$1,775.70 ", N/A ,"$1,973.00 ","$1,292.32 ", N/A ,$856.28 , N/A , N/A ,"$1,775.70 ", N/A ,"$1,244.96 ","$1,183.80 ","$1,775.70 ", N/A ,"$1,775.70 ","$1,775.70 ", N/A ,"$1,282.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000444,49406,HC PERC DRN ABSC/HEM/CYST PERIT/RETROPER,320,1 ,"$4,043.00 ","$2,627.95 ","$1,430.32 ","$4,043.00 ","$3,012.04 ","$2,648.17 ","$1,430.32 ","$2,130.66 ","$1,430.32 ","$2,551.13 ","$2,551.13 ","$2,551.13 ","$2,551.13 ","$3,638.70 ","$3,032.25 ","$1,430.32 ","$3,557.84 ","$1,430.32 ","$3,032.25 ","$3,032.25 ","$3,436.55 ","$3,436.55 ","$1,430.32 ","$3,436.55 ","$1,430.32 ","$3,193.97 ","$3,193.97 ","$3,193.97 ","$3,638.70 ","$3,433.56 ","$3,638.70 ","$1,430.32 ","$4,043.00 ","$2,648.17 ","$1,430.32 ","$1,754.66 ", N/A ,"$1,497.09 ","$3,638.70 ","$3,099.69 ","$2,551.13 ","$2,425.80 ","$3,638.70 ","$1,430.32 ","$3,638.70 ","$3,638.70 ","$1,430.32 ","$2,627.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000445,75989,HC GUID FOR PERC DRAIN ABSCESS,320,1 ,"$2,210.00 ","$1,436.50 ",$959.14 ,"$2,210.00 ","$1,646.45 ","$1,447.55 ", N/A ,"$1,164.67 ", N/A ,"$1,394.51 ","$1,394.51 ","$1,394.51 ","$1,394.51 ","$1,989.00 ","$1,657.50 ", N/A ,"$1,944.80 ", N/A ,"$1,657.50 ","$1,657.50 ","$1,878.50 ","$1,878.50 ", N/A ,"$1,878.50 ", N/A ,"$1,745.90 ","$1,745.90 ","$1,745.90 ","$1,989.00 ", N/A ,"$1,989.00 ", N/A ,"$2,210.00 ","$1,447.55 ", N/A ,$959.14 , N/A , N/A ,"$1,989.00 ", N/A ,"$1,394.51 ","$1,326.00 ","$1,989.00 ", N/A ,"$1,989.00 ","$1,989.00 ", N/A ,"$1,436.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000447,76000,HC FLUOROSCOPY UP TO 1 HR 76000,320,1 ,$822.00 ,$534.30 ,$233.94 ,$822.00 ,$612.39 ,$538.41 ,$233.94 ,$433.19 ,$233.94 ,$518.68 ,$518.68 ,$518.68 ,$518.68 ,$739.80 ,$616.50 ,$233.94 ,$723.36 ,$233.94 ,$616.50 ,$616.50 ,$698.70 ,$698.70 ,$233.94 ,$698.70 ,$233.94 ,$649.38 ,$649.38 ,$649.38 ,$739.80 ,$561.60 ,$739.80 ,$233.94 ,$822.00 ,$538.41 ,$233.94 ,$356.75 , N/A ,$244.87 ,$739.80 ,$506.99 ,$518.68 ,$493.20 ,$739.80 ,$233.94 ,$739.80 ,$739.80 ,$233.94 ,$534.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000464,76010,HC BABYGRAM,320,1 ,$399.00 ,$259.35 ,$82.24 ,$399.00 ,$297.26 ,$261.35 ,$82.24 ,$210.27 ,$82.24 ,$251.77 ,$251.77 ,$251.77 ,$251.77 ,$359.10 ,$299.25 ,$82.24 ,$351.12 ,$82.24 ,$299.25 ,$299.25 ,$339.15 ,$339.15 ,$82.24 ,$339.15 ,$82.24 ,$315.21 ,$315.21 ,$315.21 ,$359.10 ,$197.42 ,$359.10 ,$82.24 ,$399.00 ,$261.35 ,$82.24 ,$173.17 , N/A ,$86.08 ,$359.10 ,$178.23 ,$251.77 ,$239.40 ,$359.10 ,$82.24 ,$359.10 ,$359.10 ,$82.24 ,$259.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000465,76080,HC ABSCESS FISTULA OR SINUS TRACT,320,1 ,"$1,295.00 ",$841.75 ,$490.89 ,"$1,295.00 ",$964.78 ,$848.23 ,$490.89 ,$682.47 ,$490.89 ,$817.15 ,$817.15 ,$817.15 ,$817.15 ,"$1,165.50 ",$971.25 ,$490.89 ,"$1,139.60 ",$490.89 ,$971.25 ,$971.25 ,"$1,100.75 ","$1,100.75 ",$490.89 ,"$1,100.75 ",$490.89 ,"$1,023.05 ","$1,023.05 ","$1,023.05 ","$1,165.50 ","$1,178.42 ","$1,165.50 ",$490.89 ,"$1,295.00 ",$848.23 ,$490.89 ,$562.03 , N/A ,$513.81 ,"$1,165.50 ","$1,063.83 ",$817.15 ,$777.00 ,"$1,165.50 ",$490.89 ,"$1,165.50 ","$1,165.50 ",$490.89 ,$841.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000467,76098,HC RADIOLOGICAL EXAM SURG SPEC,320,1 ,$841.00 ,$546.65 ,$28.70 ,"$1,063.83 ",$626.55 ,$550.86 ,$490.89 ,$443.21 ,$490.89 ,$530.67 ,$530.67 ,$530.67 ,$530.67 ,$756.90 ,$630.75 ,$490.89 ,$740.08 ,$490.89 ,$630.75 ,$630.75 ,$714.85 ,$714.85 ,$490.89 ,$714.85 ,$490.89 ,$664.39 ,$664.39 ,$664.39 ,$756.90 ,$841.00 ,$756.90 ,$490.89 ,$28.70 ,$550.86 ,$490.89 ,$364.99 , N/A ,$513.81 ,$756.90 ,"$1,063.83 ",$530.67 ,$504.60 ,$756.90 ,$490.89 ,$756.90 ,$756.90 ,$490.89 ,$546.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000475,77001,HC FLUORO CV ACCESS PLACEMENT,320,1 ,$234.00 ,$152.10 ,$101.56 ,$234.00 ,$174.33 ,$153.27 , N/A ,$123.32 , N/A ,$147.65 ,$147.65 ,$147.65 ,$147.65 ,$210.60 ,$175.50 , N/A ,$205.92 , N/A ,$175.50 ,$175.50 ,$198.90 ,$198.90 , N/A ,$198.90 , N/A ,$184.86 ,$184.86 ,$184.86 ,$210.60 , N/A ,$210.60 , N/A ,$234.00 ,$153.27 , N/A ,$101.56 , N/A , N/A ,$210.60 , N/A ,$147.65 ,$140.40 ,$210.60 , N/A ,$210.60 ,$210.60 , N/A ,$152.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000476,77002,HC FLUORO NEEDLE PLACEMENT,320,1 ,$656.00 ,$426.40 ,$284.70 ,$656.00 ,$488.72 ,$429.68 , N/A ,$345.71 , N/A ,$413.94 ,$413.94 ,$413.94 ,$413.94 ,$590.40 ,$492.00 , N/A ,$577.28 , N/A ,$492.00 ,$492.00 ,$557.60 ,$557.60 , N/A ,$557.60 , N/A ,$518.24 ,$518.24 ,$518.24 ,$590.40 , N/A ,$590.40 , N/A ,$656.00 ,$429.68 , N/A ,$284.70 , N/A , N/A ,$590.40 , N/A ,$413.94 ,$393.60 ,$590.40 , N/A ,$590.40 ,$590.40 , N/A ,$426.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000481,77003,HC FLUORO NEEDLE LOCALIZATION,320,1 ,"$1,166.00 ",$757.90 ,$506.04 ,"$1,166.00 ",$868.67 ,$763.73 , N/A ,$614.48 , N/A ,$735.75 ,$735.75 ,$735.75 ,$735.75 ,"$1,049.40 ",$874.50 , N/A ,"$1,026.08 ", N/A ,$874.50 ,$874.50 ,$991.10 ,$991.10 , N/A ,$991.10 , N/A ,$921.14 ,$921.14 ,$921.14 ,"$1,049.40 ", N/A ,"$1,049.40 ", N/A ,"$1,166.00 ",$763.73 , N/A ,$506.04 , N/A , N/A ,"$1,049.40 ", N/A ,$735.75 ,$699.60 ,"$1,049.40 ", N/A ,"$1,049.40 ","$1,049.40 ", N/A ,$757.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000483,19283,HC MAMM STER GUIDE BRST NDL PL,320,1 ,"$1,004.00 ",$652.60 ,$294.90 ,"$1,370.23 ",$747.98 ,$657.62 ,$632.28 ,$529.11 ,$632.28 ,$633.52 ,$633.52 ,$633.52 ,$633.52 ,$903.60 ,$753.00 ,$632.28 ,$883.52 ,$632.28 ,$753.00 ,$753.00 ,$853.40 ,$853.40 ,$632.28 ,$853.40 ,$632.28 ,$793.16 ,$793.16 ,$793.16 ,$903.60 ,"$1,004.00 ",$903.60 ,$632.28 ,$294.90 ,$657.62 ,$632.28 ,$435.74 , N/A ,$661.80 ,$903.60 ,"$1,370.23 ",$633.52 ,$602.40 ,$903.60 ,$632.28 ,$903.60 ,$903.60 ,$632.28 ,$652.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000483,19283,HC MAMM STER GUIDE BRST NDL PL,320,1 ,"$1,507.00 ",$979.55 ,$294.90 ,"$1,507.00 ","$1,122.72 ",$987.09 ,$632.28 ,$794.19 ,$632.28 ,$950.92 ,$950.92 ,$950.92 ,$950.92 ,"$1,356.30 ","$1,130.25 ",$632.28 ,"$1,326.16 ",$632.28 ,"$1,130.25 ","$1,130.25 ","$1,280.95 ","$1,280.95 ",$632.28 ,"$1,280.95 ",$632.28 ,"$1,190.53 ","$1,190.53 ","$1,190.53 ","$1,356.30 ","$1,507.00 ","$1,356.30 ",$632.28 ,$294.90 ,$987.09 ,$632.28 ,$654.04 , N/A ,$661.80 ,"$1,356.30 ","$1,370.23 ",$950.92 ,$904.20 ,"$1,356.30 ",$632.28 ,"$1,356.30 ","$1,356.30 ",$632.28 ,$979.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000487,19081,HC MAMM STER GUIDE BRST MAMMT STEREO CORE,320,1 ,"$3,906.00 ","$2,538.90 ",$619.99 ,"$3,906.00 ","$2,909.97 ","$2,558.43 ","$1,430.32 ","$2,058.46 ","$1,430.32 ","$2,464.69 ","$2,464.69 ","$2,464.69 ","$2,464.69 ","$3,515.40 ","$2,929.50 ","$1,430.32 ","$3,437.28 ","$1,430.32 ","$2,929.50 ","$2,929.50 ","$3,320.10 ","$3,320.10 ","$1,430.32 ","$3,320.10 ","$1,430.32 ","$3,085.74 ","$3,085.74 ","$3,085.74 ","$3,515.40 ","$3,433.56 ","$3,515.40 ","$1,430.32 ",$619.99 ,"$2,558.43 ","$1,430.32 ","$1,695.20 ", N/A ,"$1,497.09 ","$3,515.40 ","$3,099.69 ","$2,464.69 ","$2,343.60 ","$3,515.40 ","$1,430.32 ","$3,515.40 ","$3,515.40 ","$1,430.32 ","$2,538.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000487,19081,HC MAMM STER GUIDE BRST MAMMT STEREO CORE,320,1 ,"$5,859.00 ","$3,808.35 ",$619.99 ,"$5,859.00 ","$4,364.96 ","$3,837.65 ","$2,409.29 ","$3,087.69 ","$2,409.29 ","$3,697.03 ","$3,697.03 ","$3,697.03 ","$3,697.03 ","$5,273.10 ","$4,394.25 ","$2,409.29 ","$5,155.92 ","$2,409.29 ","$4,394.25 ","$4,394.25 ","$4,980.15 ","$4,980.15 ","$2,409.29 ","$4,980.15 ","$2,409.29 ","$4,628.61 ","$4,628.61 ","$4,628.61 ","$5,273.10 ","$5,783.63 ","$5,273.10 ","$2,409.29 ",$619.99 ,"$3,837.65 ","$2,409.29 ","$2,542.81 ", N/A ,"$2,521.76 ","$5,273.10 ","$5,221.24 ","$3,697.03 ","$3,515.40 ","$5,273.10 ","$2,409.29 ","$5,273.10 ","$5,273.10 ","$2,409.29 ","$3,808.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000489,19281,HC MAMM GUIDE NDL PLACEMENT,320,1 ,$875.00 ,$568.75 ,$266.06 ,"$1,370.23 ",$651.88 ,$573.13 ,$632.28 ,$461.13 ,$632.28 ,$552.13 ,$552.13 ,$552.13 ,$552.13 ,$787.50 ,$656.25 ,$632.28 ,$770.00 ,$632.28 ,$656.25 ,$656.25 ,$743.75 ,$743.75 ,$632.28 ,$743.75 ,$632.28 ,$691.25 ,$691.25 ,$691.25 ,$787.50 ,$875.00 ,$787.50 ,$632.28 ,$266.06 ,$573.13 ,$632.28 ,$379.75 , N/A ,$661.80 ,$787.50 ,"$1,370.23 ",$552.13 ,$525.00 ,$787.50 ,$632.28 ,$787.50 ,$787.50 ,$632.28 ,$568.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000489,19281,HC MAMM GUIDE NDL PLACEMENT,320,1 ,"$1,313.00 ",$853.45 ,$266.06 ,"$1,370.23 ",$978.19 ,$860.02 ,$632.28 ,$691.95 ,$632.28 ,$828.50 ,$828.50 ,$828.50 ,$828.50 ,"$1,181.70 ",$984.75 ,$632.28 ,"$1,155.44 ",$632.28 ,$984.75 ,$984.75 ,"$1,116.05 ","$1,116.05 ",$632.28 ,"$1,116.05 ",$632.28 ,"$1,037.27 ","$1,037.27 ","$1,037.27 ","$1,181.70 ","$1,313.00 ","$1,181.70 ",$632.28 ,$266.06 ,$860.02 ,$632.28 ,$569.84 , N/A ,$661.80 ,"$1,181.70 ","$1,370.23 ",$828.50 ,$787.80 ,"$1,181.70 ",$632.28 ,"$1,181.70 ","$1,181.70 ",$632.28 ,$853.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000492,77073,HC BONE LENGTH STUDIES,320,1 ,$694.00 ,$451.10 ,$110.78 ,$694.00 ,$517.03 ,$454.57 ,$110.78 ,$365.74 ,$110.78 ,$437.91 ,$437.91 ,$437.91 ,$437.91 ,$624.60 ,$520.50 ,$110.78 ,$610.72 ,$110.78 ,$520.50 ,$520.50 ,$589.90 ,$589.90 ,$110.78 ,$589.90 ,$110.78 ,$548.26 ,$548.26 ,$548.26 ,$624.60 ,$265.92 ,$624.60 ,$110.78 ,$694.00 ,$454.57 ,$110.78 ,$301.20 , N/A ,$115.95 ,$624.60 ,$240.07 ,$437.91 ,$416.40 ,$624.60 ,$110.78 ,$624.60 ,$624.60 ,$110.78 ,$451.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000494,77075,HC BONE SURVEY COMPLETE,320,1 ,"$1,051.00 ",$683.15 ,$110.78 ,"$1,051.00 ",$783.00 ,$688.41 ,$110.78 ,$553.88 ,$110.78 ,$663.18 ,$663.18 ,$663.18 ,$663.18 ,$945.90 ,$788.25 ,$110.78 ,$924.88 ,$110.78 ,$788.25 ,$788.25 ,$893.35 ,$893.35 ,$110.78 ,$893.35 ,$110.78 ,$830.29 ,$830.29 ,$830.29 ,$945.90 ,$265.92 ,$945.90 ,$110.78 ,"$1,051.00 ",$688.41 ,$110.78 ,$456.13 , N/A ,$115.95 ,$945.90 ,$240.07 ,$663.18 ,$630.60 ,$945.90 ,$110.78 ,$945.90 ,$945.90 ,$110.78 ,$683.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000495,77076,HC OSSEOUS SURVEY INFANT,320,1 ,$891.00 ,$579.15 ,$110.78 ,$891.00 ,$663.80 ,$583.61 ,$110.78 ,$469.56 ,$110.78 ,$562.22 ,$562.22 ,$562.22 ,$562.22 ,$801.90 ,$668.25 ,$110.78 ,$784.08 ,$110.78 ,$668.25 ,$668.25 ,$757.35 ,$757.35 ,$110.78 ,$757.35 ,$110.78 ,$703.89 ,$703.89 ,$703.89 ,$801.90 ,$265.92 ,$801.90 ,$110.78 ,$891.00 ,$583.61 ,$110.78 ,$386.69 , N/A ,$115.95 ,$801.90 ,$240.07 ,$562.22 ,$534.60 ,$801.90 ,$110.78 ,$801.90 ,$801.90 ,$110.78 ,$579.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000496,77080,HC BONE DENSITY DXA,320,1 ,$810.00 ,$526.50 ,$110.78 ,$810.00 ,$603.45 ,$530.55 ,$110.78 ,$426.87 ,$110.78 ,$511.11 ,$511.11 ,$511.11 ,$511.11 ,$729.00 ,$607.50 ,$110.78 ,$712.80 ,$110.78 ,$607.50 ,$607.50 ,$688.50 ,$688.50 ,$110.78 ,$688.50 ,$110.78 ,$639.90 ,$639.90 ,$639.90 ,$729.00 ,$265.92 ,$729.00 ,$110.78 ,$810.00 ,$530.55 ,$110.78 ,$351.54 , N/A ,$115.95 ,$729.00 ,$240.07 ,$511.11 ,$486.00 ,$729.00 ,$110.78 ,$729.00 ,$729.00 ,$110.78 ,$526.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000497,77081,HC BONE DENSITY PERIPHERAL,320,1 ,$587.00 ,$381.55 ,$82.24 ,$587.00 ,$437.32 ,$384.49 ,$82.24 ,$309.35 ,$82.24 ,$370.40 ,$370.40 ,$370.40 ,$370.40 ,$528.30 ,$440.25 ,$82.24 ,$516.56 ,$82.24 ,$440.25 ,$440.25 ,$498.95 ,$498.95 ,$82.24 ,$498.95 ,$82.24 ,$463.73 ,$463.73 ,$463.73 ,$528.30 ,$197.42 ,$528.30 ,$82.24 ,$587.00 ,$384.49 ,$82.24 ,$254.76 , N/A ,$86.08 ,$528.30 ,$178.23 ,$370.40 ,$352.20 ,$528.30 ,$82.24 ,$528.30 ,$528.30 ,$82.24 ,$381.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000499,0238T,HC TRNLUM PERIP ATHRC ILIAC ARTY 0238T,320,1 ,"$48,724.00 ","$31,670.60 ","$16,330.21 ","$48,724.00 ","$36,299.38 ","$31,914.22 ","$16,330.21 ","$25,677.55 ","$16,330.21 ","$30,744.84 ","$30,744.84 ","$30,744.84 ","$30,744.84 ","$43,851.60 ","$36,543.00 ","$16,330.21 ","$42,877.12 ","$16,330.21 ","$36,543.00 ","$36,543.00 ","$41,415.40 ","$41,415.40 ","$16,330.21 ","$41,415.40 ","$16,330.21 ","$38,491.96 ","$38,491.96 ","$38,491.96 ","$43,851.60 ","$39,201.65 ","$43,851.60 ","$16,330.21 ","$48,724.00 ","$31,914.22 ","$16,330.21 ","$21,146.22 ", N/A ,"$17,092.59 ","$43,851.60 ","$35,389.74 ","$30,744.84 ","$29,234.40 ","$43,851.60 ","$16,330.21 ","$43,851.60 ","$43,851.60 ","$16,330.21 ","$31,670.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000500,76000,HC FLUOROSCOPY UP TO 1 HR SNIFF DIAPHRM,320,1 ,$822.00 ,$534.30 ,$233.94 ,$822.00 ,$612.39 ,$538.41 ,$233.94 ,$433.19 ,$233.94 ,$518.68 ,$518.68 ,$518.68 ,$518.68 ,$739.80 ,$616.50 ,$233.94 ,$723.36 ,$233.94 ,$616.50 ,$616.50 ,$698.70 ,$698.70 ,$233.94 ,$698.70 ,$233.94 ,$649.38 ,$649.38 ,$649.38 ,$739.80 ,$561.60 ,$739.80 ,$233.94 ,$822.00 ,$538.41 ,$233.94 ,$356.75 , N/A ,$244.87 ,$739.80 ,$506.99 ,$518.68 ,$493.20 ,$739.80 ,$233.94 ,$739.80 ,$739.80 ,$233.94 ,$534.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000503,20501,HC INJ TRACT SINOGRAM DIAG,320,1 ,$792.00 ,$514.80 ,$343.73 ,$792.00 ,$590.04 ,$518.76 , N/A ,$417.38 , N/A ,$499.75 ,$499.75 ,$499.75 ,$499.75 ,$712.80 ,$594.00 , N/A ,$696.96 , N/A ,$594.00 ,$594.00 ,$673.20 ,$673.20 , N/A ,$673.20 , N/A ,$625.68 ,$625.68 ,$625.68 ,$712.80 , N/A ,$712.80 , N/A ,$792.00 ,$518.76 , N/A ,$343.73 , N/A , N/A ,$712.80 , N/A ,$499.75 ,$475.20 ,$712.80 , N/A ,$712.80 ,$712.80 , N/A ,$514.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000504,20550,HC INJ SINGLE TENDON/LIGAMENT,320,1 ,$670.00 ,$435.50 ,$265.50 ,$670.00 ,$499.15 ,$438.85 ,$265.50 ,$353.09 ,$265.50 ,$422.77 ,$422.77 ,$422.77 ,$422.77 ,$603.00 ,$502.50 ,$265.50 ,$589.60 ,$265.50 ,$502.50 ,$502.50 ,$569.50 ,$569.50 ,$265.50 ,$569.50 ,$265.50 ,$529.30 ,$529.30 ,$529.30 ,$603.00 ,$637.34 ,$603.00 ,$265.50 ,$670.00 ,$438.85 ,$265.50 ,$290.78 , N/A ,$277.89 ,$603.00 ,$575.37 ,$422.77 ,$402.00 ,$603.00 ,$265.50 ,$603.00 ,$603.00 ,$265.50 ,$435.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000505,20552,HC INJ TRIGGER PT 1-2 MUSCLE(S),320,1 ,$921.00 ,$598.65 ,$265.50 ,$921.00 ,$686.15 ,$603.26 ,$265.50 ,$485.37 ,$265.50 ,$581.15 ,$581.15 ,$581.15 ,$581.15 ,$828.90 ,$690.75 ,$265.50 ,$810.48 ,$265.50 ,$690.75 ,$690.75 ,$782.85 ,$782.85 ,$265.50 ,$782.85 ,$265.50 ,$727.59 ,$727.59 ,$727.59 ,$828.90 ,$637.34 ,$828.90 ,$265.50 ,$921.00 ,$603.26 ,$265.50 ,$399.71 , N/A ,$277.89 ,$828.90 ,$575.37 ,$581.15 ,$552.60 ,$828.90 ,$265.50 ,$828.90 ,$828.90 ,$265.50 ,$598.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000506,20553,HC INJ TRIGGER PT 3+ MUSC GROUP,320,1 ,$921.00 ,$598.65 ,$265.50 ,$921.00 ,$686.15 ,$603.26 ,$265.50 ,$485.37 ,$265.50 ,$581.15 ,$581.15 ,$581.15 ,$581.15 ,$828.90 ,$690.75 ,$265.50 ,$810.48 ,$265.50 ,$690.75 ,$690.75 ,$782.85 ,$782.85 ,$265.50 ,$782.85 ,$265.50 ,$727.59 ,$727.59 ,$727.59 ,$828.90 ,$637.34 ,$828.90 ,$265.50 ,$921.00 ,$603.26 ,$265.50 ,$399.71 , N/A ,$277.89 ,$828.90 ,$575.37 ,$581.15 ,$552.60 ,$828.90 ,$265.50 ,$828.90 ,$828.90 ,$265.50 ,$598.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000509,77072,HC BONE AGE STUDIES,320,1 ,$678.00 ,$440.70 ,$110.78 ,$678.00 ,$505.11 ,$444.09 ,$110.78 ,$357.31 ,$110.78 ,$427.82 ,$427.82 ,$427.82 ,$427.82 ,$610.20 ,$508.50 ,$110.78 ,$596.64 ,$110.78 ,$508.50 ,$508.50 ,$576.30 ,$576.30 ,$110.78 ,$576.30 ,$110.78 ,$535.62 ,$535.62 ,$535.62 ,$610.20 ,$265.92 ,$610.20 ,$110.78 ,$678.00 ,$444.09 ,$110.78 ,$294.25 , N/A ,$115.95 ,$610.20 ,$240.07 ,$427.82 ,$406.80 ,$610.20 ,$110.78 ,$610.20 ,$610.20 ,$110.78 ,$440.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000515,G0278,HC ILIAC ARTERY ANGIO W CATH G0278,320,1 ,"$6,141.00 ","$3,991.65 ","$2,665.19 ","$6,141.00 ","$4,575.05 ","$4,022.36 ", N/A ,"$3,236.31 ", N/A ,"$3,874.97 ","$3,874.97 ","$3,874.97 ","$3,874.97 ","$5,526.90 ","$4,605.75 ", N/A ,"$5,404.08 ", N/A ,"$4,605.75 ","$4,605.75 ","$5,219.85 ","$5,219.85 ", N/A ,"$5,219.85 ", N/A ,"$4,851.39 ","$4,851.39 ","$4,851.39 ","$5,526.90 ", N/A ,"$5,526.90 ", N/A ,"$6,141.00 ","$4,022.36 ", N/A ,"$2,665.19 ", N/A , N/A ,"$5,526.90 ", N/A ,"$3,874.97 ","$3,684.60 ","$5,526.90 ", N/A ,"$5,526.90 ","$5,526.90 ", N/A ,"$3,991.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000530,32554,HC THORACENTESIS W/O IMAGING 32554,320,1 ,"$1,731.00 ","$1,125.15 ",$550.60 ,"$1,731.00 ","$1,289.60 ","$1,133.81 ",$550.60 ,$912.24 ,$550.60 ,"$1,092.26 ","$1,092.26 ","$1,092.26 ","$1,092.26 ","$1,557.90 ","$1,298.25 ",$550.60 ,"$1,523.28 ",$550.60 ,"$1,298.25 ","$1,298.25 ","$1,471.35 ","$1,471.35 ",$550.60 ,"$1,471.35 ",$550.60 ,"$1,367.49 ","$1,367.49 ","$1,367.49 ","$1,557.90 ","$1,321.74 ","$1,557.90 ",$550.60 ,"$1,731.00 ","$1,133.81 ",$550.60 ,$751.25 , N/A ,$576.30 ,"$1,557.90 ","$1,193.21 ","$1,092.26 ","$1,038.60 ","$1,557.90 ",$550.60 ,"$1,557.90 ","$1,557.90 ",$550.60 ,"$1,125.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000531,32555,HC THORACENTESIS W IMAGING 32555,320,1 ,"$1,905.00 ","$1,238.25 ",$550.60 ,"$1,905.00 ","$1,419.23 ","$1,247.78 ",$550.60 ,"$1,003.94 ",$550.60 ,"$1,202.06 ","$1,202.06 ","$1,202.06 ","$1,202.06 ","$1,714.50 ","$1,428.75 ",$550.60 ,"$1,676.40 ",$550.60 ,"$1,428.75 ","$1,428.75 ","$1,619.25 ","$1,619.25 ",$550.60 ,"$1,619.25 ",$550.60 ,"$1,504.95 ","$1,504.95 ","$1,504.95 ","$1,714.50 ","$1,321.74 ","$1,714.50 ",$550.60 ,"$1,905.00 ","$1,247.78 ",$550.60 ,$826.77 , N/A ,$576.30 ,"$1,714.50 ","$1,193.21 ","$1,202.06 ","$1,143.00 ","$1,714.50 ",$550.60 ,"$1,714.50 ","$1,714.50 ",$550.60 ,"$1,238.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000532,32556,HC PLEURAL DRAINAGE W/O IMAGING 32556,450,1 ,"$2,137.00 ","$1,389.05 ",$927.46 ,"$3,580.00 ","$1,592.07 ","$1,399.74 ","$1,651.95 ","$1,126.20 ","$1,651.95 ","$1,348.45 ","$1,348.45 ","$1,348.45 ","$1,348.45 ","$1,923.30 ","$1,602.75 ","$1,651.95 ","$1,880.56 ","$1,651.95 ","$1,602.75 ","$1,602.75 ","$1,816.45 ","$1,816.45 ","$1,651.95 ","$1,816.45 ","$1,651.95 ","$1,688.23 ","$1,688.23 ","$1,688.23 ","$1,923.30 ","$2,137.00 ","$1,923.30 ","$1,651.95 ","$2,137.00 ","$1,399.74 ","$1,651.95 ",$927.46 , N/A ,"$1,729.07 ","$1,923.30 ","$3,580.00 ","$1,348.45 ","$1,282.20 ","$1,923.30 ","$1,651.95 ","$1,923.30 ","$1,923.30 ","$1,651.95 ","$1,389.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000533,32557,HC PLEURAL DRAINAGE W/IMAGING 32557,320,1 ,"$3,347.00 ","$2,175.55 ","$1,429.44 ","$3,347.00 ","$2,493.52 ","$2,192.29 ","$1,429.44 ","$1,763.87 ","$1,429.44 ","$2,111.96 ","$2,111.96 ","$2,111.96 ","$2,111.96 ","$3,012.30 ","$2,510.25 ","$1,429.44 ","$2,945.36 ","$1,429.44 ","$2,510.25 ","$2,510.25 ","$2,844.95 ","$2,844.95 ","$1,429.44 ","$2,844.95 ","$1,429.44 ","$2,644.13 ","$2,644.13 ","$2,644.13 ","$3,012.30 ","$3,347.00 ","$3,012.30 ","$1,429.44 ","$3,347.00 ","$2,192.29 ","$1,429.44 ","$1,452.60 ", N/A ,"$1,496.18 ","$3,012.30 ","$3,097.79 ","$2,111.96 ","$2,008.20 ","$3,012.30 ","$1,429.44 ","$3,012.30 ","$3,012.30 ","$1,429.44 ","$2,175.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000542,20551,HC INJ TENDON ORIGIN,320,1 ,$750.45 ,$487.79 ,$265.50 ,$750.45 ,$559.09 ,$491.54 ,$265.50 ,$395.49 ,$265.50 ,$473.53 ,$473.53 ,$473.53 ,$473.53 ,$675.41 ,$562.84 ,$265.50 ,$660.40 ,$265.50 ,$562.84 ,$562.84 ,$637.88 ,$637.88 ,$265.50 ,$637.88 ,$265.50 ,$592.86 ,$592.86 ,$592.86 ,$675.41 ,$637.34 ,$675.41 ,$265.50 ,$750.45 ,$491.54 ,$265.50 ,$325.70 , N/A ,$277.89 ,$675.41 ,$575.37 ,$473.53 ,$450.27 ,$675.41 ,$265.50 ,$675.41 ,$675.41 ,$265.50 ,$487.79 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000551,77077,HC XR JOINT SRVY SINGLE 2 JOINTS,320,1 ,$318.00 ,$206.70 ,$110.78 ,$318.00 ,$236.91 ,$208.29 ,$110.78 ,$167.59 ,$110.78 ,$200.66 ,$200.66 ,$200.66 ,$200.66 ,$286.20 ,$238.50 ,$110.78 ,$279.84 ,$110.78 ,$238.50 ,$238.50 ,$270.30 ,$270.30 ,$110.78 ,$270.30 ,$110.78 ,$251.22 ,$251.22 ,$251.22 ,$286.20 ,$265.92 ,$286.20 ,$110.78 ,$318.00 ,$208.29 ,$110.78 ,$138.01 , N/A ,$115.95 ,$286.20 ,$240.07 ,$200.66 ,$190.80 ,$286.20 ,$110.78 ,$286.20 ,$286.20 ,$110.78 ,$206.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000552,70100,HC XR MANDIBLE <3V,320,1 ,$490.00 ,$318.50 ,$82.24 ,$490.00 ,$365.05 ,$320.95 ,$82.24 ,$258.23 ,$82.24 ,$309.19 ,$309.19 ,$309.19 ,$309.19 ,$441.00 ,$367.50 ,$82.24 ,$431.20 ,$82.24 ,$367.50 ,$367.50 ,$416.50 ,$416.50 ,$82.24 ,$416.50 ,$82.24 ,$387.10 ,$387.10 ,$387.10 ,$441.00 ,$197.42 ,$441.00 ,$82.24 ,$490.00 ,$320.95 ,$82.24 ,$212.66 , N/A ,$86.08 ,$441.00 ,$178.23 ,$309.19 ,$294.00 ,$441.00 ,$82.24 ,$441.00 ,$441.00 ,$82.24 ,$318.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000561,49405,HC ABSCESS DRAIN KIDN/LIV/SPLN/LUNG VISERAL 49405,320,1 ,"$2,924.00 ","$1,900.60 ","$1,269.02 ","$3,099.69 ","$2,178.38 ","$1,915.22 ","$1,430.32 ","$1,540.95 ","$1,430.32 ","$1,845.04 ","$1,845.04 ","$1,845.04 ","$1,845.04 ","$2,631.60 ","$2,193.00 ","$1,430.32 ","$2,573.12 ","$1,430.32 ","$2,193.00 ","$2,193.00 ","$2,485.40 ","$2,485.40 ","$1,430.32 ","$2,485.40 ","$1,430.32 ","$2,309.96 ","$2,309.96 ","$2,309.96 ","$2,631.60 ","$2,924.00 ","$2,631.60 ","$1,430.32 ","$2,924.00 ","$1,915.22 ","$1,430.32 ","$1,269.02 ", N/A ,"$1,497.09 ","$2,631.60 ","$3,099.69 ","$1,845.04 ","$1,754.40 ","$2,631.60 ","$1,430.32 ","$2,631.60 ","$2,631.60 ","$1,430.32 ","$1,900.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000562,49406,HC ABSCESS DRAIN PERI/ RETROPER PERC 49406,320,1 ,"$4,043.00 ","$2,627.95 ","$1,430.32 ","$4,043.00 ","$3,012.04 ","$2,648.17 ","$1,430.32 ","$2,130.66 ","$1,430.32 ","$2,551.13 ","$2,551.13 ","$2,551.13 ","$2,551.13 ","$3,638.70 ","$3,032.25 ","$1,430.32 ","$3,557.84 ","$1,430.32 ","$3,032.25 ","$3,032.25 ","$3,436.55 ","$3,436.55 ","$1,430.32 ","$3,436.55 ","$1,430.32 ","$3,193.97 ","$3,193.97 ","$3,193.97 ","$3,638.70 ","$3,433.56 ","$3,638.70 ","$1,430.32 ","$4,043.00 ","$2,648.17 ","$1,430.32 ","$1,754.66 ", N/A ,"$1,497.09 ","$3,638.70 ","$3,099.69 ","$2,551.13 ","$2,425.80 ","$3,638.70 ","$1,430.32 ","$3,638.70 ","$3,638.70 ","$1,430.32 ","$2,627.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000567,70100,HC XR MANDIBLE 1-3 VIEW,320,1 ,$490.00 ,$318.50 ,$82.24 ,$490.00 ,$365.05 ,$320.95 ,$82.24 ,$258.23 ,$82.24 ,$309.19 ,$309.19 ,$309.19 ,$309.19 ,$441.00 ,$367.50 ,$82.24 ,$431.20 ,$82.24 ,$367.50 ,$367.50 ,$416.50 ,$416.50 ,$82.24 ,$416.50 ,$82.24 ,$387.10 ,$387.10 ,$387.10 ,$441.00 ,$197.42 ,$441.00 ,$82.24 ,$490.00 ,$320.95 ,$82.24 ,$212.66 , N/A ,$86.08 ,$441.00 ,$178.23 ,$309.19 ,$294.00 ,$441.00 ,$82.24 ,$441.00 ,$441.00 ,$82.24 ,$318.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000570,72081,HC XR SPINE/CERV SCOLIOSIS 1 VW,320,1 ,$278.00 ,$180.70 ,$82.24 ,$278.00 ,$207.11 ,$182.09 ,$82.24 ,$146.51 ,$82.24 ,$175.42 ,$175.42 ,$175.42 ,$175.42 ,$250.20 ,$208.50 ,$82.24 ,$244.64 ,$82.24 ,$208.50 ,$208.50 ,$236.30 ,$236.30 ,$82.24 ,$236.30 ,$82.24 ,$219.62 ,$219.62 ,$219.62 ,$250.20 ,$197.42 ,$250.20 ,$82.24 ,$278.00 ,$182.09 ,$82.24 ,$120.65 , N/A ,$86.08 ,$250.20 ,$178.23 ,$175.42 ,$166.80 ,$250.20 ,$82.24 ,$250.20 ,$250.20 ,$82.24 ,$180.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000571,72082,HC XR SPINE/CERV SCOLIOSIS 2-3VW,320,1 ,$459.00 ,$298.35 ,$110.78 ,$459.00 ,$341.96 ,$300.65 ,$110.78 ,$241.89 ,$110.78 ,$289.63 ,$289.63 ,$289.63 ,$289.63 ,$413.10 ,$344.25 ,$110.78 ,$403.92 ,$110.78 ,$344.25 ,$344.25 ,$390.15 ,$390.15 ,$110.78 ,$390.15 ,$110.78 ,$362.61 ,$362.61 ,$362.61 ,$413.10 ,$265.92 ,$413.10 ,$110.78 ,$459.00 ,$300.65 ,$110.78 ,$199.21 , N/A ,$115.95 ,$413.10 ,$240.07 ,$289.63 ,$275.40 ,$413.10 ,$110.78 ,$413.10 ,$413.10 ,$110.78 ,$298.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000572,72083,HC XR SPINE/CERV SCOLIOSIS 4-5VW,320,1 ,$813.00 ,$528.45 ,$110.78 ,$813.00 ,$605.69 ,$532.52 ,$110.78 ,$428.45 ,$110.78 ,$513.00 ,$513.00 ,$513.00 ,$513.00 ,$731.70 ,$609.75 ,$110.78 ,$715.44 ,$110.78 ,$609.75 ,$609.75 ,$691.05 ,$691.05 ,$110.78 ,$691.05 ,$110.78 ,$642.27 ,$642.27 ,$642.27 ,$731.70 ,$265.92 ,$731.70 ,$110.78 ,$813.00 ,$532.52 ,$110.78 ,$352.84 , N/A ,$115.95 ,$731.70 ,$240.07 ,$513.00 ,$487.80 ,$731.70 ,$110.78 ,$731.70 ,$731.70 ,$110.78 ,$528.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000574,73501,HC XR HIP W/PELVIS UNI 1VIEW,320,1 ,$278.00 ,$180.70 ,$82.24 ,$278.00 ,$207.11 ,$182.09 ,$82.24 ,$146.51 ,$82.24 ,$175.42 ,$175.42 ,$175.42 ,$175.42 ,$250.20 ,$208.50 ,$82.24 ,$244.64 ,$82.24 ,$208.50 ,$208.50 ,$236.30 ,$236.30 ,$82.24 ,$236.30 ,$82.24 ,$219.62 ,$219.62 ,$219.62 ,$250.20 ,$197.42 ,$250.20 ,$82.24 ,$278.00 ,$182.09 ,$82.24 ,$120.65 , N/A ,$86.08 ,$250.20 ,$178.23 ,$175.42 ,$166.80 ,$250.20 ,$82.24 ,$250.20 ,$250.20 ,$82.24 ,$180.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000575,73502,HC XR HIP W/PELVIS UNI 2-3VWS,320,1 ,$278.00 ,$180.70 ,$82.24 ,$278.00 ,$207.11 ,$182.09 ,$82.24 ,$146.51 ,$82.24 ,$175.42 ,$175.42 ,$175.42 ,$175.42 ,$250.20 ,$208.50 ,$82.24 ,$244.64 ,$82.24 ,$208.50 ,$208.50 ,$236.30 ,$236.30 ,$82.24 ,$236.30 ,$82.24 ,$219.62 ,$219.62 ,$219.62 ,$250.20 ,$197.42 ,$250.20 ,$82.24 ,$278.00 ,$182.09 ,$82.24 ,$120.65 , N/A ,$86.08 ,$250.20 ,$178.23 ,$175.42 ,$166.80 ,$250.20 ,$82.24 ,$250.20 ,$250.20 ,$82.24 ,$180.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000576,73503,HC XR HIP W/PELVIS UNI 4+VWS,320,1 ,$321.30 ,$208.85 ,$110.78 ,$321.30 ,$239.37 ,$210.45 ,$110.78 ,$169.33 ,$110.78 ,$202.74 ,$202.74 ,$202.74 ,$202.74 ,$289.17 ,$240.98 ,$110.78 ,$282.74 ,$110.78 ,$240.98 ,$240.98 ,$273.11 ,$273.11 ,$110.78 ,$273.11 ,$110.78 ,$253.83 ,$253.83 ,$253.83 ,$289.17 ,$265.92 ,$289.17 ,$110.78 ,$321.30 ,$210.45 ,$110.78 ,$139.44 , N/A ,$115.95 ,$289.17 ,$240.07 ,$202.74 ,$192.78 ,$289.17 ,$110.78 ,$289.17 ,$289.17 ,$110.78 ,$208.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000577,73521,HC XR HIP W/PELVIS BIL 2 VIEWS,320,1 ,$517.00 ,$336.05 ,$110.78 ,$517.00 ,$385.17 ,$338.64 ,$110.78 ,$272.46 ,$110.78 ,$326.23 ,$326.23 ,$326.23 ,$326.23 ,$465.30 ,$387.75 ,$110.78 ,$454.96 ,$110.78 ,$387.75 ,$387.75 ,$439.45 ,$439.45 ,$110.78 ,$439.45 ,$110.78 ,$408.43 ,$408.43 ,$408.43 ,$465.30 ,$265.92 ,$465.30 ,$110.78 ,$517.00 ,$338.64 ,$110.78 ,$224.38 , N/A ,$115.95 ,$465.30 ,$240.07 ,$326.23 ,$310.20 ,$465.30 ,$110.78 ,$465.30 ,$465.30 ,$110.78 ,$336.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000578,73522,HC XR HIP W/PELVIS BIL 3-4VIEWS,320,1 ,$517.00 ,$336.05 ,$110.78 ,$517.00 ,$385.17 ,$338.64 ,$110.78 ,$272.46 ,$110.78 ,$326.23 ,$326.23 ,$326.23 ,$326.23 ,$465.30 ,$387.75 ,$110.78 ,$454.96 ,$110.78 ,$387.75 ,$387.75 ,$439.45 ,$439.45 ,$110.78 ,$439.45 ,$110.78 ,$408.43 ,$408.43 ,$408.43 ,$465.30 ,$265.92 ,$465.30 ,$110.78 ,$517.00 ,$338.64 ,$110.78 ,$224.38 , N/A ,$115.95 ,$465.30 ,$240.07 ,$326.23 ,$310.20 ,$465.30 ,$110.78 ,$465.30 ,$465.30 ,$110.78 ,$336.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000579,73523,HC XR HIP W/PELVIS BIL 5+VIEWS,320,1 ,$517.00 ,$336.05 ,$110.78 ,$517.00 ,$385.17 ,$338.64 ,$110.78 ,$272.46 ,$110.78 ,$326.23 ,$326.23 ,$326.23 ,$326.23 ,$465.30 ,$387.75 ,$110.78 ,$454.96 ,$110.78 ,$387.75 ,$387.75 ,$439.45 ,$439.45 ,$110.78 ,$439.45 ,$110.78 ,$408.43 ,$408.43 ,$408.43 ,$465.30 ,$265.92 ,$465.30 ,$110.78 ,$517.00 ,$338.64 ,$110.78 ,$224.38 , N/A ,$115.95 ,$465.30 ,$240.07 ,$326.23 ,$310.20 ,$465.30 ,$110.78 ,$465.30 ,$465.30 ,$110.78 ,$336.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000580,73551,HC XR FEMUR 1VIEW,320,1 ,$278.00 ,$180.70 ,$82.24 ,$278.00 ,$207.11 ,$182.09 ,$82.24 ,$146.51 ,$82.24 ,$175.42 ,$175.42 ,$175.42 ,$175.42 ,$250.20 ,$208.50 ,$82.24 ,$244.64 ,$82.24 ,$208.50 ,$208.50 ,$236.30 ,$236.30 ,$82.24 ,$236.30 ,$82.24 ,$219.62 ,$219.62 ,$219.62 ,$250.20 ,$197.42 ,$250.20 ,$82.24 ,$278.00 ,$182.09 ,$82.24 ,$120.65 , N/A ,$86.08 ,$250.20 ,$178.23 ,$175.42 ,$166.80 ,$250.20 ,$82.24 ,$250.20 ,$250.20 ,$82.24 ,$180.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000580,73551,HC XR FEMUR 1VIEW,320,1 ,$417.00 ,$271.05 ,$82.24 ,$417.00 ,$310.67 ,$273.14 ,$82.24 ,$219.76 ,$82.24 ,$263.13 ,$263.13 ,$263.13 ,$263.13 ,$375.30 ,$312.75 ,$82.24 ,$366.96 ,$82.24 ,$312.75 ,$312.75 ,$354.45 ,$354.45 ,$82.24 ,$354.45 ,$82.24 ,$329.43 ,$329.43 ,$329.43 ,$375.30 ,$197.42 ,$375.30 ,$82.24 ,$417.00 ,$273.14 ,$82.24 ,$180.98 , N/A ,$86.08 ,$375.30 ,$178.23 ,$263.13 ,$250.20 ,$375.30 ,$82.24 ,$375.30 ,$375.30 ,$82.24 ,$271.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000581,73552,HC XR FEMUR 2+VIEWS,320,1 ,$278.00 ,$180.70 ,$82.24 ,$278.00 ,$207.11 ,$182.09 ,$82.24 ,$146.51 ,$82.24 ,$175.42 ,$175.42 ,$175.42 ,$175.42 ,$250.20 ,$208.50 ,$82.24 ,$244.64 ,$82.24 ,$208.50 ,$208.50 ,$236.30 ,$236.30 ,$82.24 ,$236.30 ,$82.24 ,$219.62 ,$219.62 ,$219.62 ,$250.20 ,$197.42 ,$250.20 ,$82.24 ,$278.00 ,$182.09 ,$82.24 ,$120.65 , N/A ,$86.08 ,$250.20 ,$178.23 ,$175.42 ,$166.80 ,$250.20 ,$82.24 ,$250.20 ,$250.20 ,$82.24 ,$180.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000581,73552,HC XR FEMUR 2+VIEWS,320,1 ,$417.00 ,$271.05 ,$82.24 ,$417.00 ,$310.67 ,$273.14 ,$82.24 ,$219.76 ,$82.24 ,$263.13 ,$263.13 ,$263.13 ,$263.13 ,$375.30 ,$312.75 ,$82.24 ,$366.96 ,$82.24 ,$312.75 ,$312.75 ,$354.45 ,$354.45 ,$82.24 ,$354.45 ,$82.24 ,$329.43 ,$329.43 ,$329.43 ,$375.30 ,$197.42 ,$375.30 ,$82.24 ,$417.00 ,$273.14 ,$82.24 ,$180.98 , N/A ,$86.08 ,$375.30 ,$178.23 ,$263.13 ,$250.20 ,$375.30 ,$82.24 ,$375.30 ,$375.30 ,$82.24 ,$271.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000589,74019,HC XR ABDOMEN 2V,320,1 ,$574.00 ,$373.10 ,$110.78 ,$574.00 ,$427.63 ,$375.97 ,$110.78 ,$302.50 ,$110.78 ,$362.19 ,$362.19 ,$362.19 ,$362.19 ,$516.60 ,$430.50 ,$110.78 ,$505.12 ,$110.78 ,$430.50 ,$430.50 ,$487.90 ,$487.90 ,$110.78 ,$487.90 ,$110.78 ,$453.46 ,$453.46 ,$453.46 ,$516.60 ,$265.92 ,$516.60 ,$110.78 ,$574.00 ,$375.97 ,$110.78 ,$249.12 , N/A ,$115.95 ,$516.60 ,$240.07 ,$362.19 ,$344.40 ,$516.60 ,$110.78 ,$516.60 ,$516.60 ,$110.78 ,$373.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000595,76000,HC FLUOROSCOPY >1HR,320,1 ,$822.00 ,$534.30 ,$233.94 ,$822.00 ,$612.39 ,$538.41 ,$233.94 ,$433.19 ,$233.94 ,$518.68 ,$518.68 ,$518.68 ,$518.68 ,$739.80 ,$616.50 ,$233.94 ,$723.36 ,$233.94 ,$616.50 ,$616.50 ,$698.70 ,$698.70 ,$233.94 ,$698.70 ,$233.94 ,$649.38 ,$649.38 ,$649.38 ,$739.80 ,$561.60 ,$739.80 ,$233.94 ,$822.00 ,$538.41 ,$233.94 ,$356.75 , N/A ,$244.87 ,$739.80 ,$506.99 ,$518.68 ,$493.20 ,$739.80 ,$233.94 ,$739.80 ,$739.80 ,$233.94 ,$534.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000609,50432,HC PERCUTANEOUS NEPHRO CATH PLCMT-BIL,320,1 ,"$6,376.00 ","$4,144.40 ","$1,822.70 ","$6,376.00 ","$4,750.12 ","$4,176.28 ","$1,822.70 ","$3,360.15 ","$1,822.70 ","$4,023.26 ","$4,023.26 ","$4,023.26 ","$4,023.26 ","$5,738.40 ","$4,782.00 ","$1,822.70 ","$5,610.88 ","$1,822.70 ","$4,782.00 ","$4,782.00 ","$5,419.60 ","$5,419.60 ","$1,822.70 ","$5,419.60 ","$1,822.70 ","$5,037.04 ","$5,037.04 ","$5,037.04 ","$5,738.40 ","$4,375.51 ","$5,738.40 ","$1,822.70 ","$6,376.00 ","$4,176.28 ","$1,822.70 ","$2,767.18 ", N/A ,"$1,907.80 ","$5,738.40 ","$3,950.04 ","$4,023.26 ","$3,825.60 ","$5,738.40 ","$1,822.70 ","$5,738.40 ","$5,738.40 ","$1,822.70 ","$4,144.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000611,G1004,HC RAD AUC CDSM NATL DECISION SUPPORT COMPANY,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000612,74248,HC XRAY SMALL INTESTINE FOLLOW THRU STUDY,320,1 ,"$1,575.00 ","$1,023.75 ",$683.55 ,"$1,575.00 ","$1,173.38 ","$1,031.63 ", N/A ,$830.03 , N/A ,$993.83 ,$993.83 ,$993.83 ,$993.83 ,"$1,417.50 ","$1,181.25 ", N/A ,"$1,386.00 ", N/A ,"$1,181.25 ","$1,181.25 ","$1,338.75 ","$1,338.75 ", N/A ,"$1,338.75 ", N/A ,"$1,244.25 ","$1,244.25 ","$1,244.25 ","$1,417.50 ", N/A ,"$1,417.50 ", N/A ,"$1,575.00 ","$1,031.63 ", N/A ,$683.55 , N/A , N/A ,"$1,417.50 ", N/A ,$993.83 ,$945.00 ,"$1,417.50 ", N/A ,"$1,417.50 ","$1,417.50 ", N/A ,"$1,023.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000613,G1002,HC RAD AUC CDSM MEDCURRENT,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000614,G1003,HC RAD AUC CDSM MEDICALIS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000615,G1005,HC RAD AUC CDSM NATIONAL IMAGING ASSOCIATES,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000616,G1006,HC RAD AUC CDSM TEST APPROPRIATE,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000617,G1007,HC RAD AUC CDSM AIM SPECIALTY HEALTH,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000618,G1008,HC RAD AUC CDSM CRANBERRY PEAK,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000619,G1009,HC RAD AUC CDSM SAGE HEALTH MGMT SOLUTIONS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000620,G1010,HC RAD AUC CDSM STANSON,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000621,G1011,HC RAD AUC CDSM QUALIFIED TOOL NOS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000622,G1000,HC RAD AUC CDSM APPLIED PATHWAYS,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),32000623,G1001,HC RAD AUC CDSM EVICORE,320,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),33500002,96401,HC CHEMO SQ/IM NON ANTI-NEOPLAST,335,1 ,$126.00 ,$81.90 ,$54.68 ,$136.52 ,$93.87 ,$82.53 ,$63.00 ,$66.40 ,$63.00 ,$79.51 ,$79.51 ,$79.51 ,$79.51 ,$113.40 ,$94.50 ,$63.00 ,$110.88 ,$63.00 ,$94.50 ,$94.50 ,$107.10 ,$107.10 ,$63.00 ,$107.10 ,$63.00 ,$99.54 ,$99.54 ,$99.54 ,$113.40 ,$126.00 ,$113.40 ,$63.00 ,$126.00 ,$82.53 ,$63.00 ,$54.68 , N/A ,$65.94 ,$113.40 ,$136.52 ,$79.51 ,$75.60 ,$113.40 ,$63.00 ,$113.40 ,$113.40 ,$63.00 ,$81.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),33500003,96409,HC CHEMO IV PUSH SINGLE/INIT,335,1 ,$252.00 ,$163.80 ,$109.37 ,$448.32 ,$187.74 ,$165.06 ,$206.87 ,$132.80 ,$206.87 ,$159.01 ,$159.01 ,$159.01 ,$159.01 ,$226.80 ,$189.00 ,$206.87 ,$221.76 ,$206.87 ,$189.00 ,$189.00 ,$214.20 ,$214.20 ,$206.87 ,$214.20 ,$206.87 ,$199.08 ,$199.08 ,$199.08 ,$226.80 ,$252.00 ,$226.80 ,$206.87 ,$252.00 ,$165.06 ,$206.87 ,$109.37 , N/A ,$216.53 ,$226.80 ,$448.32 ,$159.01 ,$151.20 ,$226.80 ,$206.87 ,$226.80 ,$226.80 ,$206.87 ,$163.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),33500004,96411,HC CHEMO IV PUSH ADDL DRUG,335,1 ,$252.00 ,$163.80 ,$63.00 ,$252.00 ,$187.74 ,$165.06 ,$63.00 ,$132.80 ,$63.00 ,$159.01 ,$159.01 ,$159.01 ,$159.01 ,$226.80 ,$189.00 ,$63.00 ,$221.76 ,$63.00 ,$189.00 ,$189.00 ,$214.20 ,$214.20 ,$63.00 ,$214.20 ,$63.00 ,$199.08 ,$199.08 ,$199.08 ,$226.80 ,$151.23 ,$226.80 ,$63.00 ,$252.00 ,$165.06 ,$63.00 ,$109.37 , N/A ,$65.94 ,$226.80 ,$136.52 ,$159.01 ,$151.20 ,$226.80 ,$63.00 ,$226.80 ,$226.80 ,$63.00 ,$163.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),33500005,96413,HC CHEMO IV INFUSION SGL/INIT<1H,335,1 ,$390.00 ,$253.50 ,$169.26 ,$684.60 ,$290.55 ,$255.45 ,$315.90 ,$205.53 ,$315.90 ,$246.09 ,$246.09 ,$246.09 ,$246.09 ,$351.00 ,$292.50 ,$315.90 ,$343.20 ,$315.90 ,$292.50 ,$292.50 ,$331.50 ,$331.50 ,$315.90 ,$331.50 ,$315.90 ,$308.10 ,$308.10 ,$308.10 ,$351.00 ,$390.00 ,$351.00 ,$315.90 ,$390.00 ,$255.45 ,$315.90 ,$169.26 , N/A ,$330.65 ,$351.00 ,$684.60 ,$246.09 ,$234.00 ,$351.00 ,$315.90 ,$351.00 ,$351.00 ,$315.90 ,$253.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),33500006,96415,HC CHEMO IV INFUSION ADDL HR,335,1 ,$126.00 ,$81.90 ,$54.68 ,$136.52 ,$93.87 ,$82.53 ,$63.00 ,$66.40 ,$63.00 ,$79.51 ,$79.51 ,$79.51 ,$79.51 ,$113.40 ,$94.50 ,$63.00 ,$110.88 ,$63.00 ,$94.50 ,$94.50 ,$107.10 ,$107.10 ,$63.00 ,$107.10 ,$63.00 ,$99.54 ,$99.54 ,$99.54 ,$113.40 ,$126.00 ,$113.40 ,$63.00 ,$126.00 ,$82.53 ,$63.00 ,$54.68 , N/A ,$65.94 ,$113.40 ,$136.52 ,$79.51 ,$75.60 ,$113.40 ,$63.00 ,$113.40 ,$113.40 ,$63.00 ,$81.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),33500008,96417,HC CHEMO IV INFUSION EA ADDL <1H,335,1 ,$190.00 ,$123.50 ,$63.00 ,$190.00 ,$141.55 ,$124.45 ,$63.00 ,$100.13 ,$63.00 ,$119.89 ,$119.89 ,$119.89 ,$119.89 ,$171.00 ,$142.50 ,$63.00 ,$167.20 ,$63.00 ,$142.50 ,$142.50 ,$161.50 ,$161.50 ,$63.00 ,$161.50 ,$63.00 ,$150.10 ,$150.10 ,$150.10 ,$171.00 ,$151.23 ,$171.00 ,$63.00 ,$190.00 ,$124.45 ,$63.00 ,$82.46 , N/A ,$65.94 ,$171.00 ,$136.52 ,$119.89 ,$114.00 ,$171.00 ,$63.00 ,$171.00 ,$171.00 ,$63.00 ,$123.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),33500013,96402,HC CHEMOTHERAPY INJECTION-HORMONAL ANTI-NEO,335,1 ,$126.00 ,$81.90 ,$54.68 ,$136.52 ,$93.87 ,$82.53 ,$63.00 ,$66.40 ,$63.00 ,$79.51 ,$79.51 ,$79.51 ,$79.51 ,$113.40 ,$94.50 ,$63.00 ,$110.88 ,$63.00 ,$94.50 ,$94.50 ,$107.10 ,$107.10 ,$63.00 ,$107.10 ,$63.00 ,$99.54 ,$99.54 ,$99.54 ,$113.40 ,$126.00 ,$113.40 ,$63.00 ,$126.00 ,$82.53 ,$63.00 ,$54.68 , N/A ,$65.94 ,$113.40 ,$136.52 ,$79.51 ,$75.60 ,$113.40 ,$63.00 ,$113.40 ,$113.40 ,$63.00 ,$81.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000004,78014,HC NM THYROID IMAGING SGL OR MULT UPTAKE 78014,340,1 ,"$1,693.00 ","$1,100.45 ",$383.37 ,"$1,693.00 ","$1,261.29 ","$1,108.92 ",$383.37 ,$892.21 ,$383.37 ,"$1,068.28 ","$1,068.28 ","$1,068.28 ","$1,068.28 ","$1,523.70 ","$1,269.75 ",$383.37 ,"$1,489.84 ",$383.37 ,"$1,269.75 ","$1,269.75 ","$1,439.05 ","$1,439.05 ",$383.37 ,"$1,439.05 ",$383.37 ,"$1,337.47 ","$1,337.47 ","$1,337.47 ","$1,523.70 ",$920.30 ,"$1,523.70 ",$383.37 ,"$1,693.00 ","$1,108.92 ",$383.37 ,$734.76 , N/A ,$401.27 ,"$1,523.70 ",$830.81 ,"$1,068.28 ","$1,015.80 ","$1,523.70 ",$383.37 ,"$1,523.70 ","$1,523.70 ",$383.37 ,"$1,100.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000007,78018,HC NM THYROID CA METS WHOLE BODY,340,1 ,"$1,642.00 ","$1,067.30 ",$497.51 ,"$1,642.00 ","$1,223.29 ","$1,075.51 ",$497.51 ,$865.33 ,$497.51 ,"$1,036.10 ","$1,036.10 ","$1,036.10 ","$1,036.10 ","$1,477.80 ","$1,231.50 ",$497.51 ,"$1,444.96 ",$497.51 ,"$1,231.50 ","$1,231.50 ","$1,395.70 ","$1,395.70 ",$497.51 ,"$1,395.70 ",$497.51 ,"$1,297.18 ","$1,297.18 ","$1,297.18 ","$1,477.80 ","$1,194.30 ","$1,477.80 ",$497.51 ,"$1,642.00 ","$1,075.51 ",$497.51 ,$712.63 , N/A ,$520.74 ,"$1,477.80 ","$1,078.17 ","$1,036.10 ",$985.20 ,"$1,477.80 ",$497.51 ,"$1,477.80 ","$1,477.80 ",$497.51 ,"$1,067.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000014,78195,HC LYMPH NODE IMAGING,340,1 ,"$1,883.00 ","$1,223.95 ",$497.51 ,"$1,883.00 ","$1,402.84 ","$1,233.37 ",$497.51 ,$992.34 ,$497.51 ,"$1,188.17 ","$1,188.17 ","$1,188.17 ","$1,188.17 ","$1,694.70 ","$1,412.25 ",$497.51 ,"$1,657.04 ",$497.51 ,"$1,412.25 ","$1,412.25 ","$1,600.55 ","$1,600.55 ",$497.51 ,"$1,600.55 ",$497.51 ,"$1,487.57 ","$1,487.57 ","$1,487.57 ","$1,694.70 ","$1,194.30 ","$1,694.70 ",$497.51 ,"$1,883.00 ","$1,233.37 ",$497.51 ,$817.22 , N/A ,$520.74 ,"$1,694.70 ","$1,078.17 ","$1,188.17 ","$1,129.80 ","$1,694.70 ",$497.51 ,"$1,694.70 ","$1,694.70 ",$497.51 ,"$1,223.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000017,78205,HC LIVER IMAGING SPECT,340,1 ,"$1,239.00 ",$805.35 ,$537.73 ,"$1,239.00 ",$923.06 ,$811.55 , N/A ,$652.95 , N/A ,$781.81 ,$781.81 ,$781.81 ,$781.81 ,"$1,115.10 ",$929.25 , N/A ,"$1,090.32 ", N/A ,$929.25 ,$929.25 ,"$1,053.15 ","$1,053.15 ", N/A ,"$1,053.15 ", N/A ,$978.81 ,$978.81 ,$978.81 ,"$1,115.10 ", N/A ,"$1,115.10 ", N/A ,"$1,239.00 ",$811.55 , N/A ,$537.73 , N/A , N/A ,"$1,115.10 ", N/A ,$781.81 ,$743.40 ,"$1,115.10 ", N/A ,"$1,115.10 ","$1,115.10 ", N/A ,$805.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000019,78215,HC LIVER SPLEEN STATIC,340,1 ,$981.00 ,$637.65 ,$383.37 ,$981.00 ,$730.85 ,$642.56 ,$383.37 ,$516.99 ,$383.37 ,$619.01 ,$619.01 ,$619.01 ,$619.01 ,$882.90 ,$735.75 ,$383.37 ,$863.28 ,$383.37 ,$735.75 ,$735.75 ,$833.85 ,$833.85 ,$383.37 ,$833.85 ,$383.37 ,$774.99 ,$774.99 ,$774.99 ,$882.90 ,$920.30 ,$882.90 ,$383.37 ,$981.00 ,$642.56 ,$383.37 ,$425.75 , N/A ,$401.27 ,$882.90 ,$830.81 ,$619.01 ,$588.60 ,$882.90 ,$383.37 ,$882.90 ,$882.90 ,$383.37 ,$637.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000022,78226,HC HEPATOBILIARY SCAN,340,1 ,"$1,638.00 ","$1,064.70 ",$383.37 ,"$1,638.00 ","$1,220.31 ","$1,072.89 ",$383.37 ,$863.23 ,$383.37 ,"$1,033.58 ","$1,033.58 ","$1,033.58 ","$1,033.58 ","$1,474.20 ","$1,228.50 ",$383.37 ,"$1,441.44 ",$383.37 ,"$1,228.50 ","$1,228.50 ","$1,392.30 ","$1,392.30 ",$383.37 ,"$1,392.30 ",$383.37 ,"$1,294.02 ","$1,294.02 ","$1,294.02 ","$1,474.20 ",$920.30 ,"$1,474.20 ",$383.37 ,"$1,638.00 ","$1,072.89 ",$383.37 ,$710.89 , N/A ,$401.27 ,"$1,474.20 ",$830.81 ,"$1,033.58 ",$982.80 ,"$1,474.20 ",$383.37 ,"$1,474.20 ","$1,474.20 ",$383.37 ,"$1,064.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000026,78264,HC GASTRIC EMPTYING STUDY,340,1 ,"$1,824.00 ","$1,185.60 ",$383.37 ,"$1,824.00 ","$1,358.88 ","$1,194.72 ",$383.37 ,$961.25 ,$383.37 ,"$1,150.94 ","$1,150.94 ","$1,150.94 ","$1,150.94 ","$1,641.60 ","$1,368.00 ",$383.37 ,"$1,605.12 ",$383.37 ,"$1,368.00 ","$1,368.00 ","$1,550.40 ","$1,550.40 ",$383.37 ,"$1,550.40 ",$383.37 ,"$1,440.96 ","$1,440.96 ","$1,440.96 ","$1,641.60 ",$920.30 ,"$1,641.60 ",$383.37 ,"$1,824.00 ","$1,194.72 ",$383.37 ,$791.62 , N/A ,$401.27 ,"$1,641.60 ",$830.81 ,"$1,150.94 ","$1,094.40 ","$1,641.60 ",$383.37 ,"$1,641.60 ","$1,641.60 ",$383.37 ,"$1,185.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000027,78278,HC GI BLEED SCAN,340,1 ,$915.00 ,$594.75 ,$383.37 ,$915.00 ,$681.68 ,$599.33 ,$383.37 ,$482.21 ,$383.37 ,$577.37 ,$577.37 ,$577.37 ,$577.37 ,$823.50 ,$686.25 ,$383.37 ,$805.20 ,$383.37 ,$686.25 ,$686.25 ,$777.75 ,$777.75 ,$383.37 ,$777.75 ,$383.37 ,$722.85 ,$722.85 ,$722.85 ,$823.50 ,$915.00 ,$823.50 ,$383.37 ,$915.00 ,$599.33 ,$383.37 ,$397.11 , N/A ,$401.27 ,$823.50 ,$830.81 ,$577.37 ,$549.00 ,$823.50 ,$383.37 ,$823.50 ,$823.50 ,$383.37 ,$594.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000028,78290,HC SM BOWEL MECKEL'S SCAN,340,1 ,"$1,102.00 ",$716.30 ,$383.37 ,"$1,102.00 ",$820.99 ,$721.81 ,$383.37 ,$580.75 ,$383.37 ,$695.36 ,$695.36 ,$695.36 ,$695.36 ,$991.80 ,$826.50 ,$383.37 ,$969.76 ,$383.37 ,$826.50 ,$826.50 ,$936.70 ,$936.70 ,$383.37 ,$936.70 ,$383.37 ,$870.58 ,$870.58 ,$870.58 ,$991.80 ,$920.30 ,$991.80 ,$383.37 ,"$1,102.00 ",$721.81 ,$383.37 ,$478.27 , N/A ,$401.27 ,$991.80 ,$830.81 ,$695.36 ,$661.20 ,$991.80 ,$383.37 ,$991.80 ,$991.80 ,$383.37 ,$716.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000029,78300,HC BONE SCAN LIMITED,340,1 ,"$1,122.00 ",$729.30 ,$383.37 ,"$1,122.00 ",$835.89 ,$734.91 ,$383.37 ,$591.29 ,$383.37 ,$707.98 ,$707.98 ,$707.98 ,$707.98 ,"$1,009.80 ",$841.50 ,$383.37 ,$987.36 ,$383.37 ,$841.50 ,$841.50 ,$953.70 ,$953.70 ,$383.37 ,$953.70 ,$383.37 ,$886.38 ,$886.38 ,$886.38 ,"$1,009.80 ",$920.30 ,"$1,009.80 ",$383.37 ,"$1,122.00 ",$734.91 ,$383.37 ,$486.95 , N/A ,$401.27 ,"$1,009.80 ",$830.81 ,$707.98 ,$673.20 ,"$1,009.80 ",$383.37 ,"$1,009.80 ","$1,009.80 ",$383.37 ,$729.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000030,78305,HC BONE SCAN MULTIPLE,340,1 ,"$1,333.00 ",$866.45 ,$383.37 ,"$1,333.00 ",$993.09 ,$873.12 ,$383.37 ,$702.49 ,$383.37 ,$841.12 ,$841.12 ,$841.12 ,$841.12 ,"$1,199.70 ",$999.75 ,$383.37 ,"$1,173.04 ",$383.37 ,$999.75 ,$999.75 ,"$1,133.05 ","$1,133.05 ",$383.37 ,"$1,133.05 ",$383.37 ,"$1,053.07 ","$1,053.07 ","$1,053.07 ","$1,199.70 ",$920.30 ,"$1,199.70 ",$383.37 ,"$1,333.00 ",$873.12 ,$383.37 ,$578.52 , N/A ,$401.27 ,"$1,199.70 ",$830.81 ,$841.12 ,$799.80 ,"$1,199.70 ",$383.37 ,"$1,199.70 ","$1,199.70 ",$383.37 ,$866.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000031,78306,HC BONE SCAN WHOLE BODY,340,1 ,"$1,504.00 ",$977.60 ,$383.37 ,"$1,504.00 ","$1,120.48 ",$985.12 ,$383.37 ,$792.61 ,$383.37 ,$949.02 ,$949.02 ,$949.02 ,$949.02 ,"$1,353.60 ","$1,128.00 ",$383.37 ,"$1,323.52 ",$383.37 ,"$1,128.00 ","$1,128.00 ","$1,278.40 ","$1,278.40 ",$383.37 ,"$1,278.40 ",$383.37 ,"$1,188.16 ","$1,188.16 ","$1,188.16 ","$1,353.60 ",$920.30 ,"$1,353.60 ",$383.37 ,"$1,504.00 ",$985.12 ,$383.37 ,$652.74 , N/A ,$401.27 ,"$1,353.60 ",$830.81 ,$949.02 ,$902.40 ,"$1,353.60 ",$383.37 ,"$1,353.60 ","$1,353.60 ",$383.37 ,$977.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000032,78315,HC BONE SCAN FLOW WHOLE BODY STATICS,340,1 ,"$1,752.00 ","$1,138.80 ",$383.37 ,"$1,752.00 ","$1,305.24 ","$1,147.56 ",$383.37 ,$923.30 ,$383.37 ,"$1,105.51 ","$1,105.51 ","$1,105.51 ","$1,105.51 ","$1,576.80 ","$1,314.00 ",$383.37 ,"$1,541.76 ",$383.37 ,"$1,314.00 ","$1,314.00 ","$1,489.20 ","$1,489.20 ",$383.37 ,"$1,489.20 ",$383.37 ,"$1,384.08 ","$1,384.08 ","$1,384.08 ","$1,576.80 ",$920.30 ,"$1,576.80 ",$383.37 ,"$1,752.00 ","$1,147.56 ",$383.37 ,$760.37 , N/A ,$401.27 ,"$1,576.80 ",$830.81 ,"$1,105.51 ","$1,051.20 ","$1,576.80 ",$383.37 ,"$1,576.80 ","$1,576.80 ",$383.37 ,"$1,138.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000033,78315,HC BONE SCAN/3 PHASE,340,1 ,"$1,752.00 ","$1,138.80 ",$383.37 ,"$1,752.00 ","$1,305.24 ","$1,147.56 ",$383.37 ,$923.30 ,$383.37 ,"$1,105.51 ","$1,105.51 ","$1,105.51 ","$1,105.51 ","$1,576.80 ","$1,314.00 ",$383.37 ,"$1,541.76 ",$383.37 ,"$1,314.00 ","$1,314.00 ","$1,489.20 ","$1,489.20 ",$383.37 ,"$1,489.20 ",$383.37 ,"$1,384.08 ","$1,384.08 ","$1,384.08 ","$1,576.80 ",$920.30 ,"$1,576.80 ",$383.37 ,"$1,752.00 ","$1,147.56 ",$383.37 ,$760.37 , N/A ,$401.27 ,"$1,576.80 ",$830.81 ,"$1,105.51 ","$1,051.20 ","$1,576.80 ",$383.37 ,"$1,576.80 ","$1,576.80 ",$383.37 ,"$1,138.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000033,78315,HC BONE SCAN/3 PHASE,340,1 ,"$1,582.00 ","$1,028.30 ",$191.68 ,"$1,582.00 ","$1,178.59 ","$1,036.21 ",$191.68 ,$833.71 ,$191.68 ,$998.24 ,$998.24 ,$998.24 ,$998.24 ,"$1,423.80 ","$1,186.50 ",$191.68 ,"$1,392.16 ",$191.68 ,"$1,186.50 ","$1,186.50 ","$1,344.70 ","$1,344.70 ",$191.68 ,"$1,344.70 ",$191.68 ,"$1,249.78 ","$1,249.78 ","$1,249.78 ","$1,423.80 ",$460.15 ,"$1,423.80 ",$191.68 ,"$1,582.00 ","$1,036.21 ",$191.68 ,$686.59 , N/A ,$200.63 ,"$1,423.80 ",$415.41 ,$998.24 ,$949.20 ,"$1,423.80 ",$191.68 ,"$1,423.80 ","$1,423.80 ",$191.68 ,"$1,028.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000034,78320,HC BONE SPECT,340,1 ,"$2,251.00 ","$1,463.15 ",$976.93 ,"$2,251.00 ","$1,677.00 ","$1,474.41 ", N/A ,"$1,186.28 ", N/A ,"$1,420.38 ","$1,420.38 ","$1,420.38 ","$1,420.38 ","$2,025.90 ","$1,688.25 ", N/A ,"$1,980.88 ", N/A ,"$1,688.25 ","$1,688.25 ","$1,913.35 ","$1,913.35 ", N/A ,"$1,913.35 ", N/A ,"$1,778.29 ","$1,778.29 ","$1,778.29 ","$2,025.90 ", N/A ,"$2,025.90 ", N/A ,"$2,251.00 ","$1,474.41 ", N/A ,$976.93 , N/A , N/A ,"$2,025.90 ", N/A ,"$1,420.38 ","$1,350.60 ","$2,025.90 ", N/A ,"$2,025.90 ","$2,025.90 ", N/A ,"$1,463.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000035,78451,HC HT MUSCLE IMAGE SPECT SINGLE,340,1 ,"$3,243.00 ","$2,107.95 ","$1,327.58 ","$3,243.00 ","$2,416.04 ","$2,124.17 ","$1,327.58 ","$1,709.06 ","$1,327.58 ","$2,046.33 ","$2,046.33 ","$2,046.33 ","$2,046.33 ","$2,918.70 ","$2,432.25 ","$1,327.58 ","$2,853.84 ","$1,327.58 ","$2,432.25 ","$2,432.25 ","$2,756.55 ","$2,756.55 ","$1,327.58 ","$2,756.55 ","$1,327.58 ","$2,561.97 ","$2,561.97 ","$2,561.97 ","$2,918.70 ","$3,186.94 ","$2,918.70 ","$1,327.58 ","$3,243.00 ","$2,124.17 ","$1,327.58 ","$1,407.46 ", N/A ,"$1,389.56 ","$2,918.70 ","$2,877.05 ","$2,046.33 ","$1,945.80 ","$2,918.70 ","$1,327.58 ","$2,918.70 ","$2,918.70 ","$1,327.58 ","$2,107.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000037,78452,HC HT MUSCLE IMAGE SPECT MULTI,340,1 ,"$6,485.00 ","$4,215.25 ","$1,327.58 ","$6,485.00 ","$4,831.33 ","$4,247.68 ","$1,327.58 ","$3,417.60 ","$1,327.58 ","$4,092.04 ","$4,092.04 ","$4,092.04 ","$4,092.04 ","$5,836.50 ","$4,863.75 ","$1,327.58 ","$5,706.80 ","$1,327.58 ","$4,863.75 ","$4,863.75 ","$5,512.25 ","$5,512.25 ","$1,327.58 ","$5,512.25 ","$1,327.58 ","$5,123.15 ","$5,123.15 ","$5,123.15 ","$5,836.50 ","$3,186.94 ","$5,836.50 ","$1,327.58 ","$6,485.00 ","$4,247.68 ","$1,327.58 ","$2,814.49 ", N/A ,"$1,389.56 ","$5,836.50 ","$2,877.05 ","$4,092.04 ","$3,891.00 ","$5,836.50 ","$1,327.58 ","$5,836.50 ","$5,836.50 ","$1,327.58 ","$4,215.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000044,78472,HC MUGA RESTING SGL,340,1 ,"$2,271.00 ","$1,476.15 ",$383.37 ,"$2,271.00 ","$1,691.90 ","$1,487.51 ",$383.37 ,"$1,196.82 ",$383.37 ,"$1,433.00 ","$1,433.00 ","$1,433.00 ","$1,433.00 ","$2,043.90 ","$1,703.25 ",$383.37 ,"$1,998.48 ",$383.37 ,"$1,703.25 ","$1,703.25 ","$1,930.35 ","$1,930.35 ",$383.37 ,"$1,930.35 ",$383.37 ,"$1,794.09 ","$1,794.09 ","$1,794.09 ","$2,043.90 ",$920.30 ,"$2,043.90 ",$383.37 ,"$2,271.00 ","$1,487.51 ",$383.37 ,$985.61 , N/A ,$401.27 ,"$2,043.90 ",$830.81 ,"$1,433.00 ","$1,362.60 ","$2,043.90 ",$383.37 ,"$2,043.90 ","$2,043.90 ",$383.37 ,"$1,476.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000047,78580,HC LUNG PERFUS,340,1 ,$964.00 ,$626.60 ,$383.37 ,$964.00 ,$718.18 ,$631.42 ,$383.37 ,$508.03 ,$383.37 ,$608.28 ,$608.28 ,$608.28 ,$608.28 ,$867.60 ,$723.00 ,$383.37 ,$848.32 ,$383.37 ,$723.00 ,$723.00 ,$819.40 ,$819.40 ,$383.37 ,$819.40 ,$383.37 ,$761.56 ,$761.56 ,$761.56 ,$867.60 ,$920.30 ,$867.60 ,$383.37 ,$964.00 ,$631.42 ,$383.37 ,$418.38 , N/A ,$401.27 ,$867.60 ,$830.81 ,$608.28 ,$578.40 ,$867.60 ,$383.37 ,$867.60 ,$867.60 ,$383.37 ,$626.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000048,78582,HC LUNG SCAN-VENT/PERF,340,1 ,"$1,499.00 ",$974.35 ,$497.51 ,"$1,499.00 ","$1,116.76 ",$981.85 ,$497.51 ,$789.97 ,$497.51 ,$945.87 ,$945.87 ,$945.87 ,$945.87 ,"$1,349.10 ","$1,124.25 ",$497.51 ,"$1,319.12 ",$497.51 ,"$1,124.25 ","$1,124.25 ","$1,274.15 ","$1,274.15 ",$497.51 ,"$1,274.15 ",$497.51 ,"$1,184.21 ","$1,184.21 ","$1,184.21 ","$1,349.10 ","$1,194.30 ","$1,349.10 ",$497.51 ,"$1,499.00 ",$981.85 ,$497.51 ,$650.57 , N/A ,$520.74 ,"$1,349.10 ","$1,078.17 ",$945.87 ,$899.40 ,"$1,349.10 ",$497.51 ,"$1,349.10 ","$1,349.10 ",$497.51 ,$974.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000058,78650,HC CSF LEAK DETECTION,340,1 ,"$3,492.00 ","$2,269.80 ","$1,327.58 ","$3,492.00 ","$2,601.54 ","$2,287.26 ","$1,327.58 ","$1,840.28 ","$1,327.58 ","$2,203.45 ","$2,203.45 ","$2,203.45 ","$2,203.45 ","$3,142.80 ","$2,619.00 ","$1,327.58 ","$3,072.96 ","$1,327.58 ","$2,619.00 ","$2,619.00 ","$2,968.20 ","$2,968.20 ","$1,327.58 ","$2,968.20 ","$1,327.58 ","$2,758.68 ","$2,758.68 ","$2,758.68 ","$3,142.80 ","$3,186.94 ","$3,142.80 ","$1,327.58 ","$3,492.00 ","$2,287.26 ","$1,327.58 ","$1,515.53 ", N/A ,"$1,389.56 ","$3,142.80 ","$2,877.05 ","$2,203.45 ","$2,095.20 ","$3,142.80 ","$1,327.58 ","$3,142.80 ","$3,142.80 ","$1,327.58 ","$2,269.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000060,78700,HC KIDNEY SCAN,340,1 ,"$1,059.00 ",$688.35 ,$383.37 ,"$1,059.00 ",$788.96 ,$693.65 ,$383.37 ,$558.09 ,$383.37 ,$668.23 ,$668.23 ,$668.23 ,$668.23 ,$953.10 ,$794.25 ,$383.37 ,$931.92 ,$383.37 ,$794.25 ,$794.25 ,$900.15 ,$900.15 ,$383.37 ,$900.15 ,$383.37 ,$836.61 ,$836.61 ,$836.61 ,$953.10 ,$920.30 ,$953.10 ,$383.37 ,"$1,059.00 ",$693.65 ,$383.37 ,$459.61 , N/A ,$401.27 ,$953.10 ,$830.81 ,$668.23 ,$635.40 ,$953.10 ,$383.37 ,$953.10 ,$953.10 ,$383.37 ,$688.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000062,78707,HC KIDNEY SCAN W/FLOW AND FUNCTION,340,1 ,"$1,001.00 ",$650.65 ,$434.43 ,"$1,078.17 ",$745.75 ,$655.66 ,$497.51 ,$527.53 ,$497.51 ,$631.63 ,$631.63 ,$631.63 ,$631.63 ,$900.90 ,$750.75 ,$497.51 ,$880.88 ,$497.51 ,$750.75 ,$750.75 ,$850.85 ,$850.85 ,$497.51 ,$850.85 ,$497.51 ,$790.79 ,$790.79 ,$790.79 ,$900.90 ,"$1,001.00 ",$900.90 ,$497.51 ,"$1,001.00 ",$655.66 ,$497.51 ,$434.43 , N/A ,$520.74 ,$900.90 ,"$1,078.17 ",$631.63 ,$600.60 ,$900.90 ,$497.51 ,$900.90 ,$900.90 ,$497.51 ,$650.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000063,78708,HC KIDNEY W/PHARMACLGCL INTER,340,1 ,"$1,382.00 ",$898.30 ,$497.51 ,"$1,382.00 ","$1,029.59 ",$905.21 ,$497.51 ,$728.31 ,$497.51 ,$872.04 ,$872.04 ,$872.04 ,$872.04 ,"$1,243.80 ","$1,036.50 ",$497.51 ,"$1,216.16 ",$497.51 ,"$1,036.50 ","$1,036.50 ","$1,174.70 ","$1,174.70 ",$497.51 ,"$1,174.70 ",$497.51 ,"$1,091.78 ","$1,091.78 ","$1,091.78 ","$1,243.80 ","$1,194.30 ","$1,243.80 ",$497.51 ,"$1,382.00 ",$905.21 ,$497.51 ,$599.79 , N/A ,$520.74 ,"$1,243.80 ","$1,078.17 ",$872.04 ,$829.20 ,"$1,243.80 ",$497.51 ,"$1,243.80 ","$1,243.80 ",$497.51 ,$898.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000065,78709,HC KIDNEY W AND W/O PHARM INTERVEN,340,1 ,"$1,364.00 ",$886.60 ,$497.51 ,"$1,364.00 ","$1,016.18 ",$893.42 ,$497.51 ,$718.83 ,$497.51 ,$860.68 ,$860.68 ,$860.68 ,$860.68 ,"$1,227.60 ","$1,023.00 ",$497.51 ,"$1,200.32 ",$497.51 ,"$1,023.00 ","$1,023.00 ","$1,159.40 ","$1,159.40 ",$497.51 ,"$1,159.40 ",$497.51 ,"$1,077.56 ","$1,077.56 ","$1,077.56 ","$1,227.60 ","$1,194.30 ","$1,227.60 ",$497.51 ,"$1,364.00 ",$893.42 ,$497.51 ,$591.98 , N/A ,$520.74 ,"$1,227.60 ","$1,078.17 ",$860.68 ,$818.40 ,"$1,227.60 ",$497.51 ,"$1,227.60 ","$1,227.60 ",$497.51 ,$886.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000068,78800,HC TUMOR LOCAL LIMITED,340,1 ,"$1,004.00 ",$652.60 ,$383.37 ,"$1,004.00 ",$747.98 ,$657.62 ,$383.37 ,$529.11 ,$383.37 ,$633.52 ,$633.52 ,$633.52 ,$633.52 ,$903.60 ,$753.00 ,$383.37 ,$883.52 ,$383.37 ,$753.00 ,$753.00 ,$853.40 ,$853.40 ,$383.37 ,$853.40 ,$383.37 ,$793.16 ,$793.16 ,$793.16 ,$903.60 ,$920.30 ,$903.60 ,$383.37 ,"$1,004.00 ",$657.62 ,$383.37 ,$435.74 , N/A ,$401.27 ,$903.60 ,$830.81 ,$633.52 ,$602.40 ,$903.60 ,$383.37 ,$903.60 ,$903.60 ,$383.37 ,$652.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000069,78801,HC TUMOR LOCAL MULTIPLE,340,1 ,"$1,286.00 ",$835.90 ,$383.37 ,"$1,286.00 ",$958.07 ,$842.33 ,$383.37 ,$677.72 ,$383.37 ,$811.47 ,$811.47 ,$811.47 ,$811.47 ,"$1,157.40 ",$964.50 ,$383.37 ,"$1,131.68 ",$383.37 ,$964.50 ,$964.50 ,"$1,093.10 ","$1,093.10 ",$383.37 ,"$1,093.10 ",$383.37 ,"$1,015.94 ","$1,015.94 ","$1,015.94 ","$1,157.40 ",$920.30 ,"$1,157.40 ",$383.37 ,"$1,286.00 ",$842.33 ,$383.37 ,$558.12 , N/A ,$401.27 ,"$1,157.40 ",$830.81 ,$811.47 ,$771.60 ,"$1,157.40 ",$383.37 ,"$1,157.40 ","$1,157.40 ",$383.37 ,$835.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000070,78802,HC TUMOR IMAGE-WHOLE BODY-1 DAY,340,1 ,"$2,434.00 ","$1,582.10 ","$1,056.36 ","$2,877.05 ","$1,813.33 ","$1,594.27 ","$1,327.58 ","$1,282.72 ","$1,327.58 ","$1,535.85 ","$1,535.85 ","$1,535.85 ","$1,535.85 ","$2,190.60 ","$1,825.50 ","$1,327.58 ","$2,141.92 ","$1,327.58 ","$1,825.50 ","$1,825.50 ","$2,068.90 ","$2,068.90 ","$1,327.58 ","$2,068.90 ","$1,327.58 ","$1,922.86 ","$1,922.86 ","$1,922.86 ","$2,190.60 ","$2,434.00 ","$2,190.60 ","$1,327.58 ","$2,434.00 ","$1,594.27 ","$1,327.58 ","$1,056.36 ", N/A ,"$1,389.56 ","$2,190.60 ","$2,877.05 ","$1,535.85 ","$1,460.40 ","$2,190.60 ","$1,327.58 ","$2,190.60 ","$2,190.60 ","$1,327.58 ","$1,582.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000071,78803,HC TUMOR IMAGING (SPECT),340,1 ,"$2,114.00 ","$1,374.10 ",$917.48 ,"$2,877.05 ","$1,574.93 ","$1,384.67 ","$1,327.58 ","$1,114.08 ","$1,327.58 ","$1,333.93 ","$1,333.93 ","$1,333.93 ","$1,333.93 ","$1,902.60 ","$1,585.50 ","$1,327.58 ","$1,860.32 ","$1,327.58 ","$1,585.50 ","$1,585.50 ","$1,796.90 ","$1,796.90 ","$1,327.58 ","$1,796.90 ","$1,327.58 ","$1,670.06 ","$1,670.06 ","$1,670.06 ","$1,902.60 ","$2,114.00 ","$1,902.60 ","$1,327.58 ","$2,114.00 ","$1,384.67 ","$1,327.58 ",$917.48 , N/A ,"$1,389.56 ","$1,902.60 ","$2,877.05 ","$1,333.93 ","$1,268.40 ","$1,902.60 ","$1,327.58 ","$1,902.60 ","$1,902.60 ","$1,327.58 ","$1,374.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000072,78803,HC TUMOR IMAGING (SPECT) MIBG,340,1 ,"$2,114.00 ","$1,374.10 ",$917.48 ,"$2,877.05 ","$1,574.93 ","$1,384.67 ","$1,327.58 ","$1,114.08 ","$1,327.58 ","$1,333.93 ","$1,333.93 ","$1,333.93 ","$1,333.93 ","$1,902.60 ","$1,585.50 ","$1,327.58 ","$1,860.32 ","$1,327.58 ","$1,585.50 ","$1,585.50 ","$1,796.90 ","$1,796.90 ","$1,327.58 ","$1,796.90 ","$1,327.58 ","$1,670.06 ","$1,670.06 ","$1,670.06 ","$1,902.60 ","$2,114.00 ","$1,902.60 ","$1,327.58 ","$2,114.00 ","$1,384.67 ","$1,327.58 ",$917.48 , N/A ,"$1,389.56 ","$1,902.60 ","$2,877.05 ","$1,333.93 ","$1,268.40 ","$1,902.60 ","$1,327.58 ","$1,902.60 ","$1,902.60 ","$1,327.58 ","$1,374.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000073,78803,HC TUMOR IMAGING (SPECT) GALLIUM,340,1 ,"$2,114.00 ","$1,374.10 ",$917.48 ,"$2,877.05 ","$1,574.93 ","$1,384.67 ","$1,327.58 ","$1,114.08 ","$1,327.58 ","$1,333.93 ","$1,333.93 ","$1,333.93 ","$1,333.93 ","$1,902.60 ","$1,585.50 ","$1,327.58 ","$1,860.32 ","$1,327.58 ","$1,585.50 ","$1,585.50 ","$1,796.90 ","$1,796.90 ","$1,327.58 ","$1,796.90 ","$1,327.58 ","$1,670.06 ","$1,670.06 ","$1,670.06 ","$1,902.60 ","$2,114.00 ","$1,902.60 ","$1,327.58 ","$2,114.00 ","$1,384.67 ","$1,327.58 ",$917.48 , N/A ,"$1,389.56 ","$1,902.60 ","$2,877.05 ","$1,333.93 ","$1,268.40 ","$1,902.60 ","$1,327.58 ","$1,902.60 ","$1,902.60 ","$1,327.58 ","$1,374.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000074,78803,HC TUMOR IMAGING (SPECT) NON GATED,340,1 ,"$2,114.00 ","$1,374.10 ",$917.48 ,"$2,877.05 ","$1,574.93 ","$1,384.67 ","$1,327.58 ","$1,114.08 ","$1,327.58 ","$1,333.93 ","$1,333.93 ","$1,333.93 ","$1,333.93 ","$1,902.60 ","$1,585.50 ","$1,327.58 ","$1,860.32 ","$1,327.58 ","$1,585.50 ","$1,585.50 ","$1,796.90 ","$1,796.90 ","$1,327.58 ","$1,796.90 ","$1,327.58 ","$1,670.06 ","$1,670.06 ","$1,670.06 ","$1,902.60 ","$2,114.00 ","$1,902.60 ","$1,327.58 ","$2,114.00 ","$1,384.67 ","$1,327.58 ",$917.48 , N/A ,"$1,389.56 ","$1,902.60 ","$2,877.05 ","$1,333.93 ","$1,268.40 ","$1,902.60 ","$1,327.58 ","$1,902.60 ","$1,902.60 ","$1,327.58 ","$1,374.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000075,78803,HC TUMOR IMAGING (SPECT) OCTREO,340,1 ,"$3,160.00 ","$2,054.00 ","$1,327.58 ","$3,160.00 ","$2,354.20 ","$2,069.80 ","$1,327.58 ","$1,665.32 ","$1,327.58 ","$1,993.96 ","$1,993.96 ","$1,993.96 ","$1,993.96 ","$2,844.00 ","$2,370.00 ","$1,327.58 ","$2,780.80 ","$1,327.58 ","$2,370.00 ","$2,370.00 ","$2,686.00 ","$2,686.00 ","$1,327.58 ","$2,686.00 ","$1,327.58 ","$2,496.40 ","$2,496.40 ","$2,496.40 ","$2,844.00 ","$3,160.00 ","$2,844.00 ","$1,327.58 ","$3,160.00 ","$2,069.80 ","$1,327.58 ","$1,371.44 ", N/A ,"$1,389.56 ","$2,844.00 ","$2,877.05 ","$1,993.96 ","$1,896.00 ","$2,844.00 ","$1,327.58 ","$2,844.00 ","$2,844.00 ","$1,327.58 ","$2,054.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000076,78803,HC TUMOR IMAGING (SPECT) PARATHYROID,340,1 ,"$2,114.00 ","$1,374.10 ",$917.48 ,"$2,877.05 ","$1,574.93 ","$1,384.67 ","$1,327.58 ","$1,114.08 ","$1,327.58 ","$1,333.93 ","$1,333.93 ","$1,333.93 ","$1,333.93 ","$1,902.60 ","$1,585.50 ","$1,327.58 ","$1,860.32 ","$1,327.58 ","$1,585.50 ","$1,585.50 ","$1,796.90 ","$1,796.90 ","$1,327.58 ","$1,796.90 ","$1,327.58 ","$1,670.06 ","$1,670.06 ","$1,670.06 ","$1,902.60 ","$2,114.00 ","$1,902.60 ","$1,327.58 ","$2,114.00 ","$1,384.67 ","$1,327.58 ",$917.48 , N/A ,"$1,389.56 ","$1,902.60 ","$2,877.05 ","$1,333.93 ","$1,268.40 ","$1,902.60 ","$1,327.58 ","$1,902.60 ","$1,902.60 ","$1,327.58 ","$1,374.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000077,78804,HC TUMOR/INF-WHOLE BODY-MULT DAY,340,1 ,"$3,491.00 ","$2,269.15 ","$1,327.58 ","$3,491.00 ","$2,600.80 ","$2,286.61 ","$1,327.58 ","$1,839.76 ","$1,327.58 ","$2,202.82 ","$2,202.82 ","$2,202.82 ","$2,202.82 ","$3,141.90 ","$2,618.25 ","$1,327.58 ","$3,072.08 ","$1,327.58 ","$2,618.25 ","$2,618.25 ","$2,967.35 ","$2,967.35 ","$1,327.58 ","$2,967.35 ","$1,327.58 ","$2,757.89 ","$2,757.89 ","$2,757.89 ","$3,141.90 ","$3,186.94 ","$3,141.90 ","$1,327.58 ","$3,491.00 ","$2,286.61 ","$1,327.58 ","$1,515.09 ", N/A ,"$1,389.56 ","$3,141.90 ","$2,877.05 ","$2,202.82 ","$2,094.60 ","$3,141.90 ","$1,327.58 ","$3,141.90 ","$3,141.90 ","$1,327.58 ","$2,269.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000079,78805,HC WBC LIMITED,340,1 ,"$1,301.00 ",$845.65 ,$564.63 ,"$1,301.00 ",$969.25 ,$852.16 , N/A ,$685.63 , N/A ,$820.93 ,$820.93 ,$820.93 ,$820.93 ,"$1,170.90 ",$975.75 , N/A ,"$1,144.88 ", N/A ,$975.75 ,$975.75 ,"$1,105.85 ","$1,105.85 ", N/A ,"$1,105.85 ", N/A ,"$1,027.79 ","$1,027.79 ","$1,027.79 ","$1,170.90 ", N/A ,"$1,170.90 ", N/A ,"$1,301.00 ",$852.16 , N/A ,$564.63 , N/A , N/A ,"$1,170.90 ", N/A ,$820.93 ,$780.60 ,"$1,170.90 ", N/A ,"$1,170.90 ","$1,170.90 ", N/A ,$845.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000080,78806,HC WBC WHOLE BODY,340,1 ,"$1,503.00 ",$976.95 ,$652.30 ,"$1,503.00 ","$1,119.74 ",$984.47 , N/A ,$792.08 , N/A ,$948.39 ,$948.39 ,$948.39 ,$948.39 ,"$1,352.70 ","$1,127.25 ", N/A ,"$1,322.64 ", N/A ,"$1,127.25 ","$1,127.25 ","$1,277.55 ","$1,277.55 ", N/A ,"$1,277.55 ", N/A ,"$1,187.37 ","$1,187.37 ","$1,187.37 ","$1,352.70 ", N/A ,"$1,352.70 ", N/A ,"$1,503.00 ",$984.47 , N/A ,$652.30 , N/A , N/A ,"$1,352.70 ", N/A ,$948.39 ,$901.80 ,"$1,352.70 ", N/A ,"$1,352.70 ","$1,352.70 ", N/A ,$976.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000081,79005,HC NM RADIOPAHARM THRPY ORAL,340,1 ,"$1,155.00 ",$750.75 ,$253.76 ,"$1,155.00 ",$860.48 ,$756.53 ,$253.76 ,$608.69 ,$253.76 ,$728.81 ,$728.81 ,$728.81 ,$728.81 ,"$1,039.50 ",$866.25 ,$253.76 ,"$1,016.40 ",$253.76 ,$866.25 ,$866.25 ,$981.75 ,$981.75 ,$253.76 ,$981.75 ,$253.76 ,$912.45 ,$912.45 ,$912.45 ,"$1,039.50 ",$609.16 ,"$1,039.50 ",$253.76 ,"$1,155.00 ",$756.53 ,$253.76 ,$501.27 , N/A ,$265.60 ,"$1,039.50 ",$549.92 ,$728.81 ,$693.00 ,"$1,039.50 ",$253.76 ,"$1,039.50 ","$1,039.50 ",$253.76 ,$750.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000090,78597,HC PULM PERF DIFF W/IMG,340,1 ,"$1,625.00 ","$1,056.25 ",$383.37 ,"$1,625.00 ","$1,210.63 ","$1,064.38 ",$383.37 ,$856.38 ,$383.37 ,"$1,025.38 ","$1,025.38 ","$1,025.38 ","$1,025.38 ","$1,462.50 ","$1,218.75 ",$383.37 ,"$1,430.00 ",$383.37 ,"$1,218.75 ","$1,218.75 ","$1,381.25 ","$1,381.25 ",$383.37 ,"$1,381.25 ",$383.37 ,"$1,283.75 ","$1,283.75 ","$1,283.75 ","$1,462.50 ",$920.30 ,"$1,462.50 ",$383.37 ,"$1,625.00 ","$1,064.38 ",$383.37 ,$705.25 , N/A ,$401.27 ,"$1,462.50 ",$830.81 ,"$1,025.38 ",$975.00 ,"$1,462.50 ",$383.37 ,"$1,462.50 ","$1,462.50 ",$383.37 ,"$1,056.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000091,78598,HC NM PULM VENT AND PERF DIFF W/IMG,340,1 ,"$2,058.00 ","$1,337.70 ",$497.51 ,"$2,058.00 ","$1,533.21 ","$1,347.99 ",$497.51 ,"$1,084.57 ",$497.51 ,"$1,298.60 ","$1,298.60 ","$1,298.60 ","$1,298.60 ","$1,852.20 ","$1,543.50 ",$497.51 ,"$1,811.04 ",$497.51 ,"$1,543.50 ","$1,543.50 ","$1,749.30 ","$1,749.30 ",$497.51 ,"$1,749.30 ",$497.51 ,"$1,625.82 ","$1,625.82 ","$1,625.82 ","$1,852.20 ","$1,194.30 ","$1,852.20 ",$497.51 ,"$2,058.00 ","$1,347.99 ",$497.51 ,$893.17 , N/A ,$520.74 ,"$1,852.20 ","$1,078.17 ","$1,298.60 ","$1,234.80 ","$1,852.20 ",$497.51 ,"$1,852.20 ","$1,852.20 ",$497.51 ,"$1,337.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000092,78227,HC NM HEPATOBILIARY DUCTS W/PHARM,340,1 ,"$1,727.00 ","$1,122.55 ",$497.51 ,"$1,727.00 ","$1,286.62 ","$1,131.19 ",$497.51 ,$910.13 ,$497.51 ,"$1,089.74 ","$1,089.74 ","$1,089.74 ","$1,089.74 ","$1,554.30 ","$1,295.25 ",$497.51 ,"$1,519.76 ",$497.51 ,"$1,295.25 ","$1,295.25 ","$1,467.95 ","$1,467.95 ",$497.51 ,"$1,467.95 ",$497.51 ,"$1,364.33 ","$1,364.33 ","$1,364.33 ","$1,554.30 ","$1,194.30 ","$1,554.30 ",$497.51 ,"$1,727.00 ","$1,131.19 ",$497.51 ,$749.52 , N/A ,$520.74 ,"$1,554.30 ","$1,078.17 ","$1,089.74 ","$1,036.20 ","$1,554.30 ",$497.51 ,"$1,554.30 ","$1,554.30 ",$497.51 ,"$1,122.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34000093,78071,HC PARATHYROID IMG W/SPECT 78071,340,1 ,"$2,417.00 ","$1,571.05 ",$383.37 ,"$2,417.00 ","$1,800.67 ","$1,583.14 ",$383.37 ,"$1,273.76 ",$383.37 ,"$1,525.13 ","$1,525.13 ","$1,525.13 ","$1,525.13 ","$2,175.30 ","$1,812.75 ",$383.37 ,"$2,126.96 ",$383.37 ,"$1,812.75 ","$1,812.75 ","$2,054.45 ","$2,054.45 ",$383.37 ,"$2,054.45 ",$383.37 ,"$1,909.43 ","$1,909.43 ","$1,909.43 ","$2,175.30 ",$920.30 ,"$2,175.30 ",$383.37 ,"$2,417.00 ","$1,583.14 ",$383.37 ,"$1,048.98 ", N/A ,$401.27 ,"$2,175.30 ",$830.81 ,"$1,525.13 ","$1,450.20 ","$2,175.30 ",$383.37 ,"$2,175.30 ","$2,175.30 ",$383.37 ,"$1,571.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34100024,78807,HC NM RADIONUC ABSCESS SPEC,341,1 ,"$1,557.00 ","$1,012.05 ",$675.74 ,"$1,557.00 ","$1,159.97 ","$1,019.84 ", N/A ,$820.54 , N/A ,$982.47 ,$982.47 ,$982.47 ,$982.47 ,"$1,401.30 ","$1,167.75 ", N/A ,"$1,370.16 ", N/A ,"$1,167.75 ","$1,167.75 ","$1,323.45 ","$1,323.45 ", N/A ,"$1,323.45 ", N/A ,"$1,230.03 ","$1,230.03 ","$1,230.03 ","$1,401.30 ", N/A ,"$1,401.30 ", N/A ,"$1,557.00 ","$1,019.84 ", N/A ,$675.74 , N/A , N/A ,"$1,401.30 ", N/A ,$982.47 ,$934.20 ,"$1,401.30 ", N/A ,"$1,401.30 ","$1,401.30 ", N/A ,"$1,012.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34100033,78831,HC TUMOR LOCAL SPECT MULT AREA 1 DAY OR SGL AREA W/MULT DAYS,341,1 ,"$3,491.00 ","$2,269.15 ","$1,327.58 ","$3,491.00 ","$2,600.80 ","$2,286.61 ","$1,327.58 ","$1,839.76 ","$1,327.58 ","$2,202.82 ","$2,202.82 ","$2,202.82 ","$2,202.82 ","$3,141.90 ","$2,618.25 ","$1,327.58 ","$3,072.08 ","$1,327.58 ","$2,618.25 ","$2,618.25 ","$2,967.35 ","$2,967.35 ","$1,327.58 ","$2,967.35 ","$1,327.58 ","$2,757.89 ","$2,757.89 ","$2,757.89 ","$3,141.90 ","$3,186.94 ","$3,141.90 ","$1,327.58 ","$3,491.00 ","$2,286.61 ","$1,327.58 ","$1,515.09 ", N/A ,"$1,389.56 ","$3,141.90 ","$2,877.05 ","$2,202.82 ","$2,094.60 ","$3,141.90 ","$1,327.58 ","$3,141.90 ","$3,141.90 ","$1,327.58 ","$2,269.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34100034,78830,HC TUMOR IMAGING SPECT W/CT SGL AREA 1 DAY,341,1 ,"$3,491.00 ","$2,269.15 ","$1,327.58 ","$3,491.00 ","$2,600.80 ","$2,286.61 ","$1,327.58 ","$1,839.76 ","$1,327.58 ","$2,202.82 ","$2,202.82 ","$2,202.82 ","$2,202.82 ","$3,141.90 ","$2,618.25 ","$1,327.58 ","$3,072.08 ","$1,327.58 ","$2,618.25 ","$2,618.25 ","$2,967.35 ","$2,967.35 ","$1,327.58 ","$2,967.35 ","$1,327.58 ","$2,757.89 ","$2,757.89 ","$2,757.89 ","$3,141.90 ","$3,186.94 ","$3,141.90 ","$1,327.58 ","$3,491.00 ","$2,286.61 ","$1,327.58 ","$1,515.09 ", N/A ,"$1,389.56 ","$3,141.90 ","$2,877.05 ","$2,202.82 ","$2,094.60 ","$3,141.90 ","$1,327.58 ","$3,141.90 ","$3,141.90 ","$1,327.58 ","$2,269.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300002,A9500,HC DIAGNUCLIDE CARDIO UP TO 40MCI,343,1 ,$707.00 ,$459.55 ,$306.84 ,$707.00 ,$526.72 ,$463.09 , N/A ,$372.59 , N/A ,$446.12 ,$446.12 ,$446.12 ,$446.12 ,$636.30 ,$530.25 , N/A ,$622.16 , N/A ,$530.25 ,$530.25 ,$600.95 ,$600.95 , N/A ,$600.95 , N/A ,$558.53 ,$558.53 ,$558.53 ,$636.30 , N/A ,$636.30 , N/A ,$707.00 ,$463.09 , N/A ,$306.84 , N/A , N/A ,$636.30 , N/A ,$446.12 ,$424.20 ,$636.30 , N/A ,$636.30 ,$636.30 , N/A ,$459.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300004,A9503,HC DIAGNUCLIDE MDP UP TO 30MCI,343,1 ,$164.00 ,$106.60 ,$71.18 ,$164.00 ,$122.18 ,$107.42 , N/A ,$86.43 , N/A ,$103.48 ,$103.48 ,$103.48 ,$103.48 ,$147.60 ,$123.00 , N/A ,$144.32 , N/A ,$123.00 ,$123.00 ,$139.40 ,$139.40 , N/A ,$139.40 , N/A ,$129.56 ,$129.56 ,$129.56 ,$147.60 , N/A ,$147.60 , N/A ,$164.00 ,$107.42 , N/A ,$71.18 , N/A , N/A ,$147.60 , N/A ,$103.48 ,$98.40 ,$147.60 , N/A ,$147.60 ,$147.60 , N/A ,$106.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300006,A9505,HC DIAGNUCLIDE THALL 201 PER MCI,343,1 ,$152.00 ,$98.80 ,$65.97 ,$152.00 ,$113.24 ,$99.56 , N/A ,$80.10 , N/A ,$95.91 ,$95.91 ,$95.91 ,$95.91 ,$136.80 ,$114.00 , N/A ,$133.76 , N/A ,$114.00 ,$114.00 ,$129.20 ,$129.20 , N/A ,$129.20 , N/A ,$120.08 ,$120.08 ,$120.08 ,$136.80 , N/A ,$136.80 , N/A ,$152.00 ,$99.56 , N/A ,$65.97 , N/A , N/A ,$136.80 , N/A ,$95.91 ,$91.20 ,$136.80 , N/A ,$136.80 ,$136.80 , N/A ,$98.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300009,A9512,HC TECHNETIUM TC99 PERTECH PER MCI,343,1 ,$2.36 ,$1.53 ,$1.02 ,$2.36 ,$1.76 ,$1.55 , N/A ,$1.24 , N/A ,$1.49 ,$1.49 ,$1.49 ,$1.49 ,$2.12 ,$1.77 , N/A ,$2.08 , N/A ,$1.77 ,$1.77 ,$2.01 ,$2.01 , N/A ,$2.01 , N/A ,$1.86 ,$1.86 ,$1.86 ,$2.12 , N/A ,$2.12 , N/A ,$2.36 ,$1.55 , N/A ,$1.02 , N/A , N/A ,$2.12 , N/A ,$1.49 ,$1.42 ,$2.12 , N/A ,$2.12 ,$2.12 , N/A ,$1.53 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300010,A9516,HC DIAGNUCLIDE I123 CAPS 100 MICR,343,1 ,$208.00 ,$135.20 ,$90.27 ,$208.00 ,$154.96 ,$136.24 , N/A ,$109.62 , N/A ,$131.25 ,$131.25 ,$131.25 ,$131.25 ,$187.20 ,$156.00 , N/A ,$183.04 , N/A ,$156.00 ,$156.00 ,$176.80 ,$176.80 , N/A ,$176.80 , N/A ,$164.32 ,$164.32 ,$164.32 ,$187.20 , N/A ,$187.20 , N/A ,$208.00 ,$136.24 , N/A ,$90.27 , N/A , N/A ,$187.20 , N/A ,$131.25 ,$124.80 ,$187.20 , N/A ,$187.20 ,$187.20 , N/A ,$135.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300011,A9517,HC DIAGNUCLIDE I131 CAPS PER MCI,343,1 ,$34.00 ,$22.10 ,$14.76 ,$45.27 ,$25.33 ,$22.27 ,$20.12 ,$17.92 ,$20.12 ,$21.45 ,$21.45 ,$21.45 ,$21.45 ,$30.60 ,$25.50 ,$20.12 ,$29.92 ,$20.12 ,$25.50 ,$25.50 ,$28.90 ,$28.90 ,$20.12 ,$28.90 ,$20.12 ,$26.86 ,$26.86 ,$26.86 ,$30.60 ,$34.00 ,$30.60 ,$20.12 ,$34.00 ,$22.27 ,$20.12 ,$14.76 , N/A ,$21.13 ,$30.60 ,$45.27 ,$21.45 ,$20.40 ,$30.60 ,$20.12 ,$30.60 ,$30.60 ,$20.12 ,$22.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300016,A9537,HC DIAGNUCLIDE CHOLETEC HEPAT PER DOSE,343,1 ,$239.00 ,$155.35 ,$103.73 ,$239.00 ,$178.06 ,$156.55 , N/A ,$125.95 , N/A ,$150.81 ,$150.81 ,$150.81 ,$150.81 ,$215.10 ,$179.25 , N/A ,$210.32 , N/A ,$179.25 ,$179.25 ,$203.15 ,$203.15 , N/A ,$203.15 , N/A ,$188.81 ,$188.81 ,$188.81 ,$215.10 , N/A ,$215.10 , N/A ,$239.00 ,$156.55 , N/A ,$103.73 , N/A , N/A ,$215.10 , N/A ,$150.81 ,$143.40 ,$215.10 , N/A ,$215.10 ,$215.10 , N/A ,$155.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300017,A9539,HC DIAGNUCLIDE DTPA KIDNEY PER DOSE,343,1 ,$209.00 ,$135.85 ,$90.71 ,$209.00 ,$155.71 ,$136.90 , N/A ,$110.14 , N/A ,$131.88 ,$131.88 ,$131.88 ,$131.88 ,$188.10 ,$156.75 , N/A ,$183.92 , N/A ,$156.75 ,$156.75 ,$177.65 ,$177.65 , N/A ,$177.65 , N/A ,$165.11 ,$165.11 ,$165.11 ,$188.10 , N/A ,$188.10 , N/A ,$209.00 ,$136.90 , N/A ,$90.71 , N/A , N/A ,$188.10 , N/A ,$131.88 ,$125.40 ,$188.10 , N/A ,$188.10 ,$188.10 , N/A ,$135.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300019,A9540,HC DIAGNUCLIDE MAA LUNG SCAN PER DOSE<10MCI,343,1 ,$138.00 ,$89.70 ,$59.89 ,$138.00 ,$102.81 ,$90.39 , N/A ,$72.73 , N/A ,$87.08 ,$87.08 ,$87.08 ,$87.08 ,$124.20 ,$103.50 , N/A ,$121.44 , N/A ,$103.50 ,$103.50 ,$117.30 ,$117.30 , N/A ,$117.30 , N/A ,$109.02 ,$109.02 ,$109.02 ,$124.20 , N/A ,$124.20 , N/A ,$138.00 ,$90.39 , N/A ,$59.89 , N/A , N/A ,$124.20 , N/A ,$87.08 ,$82.80 ,$124.20 , N/A ,$124.20 ,$124.20 , N/A ,$89.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300020,A9541,HC DIAGNUCLIDE SULFUR COLLOID UP TO 20MCI,343,1 ,$304.00 ,$197.60 ,$131.94 ,$304.00 ,$226.48 ,$199.12 , N/A ,$160.21 , N/A ,$191.82 ,$191.82 ,$191.82 ,$191.82 ,$273.60 ,$228.00 , N/A ,$267.52 , N/A ,$228.00 ,$228.00 ,$258.40 ,$258.40 , N/A ,$258.40 , N/A ,$240.16 ,$240.16 ,$240.16 ,$273.60 , N/A ,$273.60 , N/A ,$304.00 ,$199.12 , N/A ,$131.94 , N/A , N/A ,$273.60 , N/A ,$191.82 ,$182.40 ,$273.60 , N/A ,$273.60 ,$273.60 , N/A ,$197.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300029,A9552,HC DIAGNUCLIDE 18FDG,343,1 ,"$1,420.00 ",$923.00 ,$616.28 ,"$1,420.00 ","$1,057.90 ",$930.10 , N/A ,$748.34 , N/A ,$896.02 ,$896.02 ,$896.02 ,$896.02 ,"$1,278.00 ","$1,065.00 ", N/A ,"$1,249.60 ", N/A ,"$1,065.00 ","$1,065.00 ","$1,207.00 ","$1,207.00 ", N/A ,"$1,207.00 ", N/A ,"$1,121.80 ","$1,121.80 ","$1,121.80 ","$1,278.00 ", N/A ,"$1,278.00 ", N/A ,"$1,420.00 ",$930.10 , N/A ,$616.28 , N/A , N/A ,"$1,278.00 ", N/A ,$896.02 ,$852.00 ,"$1,278.00 ", N/A ,"$1,278.00 ","$1,278.00 ", N/A ,$923.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300033,A9558,HC DIAGNUCLIDE XE133 10 MCI,343,1 ,$124.00 ,$80.60 ,$53.82 ,$124.00 ,$92.38 ,$81.22 , N/A ,$65.35 , N/A ,$78.24 ,$78.24 ,$78.24 ,$78.24 ,$111.60 ,$93.00 , N/A ,$109.12 , N/A ,$93.00 ,$93.00 ,$105.40 ,$105.40 , N/A ,$105.40 , N/A ,$97.96 ,$97.96 ,$97.96 ,$111.60 , N/A ,$111.60 , N/A ,$124.00 ,$81.22 , N/A ,$53.82 , N/A , N/A ,$111.60 , N/A ,$78.24 ,$74.40 ,$111.60 , N/A ,$111.60 ,$111.60 , N/A ,$80.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300036,A9560,HC RBC TAG KIT WITH TC99,343,1 ,$268.00 ,$174.20 ,$116.31 ,$268.00 ,$199.66 ,$175.54 , N/A ,$141.24 , N/A ,$169.11 ,$169.11 ,$169.11 ,$169.11 ,$241.20 ,$201.00 , N/A ,$235.84 , N/A ,$201.00 ,$201.00 ,$227.80 ,$227.80 , N/A ,$227.80 , N/A ,$211.72 ,$211.72 ,$211.72 ,$241.20 , N/A ,$241.20 , N/A ,$268.00 ,$175.54 , N/A ,$116.31 , N/A , N/A ,$241.20 , N/A ,$169.11 ,$160.80 ,$241.20 , N/A ,$241.20 ,$241.20 , N/A ,$174.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300038,A9572,HC DIAGNUCLIDE OCTREOTIDE PER DOSE UP TO 6MCI,343,1 ,"$5,952.00 ","$3,868.80 ","$2,583.17 ","$5,952.00 ","$4,434.24 ","$3,898.56 ", N/A ,"$3,136.70 ", N/A ,"$3,755.71 ","$3,755.71 ","$3,755.71 ","$3,755.71 ","$5,356.80 ","$4,464.00 ", N/A ,"$5,237.76 ", N/A ,"$4,464.00 ","$4,464.00 ","$5,059.20 ","$5,059.20 ", N/A ,"$5,059.20 ", N/A ,"$4,702.08 ","$4,702.08 ","$4,702.08 ","$5,356.80 ", N/A ,"$5,356.80 ", N/A ,"$5,952.00 ","$3,898.56 ", N/A ,"$2,583.17 ", N/A , N/A ,"$5,356.80 ", N/A ,"$3,755.71 ","$3,571.20 ","$5,356.80 ", N/A ,"$5,356.80 ","$5,356.80 ", N/A ,"$3,868.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300041,J2805,HC DIAGNUCLIDE CCK,636,1 ,$202.04 ,$131.33 ,$87.69 ,$202.04 ,$150.52 ,$132.34 , N/A ,$106.48 , N/A ,$127.49 ,$127.49 ,$127.49 ,$127.49 ,$181.84 ,$151.53 , N/A ,$177.80 , N/A ,$151.53 ,$151.53 ,$171.73 ,$171.73 , N/A ,$171.73 , N/A ,$159.61 ,$159.61 ,$159.61 ,$181.84 , N/A ,$181.84 , N/A ,$202.04 ,$132.34 , N/A ,$87.69 , N/A , N/A ,$181.84 , N/A ,$127.49 ,$121.22 ,$181.84 , N/A ,$181.84 ,$181.84 , N/A ,$131.33 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300049,A9509,HC DIAGNUCLIDE I123 CAP PER MILLICURIE,343,1 ,$879.00 ,$571.35 ,$381.49 ,$879.00 ,$654.86 ,$575.75 , N/A ,$463.23 , N/A ,$554.65 ,$554.65 ,$554.65 ,$554.65 ,$791.10 ,$659.25 , N/A ,$773.52 , N/A ,$659.25 ,$659.25 ,$747.15 ,$747.15 , N/A ,$747.15 , N/A ,$694.41 ,$694.41 ,$694.41 ,$791.10 , N/A ,$791.10 , N/A ,$879.00 ,$575.75 , N/A ,$381.49 , N/A , N/A ,$791.10 , N/A ,$554.65 ,$527.40 ,$791.10 , N/A ,$791.10 ,$791.10 , N/A ,$571.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300057,A9569,HC TC99M EXAMETAZIME CERETEC DX PER DOSE,343,1 ,"$2,240.00 ","$1,456.00 ",$972.16 ,"$2,240.00 ","$1,668.80 ","$1,467.20 ", N/A ,"$1,180.48 ", N/A ,"$1,413.44 ","$1,413.44 ","$1,413.44 ","$1,413.44 ","$2,016.00 ","$1,680.00 ", N/A ,"$1,971.20 ", N/A ,"$1,680.00 ","$1,680.00 ","$1,904.00 ","$1,904.00 ", N/A ,"$1,904.00 ", N/A ,"$1,769.60 ","$1,769.60 ","$1,769.60 ","$2,016.00 ", N/A ,"$2,016.00 ", N/A ,"$2,240.00 ","$1,467.20 ", N/A ,$972.16 , N/A , N/A ,"$2,016.00 ", N/A ,"$1,413.44 ","$1,344.00 ","$2,016.00 ", N/A ,"$2,016.00 ","$2,016.00 ", N/A ,"$1,456.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300058,A9500,HC SESTAMIBI PER STUDY DOSE,343,1 ,$707.00 ,$459.55 ,$306.84 ,$707.00 ,$526.72 ,$463.09 , N/A ,$372.59 , N/A ,$446.12 ,$446.12 ,$446.12 ,$446.12 ,$636.30 ,$530.25 , N/A ,$622.16 , N/A ,$530.25 ,$530.25 ,$600.95 ,$600.95 , N/A ,$600.95 , N/A ,$558.53 ,$558.53 ,$558.53 ,$636.30 , N/A ,$636.30 , N/A ,$707.00 ,$463.09 , N/A ,$306.84 , N/A , N/A ,$636.30 , N/A ,$446.12 ,$424.20 ,$636.30 , N/A ,$636.30 ,$636.30 , N/A ,$459.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300060,A9520,HC DIAGNUCLIDE TC-99 TILMANOCEPT DIAG UP TO 0.5 MCI,343,1 ,"$1,037.00 ",$674.05 ,$450.06 ,"$1,037.00 ",$772.57 ,$679.24 , N/A ,$546.50 , N/A ,$654.35 ,$654.35 ,$654.35 ,$654.35 ,$933.30 ,$777.75 , N/A ,$912.56 , N/A ,$777.75 ,$777.75 ,$881.45 ,$881.45 , N/A ,$881.45 , N/A ,$819.23 ,$819.23 ,$819.23 ,$933.30 , N/A ,$933.30 , N/A ,"$1,037.00 ",$679.24 , N/A ,$450.06 , N/A , N/A ,$933.30 , N/A ,$654.35 ,$622.20 ,$933.30 , N/A ,$933.30 ,$933.30 , N/A ,$674.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),34300064,A9570,HC DIAGNUCLIDE INDIUM IN-111 WBC DIAG PER STUDY,343,1 ,"$2,445.00 ","$1,589.25 ","$1,061.13 ","$2,445.00 ","$1,821.53 ","$1,601.48 ", N/A ,"$1,288.52 ", N/A ,"$1,542.80 ","$1,542.80 ","$1,542.80 ","$1,542.80 ","$2,200.50 ","$1,833.75 ", N/A ,"$2,151.60 ", N/A ,"$1,833.75 ","$1,833.75 ","$2,078.25 ","$2,078.25 ", N/A ,"$2,078.25 ", N/A ,"$1,931.55 ","$1,931.55 ","$1,931.55 ","$2,200.50 ", N/A ,"$2,200.50 ", N/A ,"$2,445.00 ","$1,601.48 ", N/A ,"$1,061.13 ", N/A , N/A ,"$2,200.50 ", N/A ,"$1,542.80 ","$1,467.00 ","$2,200.50 ", N/A ,"$2,200.50 ","$2,200.50 ", N/A ,"$1,589.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000006,21550,HC BX TISSUE NECK/THORAX,350,1 ,"$4,204.00 ","$2,732.60 ","$1,000.00 ","$4,204.00 ","$3,131.98 ","$2,753.62 ","$1,430.32 ","$2,215.51 ","$1,430.32 ","$2,652.72 ","$2,652.72 ","$2,652.72 ","$2,652.72 ","$3,783.60 ","$3,153.00 ","$1,430.32 ","$3,699.52 ","$1,430.32 ","$3,153.00 ","$3,153.00 ","$3,573.40 ","$3,573.40 ","$1,430.32 ","$3,573.40 ","$1,430.32 ","$3,321.16 ","$3,321.16 ","$3,321.16 ","$3,783.60 ","$3,433.56 ","$3,783.60 ","$1,430.32 ","$4,204.00 ","$2,753.62 ","$1,430.32 ","$1,824.54 ", N/A ,"$1,497.09 ","$3,783.60 ","$3,099.69 ","$2,652.72 ","$1,000.00 ","$3,783.60 ","$1,430.32 ","$3,783.60 ","$3,783.60 ","$1,430.32 ","$2,732.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000013,32400,HC BX PLEURA NEEDLE PERC,350,1 ,"$1,060.00 ",$689.00 ,$460.04 ,"$3,099.69 ",$789.70 ,$694.30 ,"$1,060.00 ",$558.62 ,"$1,060.00 ",$668.86 ,$668.86 ,$668.86 ,$668.86 ,$954.00 ,$795.00 ,"$1,060.00 ",$932.80 ,"$1,060.00 ",$795.00 ,$795.00 ,$901.00 ,$901.00 ,"$1,060.00 ",$901.00 ,"$1,060.00 ",$837.40 ,$837.40 ,$837.40 ,$954.00 ,"$1,060.00 ",$954.00 ,"$1,060.00 ","$1,060.00 ",$694.30 ,"$1,060.00 ",$460.04 , N/A ,"$1,060.00 ",$954.00 ,"$3,099.69 ",$668.86 ,"$1,000.00 ",$954.00 ,"$1,060.00 ",$954.00 ,$954.00 ,"$1,060.00 ",$689.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000014,32405,HC BX LUNG/MEDIASTINUM PERC NDL,350,1 ,"$1,776.00 ","$1,154.40 ",$770.78 ,"$1,776.00 ","$1,323.12 ","$1,163.28 ", N/A ,$935.95 , N/A ,"$1,120.66 ","$1,120.66 ","$1,120.66 ","$1,120.66 ","$1,598.40 ","$1,332.00 ", N/A ,"$1,562.88 ", N/A ,"$1,332.00 ","$1,332.00 ","$1,509.60 ","$1,509.60 ", N/A ,"$1,509.60 ", N/A ,"$1,403.04 ","$1,403.04 ","$1,403.04 ","$1,598.40 ", N/A ,"$1,598.40 ", N/A ,"$1,776.00 ","$1,163.28 ", N/A ,$770.78 , N/A , N/A ,"$1,598.40 ", N/A ,"$1,120.66 ","$1,000.00 ","$1,598.40 ", N/A ,"$1,598.40 ","$1,598.40 ", N/A ,"$1,154.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000018,47000,HC BX LIVER NEEDLE PERC,350,1 ,"$1,216.00 ",$790.40 ,$527.74 ,"$3,099.69 ",$905.92 ,$796.48 ,"$1,216.00 ",$640.83 ,"$1,216.00 ",$767.30 ,$767.30 ,$767.30 ,$767.30 ,"$1,094.40 ",$912.00 ,"$1,216.00 ","$1,070.08 ","$1,216.00 ",$912.00 ,$912.00 ,"$1,033.60 ","$1,033.60 ","$1,216.00 ","$1,033.60 ","$1,216.00 ",$960.64 ,$960.64 ,$960.64 ,"$1,094.40 ","$1,216.00 ","$1,094.40 ","$1,216.00 ","$1,216.00 ",$796.48 ,"$1,216.00 ",$527.74 , N/A ,"$1,216.00 ","$1,094.40 ","$3,099.69 ",$767.30 ,"$1,000.00 ","$1,094.40 ","$1,216.00 ","$1,094.40 ","$1,094.40 ","$1,216.00 ",$790.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000020,49405,HC PERC DRN ABSC/HEM/CYST VISCERAL,350,1 ,"$2,924.00 ","$1,900.60 ","$1,000.00 ","$3,099.69 ","$2,178.38 ","$1,915.22 ","$1,430.32 ","$1,540.95 ","$1,430.32 ","$1,845.04 ","$1,845.04 ","$1,845.04 ","$1,845.04 ","$2,631.60 ","$2,193.00 ","$1,430.32 ","$2,573.12 ","$1,430.32 ","$2,193.00 ","$2,193.00 ","$2,485.40 ","$2,485.40 ","$1,430.32 ","$2,485.40 ","$1,430.32 ","$2,309.96 ","$2,309.96 ","$2,309.96 ","$2,631.60 ","$2,924.00 ","$2,631.60 ","$1,430.32 ","$2,924.00 ","$1,915.22 ","$1,430.32 ","$1,269.02 ", N/A ,"$1,497.09 ","$2,631.60 ","$3,099.69 ","$1,845.04 ","$1,000.00 ","$2,631.60 ","$1,430.32 ","$2,631.60 ","$2,631.60 ","$1,430.32 ","$1,900.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000023,48102,HC BX PANCREAS NEEDLE PERC,350,1 ,"$2,239.00 ","$1,455.35 ",$971.73 ,"$3,099.69 ","$1,668.06 ","$1,466.55 ","$1,430.32 ","$1,179.95 ","$1,430.32 ","$1,412.81 ","$1,412.81 ","$1,412.81 ","$1,412.81 ","$2,015.10 ","$1,679.25 ","$1,430.32 ","$1,970.32 ","$1,430.32 ","$1,679.25 ","$1,679.25 ","$1,903.15 ","$1,903.15 ","$1,430.32 ","$1,903.15 ","$1,430.32 ","$1,768.81 ","$1,768.81 ","$1,768.81 ","$2,015.10 ","$2,239.00 ","$2,015.10 ","$1,430.32 ","$2,239.00 ","$1,466.55 ","$1,430.32 ",$971.73 , N/A ,"$1,497.09 ","$2,015.10 ","$3,099.69 ","$1,412.81 ","$1,000.00 ","$2,015.10 ","$1,430.32 ","$2,015.10 ","$2,015.10 ","$1,430.32 ","$1,455.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000025,49180,HC ABDOM/RETRO/MASS BIOP,350,1 ,"$2,475.00 ","$1,608.75 ","$1,000.00 ","$3,099.69 ","$1,843.88 ","$1,621.13 ","$1,430.32 ","$1,304.33 ","$1,430.32 ","$1,561.73 ","$1,561.73 ","$1,561.73 ","$1,561.73 ","$2,227.50 ","$1,856.25 ","$1,430.32 ","$2,178.00 ","$1,430.32 ","$1,856.25 ","$1,856.25 ","$2,103.75 ","$2,103.75 ","$1,430.32 ","$2,103.75 ","$1,430.32 ","$1,955.25 ","$1,955.25 ","$1,955.25 ","$2,227.50 ","$2,475.00 ","$2,227.50 ","$1,430.32 ","$2,475.00 ","$1,621.13 ","$1,430.32 ","$1,074.15 ", N/A ,"$1,497.09 ","$2,227.50 ","$3,099.69 ","$1,561.73 ","$1,000.00 ","$2,227.50 ","$1,430.32 ","$2,227.50 ","$2,227.50 ","$1,430.32 ","$1,608.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000026,50200,"HC PERC BIOPSY/KIDNEY, NEEDLE",350,1 ,"$1,461.00 ",$949.65 ,$634.07 ,"$3,099.69 ","$1,088.45 ",$956.96 ,"$1,430.32 ",$769.95 ,"$1,430.32 ",$921.89 ,$921.89 ,$921.89 ,$921.89 ,"$1,314.90 ","$1,095.75 ","$1,430.32 ","$1,285.68 ","$1,430.32 ","$1,095.75 ","$1,095.75 ","$1,241.85 ","$1,241.85 ","$1,430.32 ","$1,241.85 ","$1,430.32 ","$1,154.19 ","$1,154.19 ","$1,154.19 ","$1,314.90 ","$1,461.00 ","$1,314.90 ","$1,430.32 ","$1,461.00 ",$956.96 ,"$1,430.32 ",$634.07 , N/A ,"$1,461.00 ","$1,314.90 ","$3,099.69 ",$921.89 ,"$1,000.00 ","$1,314.90 ","$1,430.32 ","$1,314.90 ","$1,314.90 ","$1,430.32 ",$949.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000026,50200,"HC PERC BIOPSY/KIDNEY, NEEDLE",350,1 ,"$2,192.00 ","$1,424.80 ",$951.33 ,"$3,099.69 ","$1,633.04 ","$1,435.76 ","$1,430.32 ","$1,155.18 ","$1,430.32 ","$1,383.15 ","$1,383.15 ","$1,383.15 ","$1,383.15 ","$1,972.80 ","$1,644.00 ","$1,430.32 ","$1,928.96 ","$1,430.32 ","$1,644.00 ","$1,644.00 ","$1,863.20 ","$1,863.20 ","$1,430.32 ","$1,863.20 ","$1,430.32 ","$1,731.68 ","$1,731.68 ","$1,731.68 ","$1,972.80 ","$2,192.00 ","$1,972.80 ","$1,430.32 ","$2,192.00 ","$1,435.76 ","$1,430.32 ",$951.33 , N/A ,"$1,497.09 ","$1,972.80 ","$3,099.69 ","$1,383.15 ","$1,000.00 ","$1,972.80 ","$1,430.32 ","$1,972.80 ","$1,972.80 ","$1,430.32 ","$1,424.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000027,50390,HC RENAL CYST/PELVIS ASP/INJ,350,1 ,"$1,986.00 ","$1,290.90 ",$632.28 ,"$1,986.00 ","$1,479.57 ","$1,300.83 ",$632.28 ,"$1,046.62 ",$632.28 ,"$1,253.17 ","$1,253.17 ","$1,253.17 ","$1,253.17 ","$1,787.40 ","$1,489.50 ",$632.28 ,"$1,747.68 ",$632.28 ,"$1,489.50 ","$1,489.50 ","$1,688.10 ","$1,688.10 ",$632.28 ,"$1,688.10 ",$632.28 ,"$1,568.94 ","$1,568.94 ","$1,568.94 ","$1,787.40 ","$1,517.82 ","$1,787.40 ",$632.28 ,"$1,986.00 ","$1,300.83 ",$632.28 ,$861.92 , N/A ,$661.80 ,"$1,787.40 ","$1,370.23 ","$1,253.17 ","$1,000.00 ","$1,787.40 ",$632.28 ,"$1,787.40 ","$1,787.40 ",$632.28 ,"$1,290.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000027,50390,HC RENAL CYST/PELVIS ASP/INJ,350,1 ,"$2,979.00 ","$1,936.35 ",$948.42 ,"$2,979.00 ","$2,219.36 ","$1,951.25 ",$948.42 ,"$1,569.93 ",$948.42 ,"$1,879.75 ","$1,879.75 ","$1,879.75 ","$1,879.75 ","$2,681.10 ","$2,234.25 ",$948.42 ,"$2,621.52 ",$948.42 ,"$2,234.25 ","$2,234.25 ","$2,532.15 ","$2,532.15 ",$948.42 ,"$2,532.15 ",$948.42 ,"$2,353.41 ","$2,353.41 ","$2,353.41 ","$2,681.10 ","$2,276.73 ","$2,681.10 ",$948.42 ,"$2,979.00 ","$1,951.25 ",$948.42 ,"$1,292.89 ", N/A ,$992.69 ,"$2,681.10 ","$2,055.34 ","$1,879.75 ","$1,000.00 ","$2,681.10 ",$948.42 ,"$2,681.10 ","$2,681.10 ",$948.42 ,"$1,936.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000028,60100,HC BX THYROID NEEDLE PERC,350,1 ,"$1,495.00 ",$971.75 ,$632.28 ,"$1,495.00 ","$1,113.78 ",$979.23 ,$632.28 ,$787.87 ,$632.28 ,$943.35 ,$943.35 ,$943.35 ,$943.35 ,"$1,345.50 ","$1,121.25 ",$632.28 ,"$1,315.60 ",$632.28 ,"$1,121.25 ","$1,121.25 ","$1,270.75 ","$1,270.75 ",$632.28 ,"$1,270.75 ",$632.28 ,"$1,181.05 ","$1,181.05 ","$1,181.05 ","$1,345.50 ","$1,495.00 ","$1,345.50 ",$632.28 ,"$1,495.00 ",$979.23 ,$632.28 ,$648.83 , N/A ,$661.80 ,"$1,345.50 ","$1,370.23 ",$943.35 ,"$1,000.00 ","$1,345.50 ",$632.28 ,"$1,345.50 ","$1,345.50 ",$632.28 ,$971.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000032,64430,HC INJ ANEST AGENT PUDENDAL NERVE,350,1 ,"$1,994.00 ","$1,296.10 ",$836.09 ,"$1,994.00 ","$1,485.53 ","$1,306.07 ",$836.09 ,"$1,050.84 ",$836.09 ,"$1,258.21 ","$1,258.21 ","$1,258.21 ","$1,258.21 ","$1,794.60 ","$1,495.50 ",$836.09 ,"$1,754.72 ",$836.09 ,"$1,495.50 ","$1,495.50 ","$1,694.90 ","$1,694.90 ",$836.09 ,"$1,694.90 ",$836.09 ,"$1,575.26 ","$1,575.26 ","$1,575.26 ","$1,794.60 ","$1,994.00 ","$1,794.60 ",$836.09 ,"$1,994.00 ","$1,306.07 ",$836.09 ,$865.40 , N/A ,$875.12 ,"$1,794.60 ","$1,811.92 ","$1,258.21 ","$1,000.00 ","$1,794.60 ",$836.09 ,"$1,794.60 ","$1,794.60 ",$836.09 ,"$1,296.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000036,70450,HC CT HEAD/BRAIN W/O CONTRAST,350,1 ,"$2,233.00 ","$1,451.45 ",$110.78 ,"$2,233.00 ","$1,663.59 ","$1,462.62 ",$110.78 ,"$1,176.79 ",$110.78 ,"$1,409.02 ","$1,409.02 ","$1,409.02 ","$1,409.02 ","$2,009.70 ","$1,674.75 ",$110.78 ,"$1,965.04 ",$110.78 ,"$1,674.75 ","$1,674.75 ","$1,898.05 ","$1,898.05 ",$110.78 ,"$1,898.05 ",$110.78 ,"$1,764.07 ","$1,764.07 ","$1,764.07 ","$2,009.70 ",$265.92 ,"$2,009.70 ",$110.78 ,"$2,233.00 ","$1,462.62 ",$110.78 ,$969.12 , N/A ,$115.95 ,"$2,009.70 ",$240.07 ,"$1,409.02 ","$1,000.00 ","$2,009.70 ",$110.78 ,"$2,009.70 ","$2,009.70 ",$110.78 ,"$1,451.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000037,70460,HC CT HEAD/BRAIN W/CONTRAST,350,1 ,"$3,081.00 ","$2,002.65 ",$181.51 ,"$3,081.00 ","$2,295.35 ","$2,018.06 ",$181.51 ,"$1,623.69 ",$181.51 ,"$1,944.11 ","$1,944.11 ","$1,944.11 ","$1,944.11 ","$2,772.90 ","$2,310.75 ",$181.51 ,"$2,711.28 ",$181.51 ,"$2,310.75 ","$2,310.75 ","$2,618.85 ","$2,618.85 ",$181.51 ,"$2,618.85 ",$181.51 ,"$2,433.99 ","$2,433.99 ","$2,433.99 ","$2,772.90 ",$435.72 ,"$2,772.90 ",$181.51 ,"$3,081.00 ","$2,018.06 ",$181.51 ,"$1,337.15 ", N/A ,$189.98 ,"$2,772.90 ",$393.35 ,"$1,944.11 ","$1,000.00 ","$2,772.90 ",$181.51 ,"$2,772.90 ","$2,772.90 ",$181.51 ,"$2,002.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000038,70470,HC CT HEAD/BRAIN W AND W/O CONTRAST,350,1 ,"$3,391.00 ","$2,204.15 ",$181.51 ,"$3,391.00 ","$2,526.30 ","$2,221.11 ",$181.51 ,"$1,787.06 ",$181.51 ,"$2,139.72 ","$2,139.72 ","$2,139.72 ","$2,139.72 ","$3,051.90 ","$2,543.25 ",$181.51 ,"$2,984.08 ",$181.51 ,"$2,543.25 ","$2,543.25 ","$2,882.35 ","$2,882.35 ",$181.51 ,"$2,882.35 ",$181.51 ,"$2,678.89 ","$2,678.89 ","$2,678.89 ","$3,051.90 ",$435.72 ,"$3,051.90 ",$181.51 ,"$3,391.00 ","$2,221.11 ",$181.51 ,"$1,471.69 ", N/A ,$189.98 ,"$3,051.90 ",$393.35 ,"$2,139.72 ","$1,000.00 ","$3,051.90 ",$181.51 ,"$3,051.90 ","$3,051.90 ",$181.51 ,"$2,204.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000039,70480,HC CT ORBIT/IAC/EAR W/O CONTRAST,350,1 ,"$2,858.00 ","$1,857.70 ",$110.78 ,"$2,858.00 ","$2,129.21 ","$1,871.99 ",$110.78 ,"$1,506.17 ",$110.78 ,"$1,803.40 ","$1,803.40 ","$1,803.40 ","$1,803.40 ","$2,572.20 ","$2,143.50 ",$110.78 ,"$2,515.04 ",$110.78 ,"$2,143.50 ","$2,143.50 ","$2,429.30 ","$2,429.30 ",$110.78 ,"$2,429.30 ",$110.78 ,"$2,257.82 ","$2,257.82 ","$2,257.82 ","$2,572.20 ",$265.92 ,"$2,572.20 ",$110.78 ,"$2,858.00 ","$1,871.99 ",$110.78 ,"$1,240.37 ", N/A ,$115.95 ,"$2,572.20 ",$240.07 ,"$1,803.40 ","$1,000.00 ","$2,572.20 ",$110.78 ,"$2,572.20 ","$2,572.20 ",$110.78 ,"$1,857.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000041,70481,HC CT ORBIT/IAC/EAR W/CONTRAST,350,1 ,"$3,430.00 ","$2,229.50 ",$181.51 ,"$3,430.00 ","$2,555.35 ","$2,246.65 ",$181.51 ,"$1,807.61 ",$181.51 ,"$2,164.33 ","$2,164.33 ","$2,164.33 ","$2,164.33 ","$3,087.00 ","$2,572.50 ",$181.51 ,"$3,018.40 ",$181.51 ,"$2,572.50 ","$2,572.50 ","$2,915.50 ","$2,915.50 ",$181.51 ,"$2,915.50 ",$181.51 ,"$2,709.70 ","$2,709.70 ","$2,709.70 ","$3,087.00 ",$435.72 ,"$3,087.00 ",$181.51 ,"$3,430.00 ","$2,246.65 ",$181.51 ,"$1,488.62 ", N/A ,$189.98 ,"$3,087.00 ",$393.35 ,"$2,164.33 ","$1,000.00 ","$3,087.00 ",$181.51 ,"$3,087.00 ","$3,087.00 ",$181.51 ,"$2,229.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000042,70482,HC CT ORBIT/IAC/EAR W AND W/O CONTRAST,350,1 ,"$4,002.00 ","$2,601.30 ",$181.51 ,"$4,002.00 ","$2,981.49 ","$2,621.31 ",$181.51 ,"$2,109.05 ",$181.51 ,"$2,525.26 ","$2,525.26 ","$2,525.26 ","$2,525.26 ","$3,601.80 ","$3,001.50 ",$181.51 ,"$3,521.76 ",$181.51 ,"$3,001.50 ","$3,001.50 ","$3,401.70 ","$3,401.70 ",$181.51 ,"$3,401.70 ",$181.51 ,"$3,161.58 ","$3,161.58 ","$3,161.58 ","$3,601.80 ",$435.72 ,"$3,601.80 ",$181.51 ,"$4,002.00 ","$2,621.31 ",$181.51 ,"$1,736.87 ", N/A ,$189.98 ,"$3,601.80 ",$393.35 ,"$2,525.26 ","$1,000.00 ","$3,601.80 ",$181.51 ,"$3,601.80 ","$3,601.80 ",$181.51 ,"$2,601.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000043,70486,HC CT MAX/FACIAL W/O CONTRAST,350,1 ,"$3,109.00 ","$2,020.85 ",$110.78 ,"$3,109.00 ","$2,316.21 ","$2,036.40 ",$110.78 ,"$1,638.44 ",$110.78 ,"$1,961.78 ","$1,961.78 ","$1,961.78 ","$1,961.78 ","$2,798.10 ","$2,331.75 ",$110.78 ,"$2,735.92 ",$110.78 ,"$2,331.75 ","$2,331.75 ","$2,642.65 ","$2,642.65 ",$110.78 ,"$2,642.65 ",$110.78 ,"$2,456.11 ","$2,456.11 ","$2,456.11 ","$2,798.10 ",$265.92 ,"$2,798.10 ",$110.78 ,"$3,109.00 ","$2,036.40 ",$110.78 ,"$1,349.31 ", N/A ,$115.95 ,"$2,798.10 ",$240.07 ,"$1,961.78 ","$1,000.00 ","$2,798.10 ",$110.78 ,"$2,798.10 ","$2,798.10 ",$110.78 ,"$2,020.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000045,70487,HC CT MAX/FACIAL W/CONTRAST,350,1 ,"$3,731.00 ","$2,425.15 ",$181.51 ,"$3,731.00 ","$2,779.60 ","$2,443.81 ",$181.51 ,"$1,966.24 ",$181.51 ,"$2,354.26 ","$2,354.26 ","$2,354.26 ","$2,354.26 ","$3,357.90 ","$2,798.25 ",$181.51 ,"$3,283.28 ",$181.51 ,"$2,798.25 ","$2,798.25 ","$3,171.35 ","$3,171.35 ",$181.51 ,"$3,171.35 ",$181.51 ,"$2,947.49 ","$2,947.49 ","$2,947.49 ","$3,357.90 ",$435.72 ,"$3,357.90 ",$181.51 ,"$3,731.00 ","$2,443.81 ",$181.51 ,"$1,619.25 ", N/A ,$189.98 ,"$3,357.90 ",$393.35 ,"$2,354.26 ","$1,000.00 ","$3,357.90 ",$181.51 ,"$3,357.90 ","$3,357.90 ",$181.51 ,"$2,425.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000046,70488,HC CT MAX/FACIAL W AND W/O CONTRAST,350,1 ,"$4,353.00 ","$2,829.45 ",$181.51 ,"$4,353.00 ","$3,242.99 ","$2,851.22 ",$181.51 ,"$2,294.03 ",$181.51 ,"$2,746.74 ","$2,746.74 ","$2,746.74 ","$2,746.74 ","$3,917.70 ","$3,264.75 ",$181.51 ,"$3,830.64 ",$181.51 ,"$3,264.75 ","$3,264.75 ","$3,700.05 ","$3,700.05 ",$181.51 ,"$3,700.05 ",$181.51 ,"$3,438.87 ","$3,438.87 ","$3,438.87 ","$3,917.70 ",$435.72 ,"$3,917.70 ",$181.51 ,"$4,353.00 ","$2,851.22 ",$181.51 ,"$1,889.20 ", N/A ,$189.98 ,"$3,917.70 ",$393.35 ,"$2,746.74 ","$1,000.00 ","$3,917.70 ",$181.51 ,"$3,917.70 ","$3,917.70 ",$181.51 ,"$2,829.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000047,70490,HC CT NECK SFT TISS W/O CONTRAST,350,1 ,"$2,397.00 ","$1,558.05 ",$110.78 ,"$2,397.00 ","$1,785.77 ","$1,570.04 ",$110.78 ,"$1,263.22 ",$110.78 ,"$1,512.51 ","$1,512.51 ","$1,512.51 ","$1,512.51 ","$2,157.30 ","$1,797.75 ",$110.78 ,"$2,109.36 ",$110.78 ,"$1,797.75 ","$1,797.75 ","$2,037.45 ","$2,037.45 ",$110.78 ,"$2,037.45 ",$110.78 ,"$1,893.63 ","$1,893.63 ","$1,893.63 ","$2,157.30 ",$265.92 ,"$2,157.30 ",$110.78 ,"$2,397.00 ","$1,570.04 ",$110.78 ,"$1,040.30 ", N/A ,$115.95 ,"$2,157.30 ",$240.07 ,"$1,512.51 ","$1,000.00 ","$2,157.30 ",$110.78 ,"$2,157.30 ","$2,157.30 ",$110.78 ,"$1,558.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000048,70491,HC CT NECK SFT TISS W/CONTRAST,350,1 ,"$3,400.00 ","$2,210.00 ",$181.51 ,"$3,400.00 ","$2,533.00 ","$2,227.00 ",$181.51 ,"$1,791.80 ",$181.51 ,"$2,145.40 ","$2,145.40 ","$2,145.40 ","$2,145.40 ","$3,060.00 ","$2,550.00 ",$181.51 ,"$2,992.00 ",$181.51 ,"$2,550.00 ","$2,550.00 ","$2,890.00 ","$2,890.00 ",$181.51 ,"$2,890.00 ",$181.51 ,"$2,686.00 ","$2,686.00 ","$2,686.00 ","$3,060.00 ",$435.72 ,"$3,060.00 ",$181.51 ,"$3,400.00 ","$2,227.00 ",$181.51 ,"$1,475.60 ", N/A ,$189.98 ,"$3,060.00 ",$393.35 ,"$2,145.40 ","$1,000.00 ","$3,060.00 ",$181.51 ,"$3,060.00 ","$3,060.00 ",$181.51 ,"$2,210.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000049,70492,HC CT NECK SFT TISS W AND WO CONTRAST,350,1 ,"$4,546.00 ","$2,954.90 ",$181.51 ,"$4,546.00 ","$3,386.77 ","$2,977.63 ",$181.51 ,"$2,395.74 ",$181.51 ,"$2,868.53 ","$2,868.53 ","$2,868.53 ","$2,868.53 ","$4,091.40 ","$3,409.50 ",$181.51 ,"$4,000.48 ",$181.51 ,"$3,409.50 ","$3,409.50 ","$3,864.10 ","$3,864.10 ",$181.51 ,"$3,864.10 ",$181.51 ,"$3,591.34 ","$3,591.34 ","$3,591.34 ","$4,091.40 ",$435.72 ,"$4,091.40 ",$181.51 ,"$4,546.00 ","$2,977.63 ",$181.51 ,"$1,972.96 ", N/A ,$189.98 ,"$4,091.40 ",$393.35 ,"$2,868.53 ","$1,000.00 ","$4,091.40 ",$181.51 ,"$4,091.40 ","$4,091.40 ",$181.51 ,"$2,954.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000050,70496,HC CT ANGIO HEAD W/WO,350,1 ,"$5,260.00 ","$3,419.00 ",$181.51 ,"$5,260.00 ","$3,918.70 ","$3,445.30 ",$181.51 ,"$2,772.02 ",$181.51 ,"$3,319.06 ","$3,319.06 ","$3,319.06 ","$3,319.06 ","$4,734.00 ","$3,945.00 ",$181.51 ,"$4,628.80 ",$181.51 ,"$3,945.00 ","$3,945.00 ","$4,471.00 ","$4,471.00 ",$181.51 ,"$4,471.00 ",$181.51 ,"$4,155.40 ","$4,155.40 ","$4,155.40 ","$4,734.00 ",$435.72 ,"$4,734.00 ",$181.51 ,"$5,260.00 ","$3,445.30 ",$181.51 ,"$2,282.84 ", N/A ,$189.98 ,"$4,734.00 ",$393.35 ,"$3,319.06 ","$1,000.00 ","$4,734.00 ",$181.51 ,"$4,734.00 ","$4,734.00 ",$181.51 ,"$3,419.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000051,70498,HC CT ANGIO NECK W/WO CONTRAST,350,1 ,"$2,466.00 ","$1,602.90 ",$181.51 ,"$2,466.00 ","$1,837.17 ","$1,615.23 ",$181.51 ,"$1,299.58 ",$181.51 ,"$1,556.05 ","$1,556.05 ","$1,556.05 ","$1,556.05 ","$2,219.40 ","$1,849.50 ",$181.51 ,"$2,170.08 ",$181.51 ,"$1,849.50 ","$1,849.50 ","$2,096.10 ","$2,096.10 ",$181.51 ,"$2,096.10 ",$181.51 ,"$1,948.14 ","$1,948.14 ","$1,948.14 ","$2,219.40 ",$435.72 ,"$2,219.40 ",$181.51 ,"$2,466.00 ","$1,615.23 ",$181.51 ,"$1,070.24 ", N/A ,$189.98 ,"$2,219.40 ",$393.35 ,"$1,556.05 ","$1,000.00 ","$2,219.40 ",$181.51 ,"$2,219.40 ","$2,219.40 ",$181.51 ,"$1,602.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000052,70540,HC MRI ORBIT/FACE/NECK W/O CON,610,1 ,"$3,039.00 ","$1,975.35 ",$233.94 ,"$3,039.00 ","$2,264.06 ","$1,990.55 ",$233.94 ,"$1,601.55 ",$233.94 ,"$1,917.61 ","$1,917.61 ","$1,917.61 ","$1,917.61 ","$2,735.10 ","$2,279.25 ",$233.94 ,"$2,674.32 ",$233.94 ,"$2,279.25 ","$2,279.25 ","$2,583.15 ","$2,583.15 ",$233.94 ,"$2,583.15 ",$233.94 ,"$2,400.81 ","$2,400.81 ","$2,400.81 ","$2,735.10 ",$561.60 ,"$2,735.10 ",$233.94 ,"$3,039.00 ","$1,990.55 ",$233.94 ,"$1,318.93 ", N/A ,$244.87 ,"$2,735.10 ",$506.99 ,"$1,917.61 ","$1,304.00 ","$2,735.10 ",$233.94 ,"$2,735.10 ","$2,735.10 ",$233.94 ,"$1,975.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000053,72125,HC CT C-SPINE W/O CONTRAST,350,1 ,"$3,743.00 ","$2,432.95 ",$110.78 ,"$3,743.00 ","$2,788.54 ","$2,451.67 ",$110.78 ,"$1,972.56 ",$110.78 ,"$2,361.83 ","$2,361.83 ","$2,361.83 ","$2,361.83 ","$3,368.70 ","$2,807.25 ",$110.78 ,"$3,293.84 ",$110.78 ,"$2,807.25 ","$2,807.25 ","$3,181.55 ","$3,181.55 ",$110.78 ,"$3,181.55 ",$110.78 ,"$2,956.97 ","$2,956.97 ","$2,956.97 ","$3,368.70 ",$265.92 ,"$3,368.70 ",$110.78 ,"$3,743.00 ","$2,451.67 ",$110.78 ,"$1,624.46 ", N/A ,$115.95 ,"$3,368.70 ",$240.07 ,"$2,361.83 ","$1,000.00 ","$3,368.70 ",$110.78 ,"$3,368.70 ","$3,368.70 ",$110.78 ,"$2,432.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000055,72126,HC CT C-SPINE W/CONTRAST,350,1 ,"$4,265.00 ","$2,772.25 ",$374.22 ,"$4,265.00 ","$3,177.43 ","$2,793.58 ",$374.22 ,"$2,247.66 ",$374.22 ,"$2,691.22 ","$2,691.22 ","$2,691.22 ","$2,691.22 ","$3,838.50 ","$3,198.75 ",$374.22 ,"$3,753.20 ",$374.22 ,"$3,198.75 ","$3,198.75 ","$3,625.25 ","$3,625.25 ",$374.22 ,"$3,625.25 ",$374.22 ,"$3,369.35 ","$3,369.35 ","$3,369.35 ","$3,838.50 ",$898.34 ,"$3,838.50 ",$374.22 ,"$4,265.00 ","$2,793.58 ",$374.22 ,"$1,851.01 ", N/A ,$391.69 ,"$3,838.50 ",$810.99 ,"$2,691.22 ","$1,000.00 ","$3,838.50 ",$374.22 ,"$3,838.50 ","$3,838.50 ",$374.22 ,"$2,772.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000056,72127,HC CT C-SPINE W AND W/O CONTRAST,350,1 ,"$5,129.00 ","$3,333.85 ",$181.51 ,"$5,129.00 ","$3,821.11 ","$3,359.50 ",$181.51 ,"$2,702.98 ",$181.51 ,"$3,236.40 ","$3,236.40 ","$3,236.40 ","$3,236.40 ","$4,616.10 ","$3,846.75 ",$181.51 ,"$4,513.52 ",$181.51 ,"$3,846.75 ","$3,846.75 ","$4,359.65 ","$4,359.65 ",$181.51 ,"$4,359.65 ",$181.51 ,"$4,051.91 ","$4,051.91 ","$4,051.91 ","$4,616.10 ",$435.72 ,"$4,616.10 ",$181.51 ,"$5,129.00 ","$3,359.50 ",$181.51 ,"$2,225.99 ", N/A ,$189.98 ,"$4,616.10 ",$393.35 ,"$3,236.40 ","$1,000.00 ","$4,616.10 ",$181.51 ,"$4,616.10 ","$4,616.10 ",$181.51 ,"$3,333.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000057,72128,HC CT T-SPINE W/O CONTRAST,350,1 ,"$3,138.00 ","$2,039.70 ",$110.78 ,"$3,138.00 ","$2,337.81 ","$2,055.39 ",$110.78 ,"$1,653.73 ",$110.78 ,"$1,980.08 ","$1,980.08 ","$1,980.08 ","$1,980.08 ","$2,824.20 ","$2,353.50 ",$110.78 ,"$2,761.44 ",$110.78 ,"$2,353.50 ","$2,353.50 ","$2,667.30 ","$2,667.30 ",$110.78 ,"$2,667.30 ",$110.78 ,"$2,479.02 ","$2,479.02 ","$2,479.02 ","$2,824.20 ",$265.92 ,"$2,824.20 ",$110.78 ,"$3,138.00 ","$2,055.39 ",$110.78 ,"$1,361.89 ", N/A ,$115.95 ,"$2,824.20 ",$240.07 ,"$1,980.08 ","$1,000.00 ","$2,824.20 ",$110.78 ,"$2,824.20 ","$2,824.20 ",$110.78 ,"$2,039.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000059,72129,HC CT T-SPINE W/CONTRAST,350,1 ,"$3,765.00 ","$2,447.25 ",$181.51 ,"$3,765.00 ","$2,804.93 ","$2,466.08 ",$181.51 ,"$1,984.16 ",$181.51 ,"$2,375.72 ","$2,375.72 ","$2,375.72 ","$2,375.72 ","$3,388.50 ","$2,823.75 ",$181.51 ,"$3,313.20 ",$181.51 ,"$2,823.75 ","$2,823.75 ","$3,200.25 ","$3,200.25 ",$181.51 ,"$3,200.25 ",$181.51 ,"$2,974.35 ","$2,974.35 ","$2,974.35 ","$3,388.50 ",$435.72 ,"$3,388.50 ",$181.51 ,"$3,765.00 ","$2,466.08 ",$181.51 ,"$1,634.01 ", N/A ,$189.98 ,"$3,388.50 ",$393.35 ,"$2,375.72 ","$1,000.00 ","$3,388.50 ",$181.51 ,"$3,388.50 ","$3,388.50 ",$181.51 ,"$2,447.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000060,72130,HC CT T-SPINE W AND W/O CONTRAST,350,1 ,"$4,026.00 ","$2,616.90 ",$181.51 ,"$4,026.00 ","$2,999.37 ","$2,637.03 ",$181.51 ,"$2,121.70 ",$181.51 ,"$2,540.41 ","$2,540.41 ","$2,540.41 ","$2,540.41 ","$3,623.40 ","$3,019.50 ",$181.51 ,"$3,542.88 ",$181.51 ,"$3,019.50 ","$3,019.50 ","$3,422.10 ","$3,422.10 ",$181.51 ,"$3,422.10 ",$181.51 ,"$3,180.54 ","$3,180.54 ","$3,180.54 ","$3,623.40 ",$435.72 ,"$3,623.40 ",$181.51 ,"$4,026.00 ","$2,637.03 ",$181.51 ,"$1,747.28 ", N/A ,$189.98 ,"$3,623.40 ",$393.35 ,"$2,540.41 ","$1,000.00 ","$3,623.40 ",$181.51 ,"$3,623.40 ","$3,623.40 ",$181.51 ,"$2,616.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000061,72131,HC CT L-SPINE W/O CONTRAST,350,1 ,"$3,133.00 ","$2,036.45 ",$110.78 ,"$3,133.00 ","$2,334.09 ","$2,052.12 ",$110.78 ,"$1,651.09 ",$110.78 ,"$1,976.92 ","$1,976.92 ","$1,976.92 ","$1,976.92 ","$2,819.70 ","$2,349.75 ",$110.78 ,"$2,757.04 ",$110.78 ,"$2,349.75 ","$2,349.75 ","$2,663.05 ","$2,663.05 ",$110.78 ,"$2,663.05 ",$110.78 ,"$2,475.07 ","$2,475.07 ","$2,475.07 ","$2,819.70 ",$265.92 ,"$2,819.70 ",$110.78 ,"$3,133.00 ","$2,052.12 ",$110.78 ,"$1,359.72 ", N/A ,$115.95 ,"$2,819.70 ",$240.07 ,"$1,976.92 ","$1,000.00 ","$2,819.70 ",$110.78 ,"$2,819.70 ","$2,819.70 ",$110.78 ,"$2,036.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000062,72132,HC CT L-SPINE W/CONTRAST,350,1 ,"$4,136.00 ","$2,688.40 ",$374.22 ,"$4,136.00 ","$3,081.32 ","$2,709.08 ",$374.22 ,"$2,179.67 ",$374.22 ,"$2,609.82 ","$2,609.82 ","$2,609.82 ","$2,609.82 ","$3,722.40 ","$3,102.00 ",$374.22 ,"$3,639.68 ",$374.22 ,"$3,102.00 ","$3,102.00 ","$3,515.60 ","$3,515.60 ",$374.22 ,"$3,515.60 ",$374.22 ,"$3,267.44 ","$3,267.44 ","$3,267.44 ","$3,722.40 ",$898.34 ,"$3,722.40 ",$374.22 ,"$4,136.00 ","$2,709.08 ",$374.22 ,"$1,795.02 ", N/A ,$391.69 ,"$3,722.40 ",$810.99 ,"$2,609.82 ","$1,000.00 ","$3,722.40 ",$374.22 ,"$3,722.40 ","$3,722.40 ",$374.22 ,"$2,688.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000063,72133,HC CT L-SPINE W AND W/O CONTRAST,350,1 ,"$4,741.00 ","$3,081.65 ",$181.51 ,"$4,741.00 ","$3,532.05 ","$3,105.36 ",$181.51 ,"$2,498.51 ",$181.51 ,"$2,991.57 ","$2,991.57 ","$2,991.57 ","$2,991.57 ","$4,266.90 ","$3,555.75 ",$181.51 ,"$4,172.08 ",$181.51 ,"$3,555.75 ","$3,555.75 ","$4,029.85 ","$4,029.85 ",$181.51 ,"$4,029.85 ",$181.51 ,"$3,745.39 ","$3,745.39 ","$3,745.39 ","$4,266.90 ",$435.72 ,"$4,266.90 ",$181.51 ,"$4,741.00 ","$3,105.36 ",$181.51 ,"$2,057.59 ", N/A ,$189.98 ,"$4,266.90 ",$393.35 ,"$2,991.57 ","$1,000.00 ","$4,266.90 ",$181.51 ,"$4,266.90 ","$4,266.90 ",$181.51 ,"$3,081.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000064,72191,HC CTA PELVIS W AND W/O CONTRAST,350,1 ,"$4,539.00 ","$2,950.35 ",$181.51 ,"$4,539.00 ","$3,381.56 ","$2,973.05 ",$181.51 ,"$2,392.05 ",$181.51 ,"$2,864.11 ","$2,864.11 ","$2,864.11 ","$2,864.11 ","$4,085.10 ","$3,404.25 ",$181.51 ,"$3,994.32 ",$181.51 ,"$3,404.25 ","$3,404.25 ","$3,858.15 ","$3,858.15 ",$181.51 ,"$3,858.15 ",$181.51 ,"$3,585.81 ","$3,585.81 ","$3,585.81 ","$4,085.10 ",$435.72 ,"$4,085.10 ",$181.51 ,"$4,539.00 ","$2,973.05 ",$181.51 ,"$1,969.93 ", N/A ,$189.98 ,"$4,085.10 ",$393.35 ,"$2,864.11 ","$1,000.00 ","$4,085.10 ",$181.51 ,"$4,085.10 ","$4,085.10 ",$181.51 ,"$2,950.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000065,72192,HC CT PELVIS W/O CONTRAST,350,1 ,"$2,508.00 ","$1,630.20 ",$110.78 ,"$2,508.00 ","$1,868.46 ","$1,642.74 ",$110.78 ,"$1,321.72 ",$110.78 ,"$1,582.55 ","$1,582.55 ","$1,582.55 ","$1,582.55 ","$2,257.20 ","$1,881.00 ",$110.78 ,"$2,207.04 ",$110.78 ,"$1,881.00 ","$1,881.00 ","$2,131.80 ","$2,131.80 ",$110.78 ,"$2,131.80 ",$110.78 ,"$1,981.32 ","$1,981.32 ","$1,981.32 ","$2,257.20 ",$265.92 ,"$2,257.20 ",$110.78 ,"$2,508.00 ","$1,642.74 ",$110.78 ,"$1,088.47 ", N/A ,$115.95 ,"$2,257.20 ",$240.07 ,"$1,582.55 ","$1,000.00 ","$2,257.20 ",$110.78 ,"$2,257.20 ","$2,257.20 ",$110.78 ,"$1,630.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000066,72193,HC CT PELVIS W/CONTRAST,350,1 ,"$2,983.00 ","$1,938.95 ",$181.51 ,"$2,983.00 ","$2,222.34 ","$1,953.87 ",$181.51 ,"$1,572.04 ",$181.51 ,"$1,882.27 ","$1,882.27 ","$1,882.27 ","$1,882.27 ","$2,684.70 ","$2,237.25 ",$181.51 ,"$2,625.04 ",$181.51 ,"$2,237.25 ","$2,237.25 ","$2,535.55 ","$2,535.55 ",$181.51 ,"$2,535.55 ",$181.51 ,"$2,356.57 ","$2,356.57 ","$2,356.57 ","$2,684.70 ",$435.72 ,"$2,684.70 ",$181.51 ,"$2,983.00 ","$1,953.87 ",$181.51 ,"$1,294.62 ", N/A ,$189.98 ,"$2,684.70 ",$393.35 ,"$1,882.27 ","$1,000.00 ","$2,684.70 ",$181.51 ,"$2,684.70 ","$2,684.70 ",$181.51 ,"$1,938.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000067,72194,HC CT PELVIS W AND W/O CONTRAST,350,1 ,"$3,339.00 ","$2,170.35 ",$181.51 ,"$3,339.00 ","$2,487.56 ","$2,187.05 ",$181.51 ,"$1,759.65 ",$181.51 ,"$2,106.91 ","$2,106.91 ","$2,106.91 ","$2,106.91 ","$3,005.10 ","$2,504.25 ",$181.51 ,"$2,938.32 ",$181.51 ,"$2,504.25 ","$2,504.25 ","$2,838.15 ","$2,838.15 ",$181.51 ,"$2,838.15 ",$181.51 ,"$2,637.81 ","$2,637.81 ","$2,637.81 ","$3,005.10 ",$435.72 ,"$3,005.10 ",$181.51 ,"$3,339.00 ","$2,187.05 ",$181.51 ,"$1,449.13 ", N/A ,$189.98 ,"$3,005.10 ",$393.35 ,"$2,106.91 ","$1,000.00 ","$3,005.10 ",$181.51 ,"$3,005.10 ","$3,005.10 ",$181.51 ,"$2,170.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000069,73200,HC CT UPPER EXTRM WO CONT,350,1 ,"$2,165.00 ","$1,407.25 ",$110.78 ,"$2,165.00 ","$1,612.93 ","$1,418.08 ",$110.78 ,"$1,140.96 ",$110.78 ,"$1,366.12 ","$1,366.12 ","$1,366.12 ","$1,366.12 ","$1,948.50 ","$1,623.75 ",$110.78 ,"$1,905.20 ",$110.78 ,"$1,623.75 ","$1,623.75 ","$1,840.25 ","$1,840.25 ",$110.78 ,"$1,840.25 ",$110.78 ,"$1,710.35 ","$1,710.35 ","$1,710.35 ","$1,948.50 ",$265.92 ,"$1,948.50 ",$110.78 ,"$2,165.00 ","$1,418.08 ",$110.78 ,$939.61 , N/A ,$115.95 ,"$1,948.50 ",$240.07 ,"$1,366.12 ","$1,000.00 ","$1,948.50 ",$110.78 ,"$1,948.50 ","$1,948.50 ",$110.78 ,"$1,407.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000069,73200,HC CT UPPER EXTRM WO CONT,350,1 ,"$3,248.00 ","$2,111.20 ",$228.05 ,"$3,248.00 ","$2,419.76 ","$2,127.44 ",$228.05 ,"$1,711.70 ",$228.05 ,"$2,049.49 ","$2,049.49 ","$2,049.49 ","$2,049.49 ","$2,923.20 ","$2,436.00 ",$228.05 ,"$2,858.24 ",$228.05 ,"$2,436.00 ","$2,436.00 ","$2,760.80 ","$2,760.80 ",$228.05 ,"$2,760.80 ",$228.05 ,"$2,565.92 ","$2,565.92 ","$2,565.92 ","$2,923.20 ",$547.44 ,"$2,923.20 ",$228.05 ,"$3,248.00 ","$2,127.44 ",$228.05 ,"$1,409.63 ", N/A ,$238.69 ,"$2,923.20 ",$494.21 ,"$2,049.49 ","$1,000.00 ","$2,923.20 ",$228.05 ,"$2,923.20 ","$2,923.20 ",$228.05 ,"$2,111.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000071,73201,HC CT UPPER EXTRM W CONT,350,1 ,"$2,526.00 ","$1,641.90 ",$374.22 ,"$2,526.00 ","$1,881.87 ","$1,654.53 ",$374.22 ,"$1,331.20 ",$374.22 ,"$1,593.91 ","$1,593.91 ","$1,593.91 ","$1,593.91 ","$2,273.40 ","$1,894.50 ",$374.22 ,"$2,222.88 ",$374.22 ,"$1,894.50 ","$1,894.50 ","$2,147.10 ","$2,147.10 ",$374.22 ,"$2,147.10 ",$374.22 ,"$1,995.54 ","$1,995.54 ","$1,995.54 ","$2,273.40 ",$898.34 ,"$2,273.40 ",$374.22 ,"$2,526.00 ","$1,654.53 ",$374.22 ,"$1,096.28 ", N/A ,$391.69 ,"$2,273.40 ",$810.99 ,"$1,593.91 ","$1,000.00 ","$2,273.40 ",$374.22 ,"$2,273.40 ","$2,273.40 ",$374.22 ,"$1,641.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000072,73202,HC CT UPPER EXTR W/WO CONTR,350,1 ,"$3,082.00 ","$2,003.30 ",$181.51 ,"$3,082.00 ","$2,296.09 ","$2,018.71 ",$181.51 ,"$1,624.21 ",$181.51 ,"$1,944.74 ","$1,944.74 ","$1,944.74 ","$1,944.74 ","$2,773.80 ","$2,311.50 ",$181.51 ,"$2,712.16 ",$181.51 ,"$2,311.50 ","$2,311.50 ","$2,619.70 ","$2,619.70 ",$181.51 ,"$2,619.70 ",$181.51 ,"$2,434.78 ","$2,434.78 ","$2,434.78 ","$2,773.80 ",$435.72 ,"$2,773.80 ",$181.51 ,"$3,082.00 ","$2,018.71 ",$181.51 ,"$1,337.59 ", N/A ,$189.98 ,"$2,773.80 ",$393.35 ,"$1,944.74 ","$1,000.00 ","$2,773.80 ",$181.51 ,"$2,773.80 ","$2,773.80 ",$181.51 ,"$2,003.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000072,73202,HC CT UPPER EXTR W/WO CONTR,350,1 ,"$4,623.00 ","$3,004.95 ",$442.34 ,"$4,623.00 ","$3,444.14 ","$3,028.07 ",$442.34 ,"$2,436.32 ",$442.34 ,"$2,917.11 ","$2,917.11 ","$2,917.11 ","$2,917.11 ","$4,160.70 ","$3,467.25 ",$442.34 ,"$4,068.24 ",$442.34 ,"$3,467.25 ","$3,467.25 ","$3,929.55 ","$3,929.55 ",$442.34 ,"$3,929.55 ",$442.34 ,"$3,652.17 ","$3,652.17 ","$3,652.17 ","$4,160.70 ","$1,061.87 ","$4,160.70 ",$442.34 ,"$4,623.00 ","$3,028.07 ",$442.34 ,"$2,006.38 ", N/A ,$462.99 ,"$4,160.70 ",$958.61 ,"$2,917.11 ","$1,000.00 ","$4,160.70 ",$442.34 ,"$4,160.70 ","$4,160.70 ",$442.34 ,"$3,004.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000073,73206,HC CT ANGIO UPPER EXTREM W/WO CONT,350,1 ,"$4,426.00 ","$2,876.90 ",$181.51 ,"$4,426.00 ","$3,297.37 ","$2,899.03 ",$181.51 ,"$2,332.50 ",$181.51 ,"$2,792.81 ","$2,792.81 ","$2,792.81 ","$2,792.81 ","$3,983.40 ","$3,319.50 ",$181.51 ,"$3,894.88 ",$181.51 ,"$3,319.50 ","$3,319.50 ","$3,762.10 ","$3,762.10 ",$181.51 ,"$3,762.10 ",$181.51 ,"$3,496.54 ","$3,496.54 ","$3,496.54 ","$3,983.40 ",$435.72 ,"$3,983.40 ",$181.51 ,"$4,426.00 ","$2,899.03 ",$181.51 ,"$1,920.88 ", N/A ,$189.98 ,"$3,983.40 ",$393.35 ,"$2,792.81 ","$1,000.00 ","$3,983.40 ",$181.51 ,"$3,983.40 ","$3,983.40 ",$181.51 ,"$2,876.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000074,73700,HC CT LOWER EXTRM WO CONT,350,1 ,"$2,413.00 ","$1,568.45 ",$110.78 ,"$2,413.00 ","$1,797.69 ","$1,580.52 ",$110.78 ,"$1,271.65 ",$110.78 ,"$1,522.60 ","$1,522.60 ","$1,522.60 ","$1,522.60 ","$2,171.70 ","$1,809.75 ",$110.78 ,"$2,123.44 ",$110.78 ,"$1,809.75 ","$1,809.75 ","$2,051.05 ","$2,051.05 ",$110.78 ,"$2,051.05 ",$110.78 ,"$1,906.27 ","$1,906.27 ","$1,906.27 ","$2,171.70 ",$265.92 ,"$2,171.70 ",$110.78 ,"$2,413.00 ","$1,580.52 ",$110.78 ,"$1,047.24 ", N/A ,$115.95 ,"$2,171.70 ",$240.07 ,"$1,522.60 ","$1,000.00 ","$2,171.70 ",$110.78 ,"$2,171.70 ","$2,171.70 ",$110.78 ,"$1,568.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000074,73700,HC CT LOWER EXTRM WO CONT,350,1 ,"$3,619.00 ","$2,352.35 ",$228.05 ,"$3,619.00 ","$2,696.16 ","$2,370.45 ",$228.05 ,"$1,907.21 ",$228.05 ,"$2,283.59 ","$2,283.59 ","$2,283.59 ","$2,283.59 ","$3,257.10 ","$2,714.25 ",$228.05 ,"$3,184.72 ",$228.05 ,"$2,714.25 ","$2,714.25 ","$3,076.15 ","$3,076.15 ",$228.05 ,"$3,076.15 ",$228.05 ,"$2,859.01 ","$2,859.01 ","$2,859.01 ","$3,257.10 ",$547.44 ,"$3,257.10 ",$228.05 ,"$3,619.00 ","$2,370.45 ",$228.05 ,"$1,570.65 ", N/A ,$238.69 ,"$3,257.10 ",$494.21 ,"$2,283.59 ","$1,000.00 ","$3,257.10 ",$228.05 ,"$3,257.10 ","$3,257.10 ",$228.05 ,"$2,352.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000075,73701,HC CT LOWER EXTREMITY W/CON,350,1 ,"$2,654.00 ","$1,725.10 ",$181.51 ,"$2,654.00 ","$1,977.23 ","$1,738.37 ",$181.51 ,"$1,398.66 ",$181.51 ,"$1,674.67 ","$1,674.67 ","$1,674.67 ","$1,674.67 ","$2,388.60 ","$1,990.50 ",$181.51 ,"$2,335.52 ",$181.51 ,"$1,990.50 ","$1,990.50 ","$2,255.90 ","$2,255.90 ",$181.51 ,"$2,255.90 ",$181.51 ,"$2,096.66 ","$2,096.66 ","$2,096.66 ","$2,388.60 ",$435.72 ,"$2,388.60 ",$181.51 ,"$2,654.00 ","$1,738.37 ",$181.51 ,"$1,151.84 ", N/A ,$189.98 ,"$2,388.60 ",$393.35 ,"$1,674.67 ","$1,000.00 ","$2,388.60 ",$181.51 ,"$2,388.60 ","$2,388.60 ",$181.51 ,"$1,725.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000077,73702,HC CT LOWER EXTR W/WO CONTR,350,1 ,"$2,821.00 ","$1,833.65 ",$181.51 ,"$2,821.00 ","$2,101.65 ","$1,847.76 ",$181.51 ,"$1,486.67 ",$181.51 ,"$1,780.05 ","$1,780.05 ","$1,780.05 ","$1,780.05 ","$2,538.90 ","$2,115.75 ",$181.51 ,"$2,482.48 ",$181.51 ,"$2,115.75 ","$2,115.75 ","$2,397.85 ","$2,397.85 ",$181.51 ,"$2,397.85 ",$181.51 ,"$2,228.59 ","$2,228.59 ","$2,228.59 ","$2,538.90 ",$435.72 ,"$2,538.90 ",$181.51 ,"$2,821.00 ","$1,847.76 ",$181.51 ,"$1,224.31 ", N/A ,$189.98 ,"$2,538.90 ",$393.35 ,"$1,780.05 ","$1,000.00 ","$2,538.90 ",$181.51 ,"$2,538.90 ","$2,538.90 ",$181.51 ,"$1,833.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000077,73702,HC CT LOWER EXTR W/WO CONTR,350,1 ,"$4,232.00 ","$2,750.80 ",$442.34 ,"$4,232.00 ","$3,152.84 ","$2,771.96 ",$442.34 ,"$2,230.26 ",$442.34 ,"$2,670.39 ","$2,670.39 ","$2,670.39 ","$2,670.39 ","$3,808.80 ","$3,174.00 ",$442.34 ,"$3,724.16 ",$442.34 ,"$3,174.00 ","$3,174.00 ","$3,597.20 ","$3,597.20 ",$442.34 ,"$3,597.20 ",$442.34 ,"$3,343.28 ","$3,343.28 ","$3,343.28 ","$3,808.80 ","$1,061.87 ","$3,808.80 ",$442.34 ,"$4,232.00 ","$2,771.96 ",$442.34 ,"$1,836.69 ", N/A ,$462.99 ,"$3,808.80 ",$958.61 ,"$2,670.39 ","$1,000.00 ","$3,808.80 ",$442.34 ,"$3,808.80 ","$3,808.80 ",$442.34 ,"$2,750.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000078,73706,HC CT ANGIO LOWER EXTREM W/WO CONTR,350,1 ,"$5,326.00 ","$3,461.90 ",$181.51 ,"$5,326.00 ","$3,967.87 ","$3,488.53 ",$181.51 ,"$2,806.80 ",$181.51 ,"$3,360.71 ","$3,360.71 ","$3,360.71 ","$3,360.71 ","$4,793.40 ","$3,994.50 ",$181.51 ,"$4,686.88 ",$181.51 ,"$3,994.50 ","$3,994.50 ","$4,527.10 ","$4,527.10 ",$181.51 ,"$4,527.10 ",$181.51 ,"$4,207.54 ","$4,207.54 ","$4,207.54 ","$4,793.40 ",$435.72 ,"$4,793.40 ",$181.51 ,"$5,326.00 ","$3,488.53 ",$181.51 ,"$2,311.48 ", N/A ,$189.98 ,"$4,793.40 ",$393.35 ,"$3,360.71 ","$1,000.00 ","$4,793.40 ",$181.51 ,"$4,793.40 ","$4,793.40 ",$181.51 ,"$3,461.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000079,74150,HC CT ABD W/O CONTRAST,350,1 ,"$2,734.00 ","$1,777.10 ",$110.78 ,"$2,734.00 ","$2,036.83 ","$1,790.77 ",$110.78 ,"$1,440.82 ",$110.78 ,"$1,725.15 ","$1,725.15 ","$1,725.15 ","$1,725.15 ","$2,460.60 ","$2,050.50 ",$110.78 ,"$2,405.92 ",$110.78 ,"$2,050.50 ","$2,050.50 ","$2,323.90 ","$2,323.90 ",$110.78 ,"$2,323.90 ",$110.78 ,"$2,159.86 ","$2,159.86 ","$2,159.86 ","$2,460.60 ",$265.92 ,"$2,460.60 ",$110.78 ,"$2,734.00 ","$1,790.77 ",$110.78 ,"$1,186.56 ", N/A ,$115.95 ,"$2,460.60 ",$240.07 ,"$1,725.15 ","$1,000.00 ","$2,460.60 ",$110.78 ,"$2,460.60 ","$2,460.60 ",$110.78 ,"$1,777.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000080,74160,HC CT ABDOMEN W/CONTRAST,350,1 ,"$3,144.00 ","$2,043.60 ",$181.51 ,"$3,144.00 ","$2,342.28 ","$2,059.32 ",$181.51 ,"$1,656.89 ",$181.51 ,"$1,983.86 ","$1,983.86 ","$1,983.86 ","$1,983.86 ","$2,829.60 ","$2,358.00 ",$181.51 ,"$2,766.72 ",$181.51 ,"$2,358.00 ","$2,358.00 ","$2,672.40 ","$2,672.40 ",$181.51 ,"$2,672.40 ",$181.51 ,"$2,483.76 ","$2,483.76 ","$2,483.76 ","$2,829.60 ",$435.72 ,"$2,829.60 ",$181.51 ,"$3,144.00 ","$2,059.32 ",$181.51 ,"$1,364.50 ", N/A ,$189.98 ,"$2,829.60 ",$393.35 ,"$1,983.86 ","$1,000.00 ","$2,829.60 ",$181.51 ,"$2,829.60 ","$2,829.60 ",$181.51 ,"$2,043.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000081,74170,HC CT ABDOMEN W AND W/O CONTRAST,350,1 ,"$4,253.00 ","$2,764.45 ",$181.51 ,"$4,253.00 ","$3,168.49 ","$2,785.72 ",$181.51 ,"$2,241.33 ",$181.51 ,"$2,683.64 ","$2,683.64 ","$2,683.64 ","$2,683.64 ","$3,827.70 ","$3,189.75 ",$181.51 ,"$3,742.64 ",$181.51 ,"$3,189.75 ","$3,189.75 ","$3,615.05 ","$3,615.05 ",$181.51 ,"$3,615.05 ",$181.51 ,"$3,359.87 ","$3,359.87 ","$3,359.87 ","$3,827.70 ",$435.72 ,"$3,827.70 ",$181.51 ,"$4,253.00 ","$2,785.72 ",$181.51 ,"$1,845.80 ", N/A ,$189.98 ,"$3,827.70 ",$393.35 ,"$2,683.64 ","$1,000.00 ","$3,827.70 ",$181.51 ,"$3,827.70 ","$3,827.70 ",$181.51 ,"$2,764.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000082,74175,HC CTA ABDOMEN W AND W/O CONTRAST,350,1 ,"$3,190.00 ","$2,073.50 ",$181.51 ,"$3,190.00 ","$2,376.55 ","$2,089.45 ",$181.51 ,"$1,681.13 ",$181.51 ,"$2,012.89 ","$2,012.89 ","$2,012.89 ","$2,012.89 ","$2,871.00 ","$2,392.50 ",$181.51 ,"$2,807.20 ",$181.51 ,"$2,392.50 ","$2,392.50 ","$2,711.50 ","$2,711.50 ",$181.51 ,"$2,711.50 ",$181.51 ,"$2,520.10 ","$2,520.10 ","$2,520.10 ","$2,871.00 ",$435.72 ,"$2,871.00 ",$181.51 ,"$3,190.00 ","$2,089.45 ",$181.51 ,"$1,384.46 ", N/A ,$189.98 ,"$2,871.00 ",$393.35 ,"$2,012.89 ","$1,000.00 ","$2,871.00 ",$181.51 ,"$2,871.00 ","$2,871.00 ",$181.51 ,"$2,073.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000083,74176,HC CT ABDOMEN/PELVIS W/O CONTRAST,350,1 ,"$3,355.00 ","$2,180.75 ",$233.94 ,"$3,355.00 ","$2,499.48 ","$2,197.53 ",$233.94 ,"$1,768.09 ",$233.94 ,"$2,117.01 ","$2,117.01 ","$2,117.01 ","$2,117.01 ","$3,019.50 ","$2,516.25 ",$233.94 ,"$2,952.40 ",$233.94 ,"$2,516.25 ","$2,516.25 ","$2,851.75 ","$2,851.75 ",$233.94 ,"$2,851.75 ",$233.94 ,"$2,650.45 ","$2,650.45 ","$2,650.45 ","$3,019.50 ",$561.60 ,"$3,019.50 ",$233.94 ,"$3,355.00 ","$2,197.53 ",$233.94 ,"$1,456.07 ", N/A ,$244.87 ,"$3,019.50 ",$506.99 ,"$2,117.01 ","$1,000.00 ","$3,019.50 ",$233.94 ,"$3,019.50 ","$3,019.50 ",$233.94 ,"$2,180.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000084,74177,HC CT ABDOMEN/PELVIS W/CONTRAST,350,1 ,"$5,720.00 ","$3,718.00 ",$374.22 ,"$5,720.00 ","$4,261.40 ","$3,746.60 ",$374.22 ,"$3,014.44 ",$374.22 ,"$3,609.32 ","$3,609.32 ","$3,609.32 ","$3,609.32 ","$5,148.00 ","$4,290.00 ",$374.22 ,"$5,033.60 ",$374.22 ,"$4,290.00 ","$4,290.00 ","$4,862.00 ","$4,862.00 ",$374.22 ,"$4,862.00 ",$374.22 ,"$4,518.80 ","$4,518.80 ","$4,518.80 ","$5,148.00 ",$898.34 ,"$5,148.00 ",$374.22 ,"$5,720.00 ","$3,746.60 ",$374.22 ,"$2,482.48 ", N/A ,$391.69 ,"$5,148.00 ",$810.99 ,"$3,609.32 ","$1,000.00 ","$5,148.00 ",$374.22 ,"$5,148.00 ","$5,148.00 ",$374.22 ,"$3,718.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000085,74178,HC CT ABDOMEN/PELVIS W AND W/O CONTR,350,1 ,"$7,634.00 ","$4,962.10 ",$374.22 ,"$7,634.00 ","$5,687.33 ","$5,000.27 ",$374.22 ,"$4,023.12 ",$374.22 ,"$4,817.05 ","$4,817.05 ","$4,817.05 ","$4,817.05 ","$6,870.60 ","$5,725.50 ",$374.22 ,"$6,717.92 ",$374.22 ,"$5,725.50 ","$5,725.50 ","$6,488.90 ","$6,488.90 ",$374.22 ,"$6,488.90 ",$374.22 ,"$6,030.86 ","$6,030.86 ","$6,030.86 ","$6,870.60 ",$898.34 ,"$6,870.60 ",$374.22 ,"$7,634.00 ","$5,000.27 ",$374.22 ,"$3,313.16 ", N/A ,$391.69 ,"$6,870.60 ",$810.99 ,"$4,817.05 ","$1,000.00 ","$6,870.60 ",$374.22 ,"$6,870.60 ","$6,870.60 ",$374.22 ,"$4,962.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000087,75571,HC CT HRT W/O DYE W/CA TEST,350,1 ,$198.00 ,$128.70 ,$82.24 ,$198.00 ,$147.51 ,$129.69 ,$82.24 ,$104.35 ,$82.24 ,$124.94 ,$124.94 ,$124.94 ,$124.94 ,$178.20 ,$148.50 ,$82.24 ,$174.24 ,$82.24 ,$148.50 ,$148.50 ,$168.30 ,$168.30 ,$82.24 ,$168.30 ,$82.24 ,$156.42 ,$156.42 ,$156.42 ,$178.20 ,$197.42 ,$178.20 ,$82.24 ,$198.00 ,$129.69 ,$82.24 ,$85.93 , N/A ,$86.08 ,$178.20 ,$178.23 ,$124.94 ,$198.00 ,$178.20 ,$82.24 ,$178.20 ,$178.20 ,$82.24 ,$128.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000098,75635,HC CTA ABDOMEN AORTA ILIOFEM RUNOFF,350,1 ,"$5,187.00 ","$3,371.55 ",$181.51 ,"$5,187.00 ","$3,864.32 ","$3,397.49 ",$181.51 ,"$2,733.55 ",$181.51 ,"$3,273.00 ","$3,273.00 ","$3,273.00 ","$3,273.00 ","$4,668.30 ","$3,890.25 ",$181.51 ,"$4,564.56 ",$181.51 ,"$3,890.25 ","$3,890.25 ","$4,408.95 ","$4,408.95 ",$181.51 ,"$4,408.95 ",$181.51 ,"$4,097.73 ","$4,097.73 ","$4,097.73 ","$4,668.30 ",$435.72 ,"$4,668.30 ",$181.51 ,"$5,187.00 ","$3,397.49 ",$181.51 ,"$2,251.16 ", N/A ,$189.98 ,"$4,668.30 ",$393.35 ,"$3,273.00 ","$1,000.00 ","$4,668.30 ",$181.51 ,"$4,668.30 ","$4,668.30 ",$181.51 ,"$3,371.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000099,76376,HC 3D RENDER CT NOT REQUIRE INDEP,350,1 ,$798.21 ,$518.84 ,$346.42 ,$798.21 ,$594.67 ,$522.83 , N/A ,$420.66 , N/A ,$503.67 ,$503.67 ,$503.67 ,$503.67 ,$718.39 ,$598.66 , N/A ,$702.42 , N/A ,$598.66 ,$598.66 ,$678.48 ,$678.48 , N/A ,$678.48 , N/A ,$630.59 ,$630.59 ,$630.59 ,$718.39 , N/A ,$718.39 , N/A ,$798.21 ,$522.83 , N/A ,$346.42 , N/A , N/A ,$718.39 , N/A ,$503.67 ,$798.21 ,$718.39 , N/A ,$718.39 ,$718.39 , N/A ,$518.84 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000100,76377,HC 3D RENDER CT REQUIRES INDEPENDENT,350,1 ,$930.00 ,$604.50 ,$403.62 ,$930.00 ,$692.85 ,$609.15 , N/A ,$490.11 , N/A ,$586.83 ,$586.83 ,$586.83 ,$586.83 ,$837.00 ,$697.50 , N/A ,$818.40 , N/A ,$697.50 ,$697.50 ,$790.50 ,$790.50 , N/A ,$790.50 , N/A ,$734.70 ,$734.70 ,$734.70 ,$837.00 , N/A ,$837.00 , N/A ,$930.00 ,$609.15 , N/A ,$403.62 , N/A , N/A ,$837.00 , N/A ,$586.83 ,$930.00 ,$837.00 , N/A ,$837.00 ,$837.00 , N/A ,$604.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000101,76380,HC CT LMTD OR LOCALIZ FU STUDY,350,1 ,"$1,309.00 ",$850.85 ,$82.24 ,"$1,309.00 ",$975.21 ,$857.40 ,$82.24 ,$689.84 ,$82.24 ,$825.98 ,$825.98 ,$825.98 ,$825.98 ,"$1,178.10 ",$981.75 ,$82.24 ,"$1,151.92 ",$82.24 ,$981.75 ,$981.75 ,"$1,112.65 ","$1,112.65 ",$82.24 ,"$1,112.65 ",$82.24 ,"$1,034.11 ","$1,034.11 ","$1,034.11 ","$1,178.10 ",$197.42 ,"$1,178.10 ",$82.24 ,"$1,309.00 ",$857.40 ,$82.24 ,$568.11 , N/A ,$86.08 ,"$1,178.10 ",$178.23 ,$825.98 ,"$1,000.00 ","$1,178.10 ",$82.24 ,"$1,178.10 ","$1,178.10 ",$82.24 ,$850.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000106,77012,HC CT GUIDED NEEDLE PLACEMENT,350,1 ,"$3,969.00 ","$2,579.85 ","$1,000.00 ","$3,969.00 ","$2,956.91 ","$2,599.70 ", N/A ,"$2,091.66 ", N/A ,"$2,504.44 ","$2,504.44 ","$2,504.44 ","$2,504.44 ","$3,572.10 ","$2,976.75 ", N/A ,"$3,492.72 ", N/A ,"$2,976.75 ","$2,976.75 ","$3,373.65 ","$3,373.65 ", N/A ,"$3,373.65 ", N/A ,"$3,135.51 ","$3,135.51 ","$3,135.51 ","$3,572.10 ", N/A ,"$3,572.10 ", N/A ,"$3,969.00 ","$2,599.70 ", N/A ,"$1,722.55 ", N/A , N/A ,"$3,572.10 ", N/A ,"$2,504.44 ","$1,000.00 ","$3,572.10 ", N/A ,"$3,572.10 ","$3,572.10 ", N/A ,"$2,579.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000116,64510,HC INJECT STELLATE GANGLION,350,1 ,"$4,569.00 ","$2,969.85 ",$836.09 ,"$4,569.00 ","$3,403.91 ","$2,992.70 ",$836.09 ,"$2,407.86 ",$836.09 ,"$2,883.04 ","$2,883.04 ","$2,883.04 ","$2,883.04 ","$4,112.10 ","$3,426.75 ",$836.09 ,"$4,020.72 ",$836.09 ,"$3,426.75 ","$3,426.75 ","$3,883.65 ","$3,883.65 ",$836.09 ,"$3,883.65 ",$836.09 ,"$3,609.51 ","$3,609.51 ","$3,609.51 ","$4,112.10 ","$2,007.08 ","$4,112.10 ",$836.09 ,"$4,569.00 ","$2,992.70 ",$836.09 ,"$1,982.95 ", N/A ,$875.12 ,"$4,112.10 ","$1,811.92 ","$2,883.04 ","$1,000.00 ","$4,112.10 ",$836.09 ,"$4,112.10 ","$4,112.10 ",$836.09 ,"$2,969.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000120,74174,HC CT ANGIO ABD/PELV W AND WO CONTRAST,350,1 ,"$6,367.00 ","$4,138.55 ",$374.22 ,"$6,367.00 ","$4,743.42 ","$4,170.39 ",$374.22 ,"$3,355.41 ",$374.22 ,"$4,017.58 ","$4,017.58 ","$4,017.58 ","$4,017.58 ","$5,730.30 ","$4,775.25 ",$374.22 ,"$5,602.96 ",$374.22 ,"$4,775.25 ","$4,775.25 ","$5,411.95 ","$5,411.95 ",$374.22 ,"$5,411.95 ",$374.22 ,"$5,029.93 ","$5,029.93 ","$5,029.93 ","$5,730.30 ",$898.34 ,"$5,730.30 ",$374.22 ,"$6,367.00 ","$4,170.39 ",$374.22 ,"$2,763.28 ", N/A ,$391.69 ,"$5,730.30 ",$810.99 ,"$4,017.58 ","$1,000.00 ","$5,730.30 ",$374.22 ,"$5,730.30 ","$5,730.30 ",$374.22 ,"$4,138.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000150,G0297,HC CT LUNG SCREENING,350,1 ,$262.00 ,$170.30 ,$113.71 ,$262.00 ,$195.19 ,$171.61 , N/A ,$138.07 , N/A ,$165.32 ,$165.32 ,$165.32 ,$165.32 ,$235.80 ,$196.50 , N/A ,$230.56 , N/A ,$196.50 ,$196.50 ,$222.70 ,$222.70 , N/A ,$222.70 , N/A ,$206.98 ,$206.98 ,$206.98 ,$235.80 , N/A ,$235.80 , N/A ,$262.00 ,$171.61 , N/A ,$113.71 , N/A , N/A ,$235.80 , N/A ,$165.32 ,$262.00 ,$235.80 , N/A ,$235.80 ,$235.80 , N/A ,$170.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000152,0503T,HC CORONARY FFR CTA DATA ANALYSIS,350,1 ,"$4,118.00 ","$2,676.70 ",$966.25 ,"$4,118.00 ","$3,067.91 ","$2,697.29 ",$966.25 ,"$2,170.19 ",$966.25 ,"$2,598.46 ","$2,598.46 ","$2,598.46 ","$2,598.46 ","$3,706.20 ","$3,088.50 ",$966.25 ,"$3,623.84 ",$966.25 ,"$3,088.50 ","$3,088.50 ","$3,500.30 ","$3,500.30 ",$966.25 ,"$3,500.30 ",$966.25 ,"$3,253.22 ","$3,253.22 ","$3,253.22 ","$3,706.20 ","$2,319.54 ","$3,706.20 ",$966.25 ,"$4,118.00 ","$2,697.29 ",$966.25 ,"$1,787.21 ", N/A ,"$1,011.36 ","$3,706.20 ","$2,094.00 ","$2,598.46 ","$1,000.00 ","$3,706.20 ",$966.25 ,"$3,706.20 ","$3,706.20 ",$966.25 ,"$2,676.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),35000153,0502T,HC CORONARY FFR CTA DATA PREP AND TRANSMISSION,350,1 ,$300.00 ,$195.00 ,$130.20 ,$300.00 ,$223.50 ,$196.50 , N/A ,$158.10 , N/A ,$189.30 ,$189.30 ,$189.30 ,$189.30 ,$270.00 ,$225.00 , N/A ,$264.00 , N/A ,$225.00 ,$225.00 ,$255.00 ,$255.00 , N/A ,$255.00 , N/A ,$237.00 ,$237.00 ,$237.00 ,$270.00 , N/A ,$270.00 , N/A ,$300.00 ,$196.50 , N/A ,$130.20 , N/A , N/A ,$270.00 , N/A ,$189.30 ,$300.00 ,$270.00 , N/A ,$270.00 ,$270.00 , N/A ,$195.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000027,10060,HC I AND D ABSC SMP FAC,360,1 ,$573.00 ,$372.45 ,$182.53 ,$573.00 ,$426.89 ,$375.32 ,$182.53 ,$301.97 ,$182.53 ,$361.56 ,$361.56 ,$361.56 ,$361.56 ,$515.70 ,$429.75 ,$182.53 ,$504.24 ,$182.53 ,$429.75 ,$429.75 ,$487.05 ,$487.05 ,$182.53 ,$487.05 ,$182.53 ,$452.67 ,$452.67 ,$452.67 ,$515.70 ,$438.16 ,$515.70 ,$182.53 ,$573.00 ,$375.32 ,$182.53 ,$248.68 , N/A ,$191.05 ,$515.70 ,$395.56 ,$361.56 ,$343.80 ,$515.70 ,$182.53 ,$515.70 ,$515.70 ,$182.53 ,$372.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000029,10140,HC I AND D HEMATOMA/SEROMA/FLUID,360,1 ,"$3,881.00 ","$2,522.65 ","$1,430.32 ","$3,881.00 ","$2,891.35 ","$2,542.06 ","$1,430.32 ","$2,045.29 ","$1,430.32 ","$2,448.91 ","$2,448.91 ","$2,448.91 ","$2,448.91 ","$3,492.90 ","$2,910.75 ","$1,430.32 ","$3,415.28 ","$1,430.32 ","$2,910.75 ","$2,910.75 ","$3,298.85 ","$3,298.85 ","$1,430.32 ","$3,298.85 ","$1,430.32 ","$3,065.99 ","$3,065.99 ","$3,065.99 ","$3,492.90 ","$3,433.56 ","$3,492.90 ","$1,430.32 ","$3,881.00 ","$2,542.06 ","$1,430.32 ","$1,684.35 ", N/A ,"$1,497.09 ","$3,492.90 ","$3,099.69 ","$2,448.91 ","$2,328.60 ","$3,492.90 ","$1,430.32 ","$3,492.90 ","$3,492.90 ","$1,430.32 ","$2,522.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000030,10160,HC ASP ABSC/HEMA/CYST/BULLA FAC,360,1 ,$573.00 ,$372.45 ,$248.68 ,$761.90 ,$426.89 ,$375.32 ,$351.57 ,$301.97 ,$351.57 ,$361.56 ,$361.56 ,$361.56 ,$361.56 ,$515.70 ,$429.75 ,$351.57 ,$504.24 ,$351.57 ,$429.75 ,$429.75 ,$487.05 ,$487.05 ,$351.57 ,$487.05 ,$351.57 ,$452.67 ,$452.67 ,$452.67 ,$515.70 ,$573.00 ,$515.70 ,$351.57 ,$573.00 ,$375.32 ,$351.57 ,$248.68 , N/A ,$367.98 ,$515.70 ,$761.90 ,$361.56 ,$343.80 ,$515.70 ,$351.57 ,$515.70 ,$515.70 ,$351.57 ,$372.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000078,19000,HC ASP CYST BREAST,360,1 ,"$1,124.00 ",$730.60 ,$177.68 ,"$1,370.23 ",$837.38 ,$736.22 ,$632.28 ,$592.35 ,$632.28 ,$709.24 ,$709.24 ,$709.24 ,$709.24 ,"$1,011.60 ",$843.00 ,$632.28 ,$989.12 ,$632.28 ,$843.00 ,$843.00 ,$955.40 ,$955.40 ,$632.28 ,$955.40 ,$632.28 ,$887.96 ,$887.96 ,$887.96 ,"$1,011.60 ","$1,124.00 ","$1,011.60 ",$632.28 ,$177.68 ,$736.22 ,$632.28 ,$487.82 , N/A ,$661.80 ,"$1,011.60 ","$1,370.23 ",$709.24 ,$674.40 ,"$1,011.60 ",$632.28 ,"$1,011.60 ","$1,011.60 ",$632.28 ,$730.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000079,19001,HC ASP CYST BREAST EA ADDL,360,1 ,$203.00 ,$131.95 ,$29.74 ,$203.00 ,$151.24 ,$132.97 , N/A ,$106.98 , N/A ,$128.09 ,$128.09 ,$128.09 ,$128.09 ,$182.70 ,$152.25 , N/A ,$178.64 , N/A ,$152.25 ,$152.25 ,$172.55 ,$172.55 , N/A ,$172.55 , N/A ,$160.37 ,$160.37 ,$160.37 ,$182.70 , N/A ,$182.70 , N/A ,$29.74 ,$132.97 , N/A ,$88.10 , N/A , N/A ,$182.70 , N/A ,$128.09 ,$121.80 ,$182.70 , N/A ,$182.70 ,$182.70 , N/A ,$131.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$1,881.00 ","$1,222.65 ",$620.94 ,"$3,099.69 ","$1,401.35 ","$1,232.06 ","$1,430.32 ",$991.29 ,"$1,430.32 ","$1,186.91 ","$1,186.91 ","$1,186.91 ","$1,186.91 ","$1,692.90 ","$1,410.75 ","$1,430.32 ","$1,655.28 ","$1,430.32 ","$1,410.75 ","$1,410.75 ","$1,598.85 ","$1,598.85 ","$1,430.32 ","$1,598.85 ","$1,430.32 ","$1,485.99 ","$1,485.99 ","$1,485.99 ","$1,692.90 ","$1,881.00 ","$1,692.90 ","$1,430.32 ",$620.94 ,"$1,232.06 ","$1,430.32 ",$816.35 , N/A ,"$1,497.09 ","$1,692.90 ","$3,099.69 ","$1,186.91 ","$1,128.60 ","$1,692.90 ","$1,430.32 ","$1,692.90 ","$1,692.90 ","$1,430.32 ","$1,222.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000082,19083,HC BREAST BIOPSY W/IMAG GUIDE ULTRA,360,1 ,"$2,821.00 ","$1,833.65 ",$620.94 ,"$5,221.24 ","$2,101.65 ","$1,847.76 ","$2,409.29 ","$1,486.67 ","$2,409.29 ","$1,780.05 ","$1,780.05 ","$1,780.05 ","$1,780.05 ","$2,538.90 ","$2,115.75 ","$2,409.29 ","$2,482.48 ","$2,409.29 ","$2,115.75 ","$2,115.75 ","$2,397.85 ","$2,397.85 ","$2,409.29 ","$2,397.85 ","$2,409.29 ","$2,228.59 ","$2,228.59 ","$2,228.59 ","$2,538.90 ","$2,821.00 ","$2,538.90 ","$2,409.29 ",$620.94 ,"$1,847.76 ","$2,409.29 ","$1,224.31 ", N/A ,"$2,521.76 ","$2,538.90 ","$5,221.24 ","$1,780.05 ","$1,692.60 ","$2,538.90 ","$2,409.29 ","$2,538.90 ","$2,538.90 ","$2,409.29 ","$1,833.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000085,19285,HC PLCMNT NEEDLE LOC WIRE BRST ULTRA,360,1 ,"$1,449.00 ",$941.85 ,$464.28 ,"$1,449.00 ","$1,079.51 ",$949.10 ,$632.28 ,$763.62 ,$632.28 ,$914.32 ,$914.32 ,$914.32 ,$914.32 ,"$1,304.10 ","$1,086.75 ",$632.28 ,"$1,275.12 ",$632.28 ,"$1,086.75 ","$1,086.75 ","$1,231.65 ","$1,231.65 ",$632.28 ,"$1,231.65 ",$632.28 ,"$1,144.71 ","$1,144.71 ","$1,144.71 ","$1,304.10 ","$1,449.00 ","$1,304.10 ",$632.28 ,$464.28 ,$949.10 ,$632.28 ,$628.87 , N/A ,$661.80 ,"$1,304.10 ","$1,370.23 ",$914.32 ,$869.40 ,"$1,304.10 ",$632.28 ,"$1,304.10 ","$1,304.10 ",$632.28 ,$941.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000085,19285,HC PLCMNT NEEDLE LOC WIRE BRST ULTRA,360,1 ,"$2,174.00 ","$1,413.10 ",$464.28 ,"$2,174.00 ","$1,619.63 ","$1,423.97 ",$632.28 ,"$1,145.70 ",$632.28 ,"$1,371.79 ","$1,371.79 ","$1,371.79 ","$1,371.79 ","$1,956.60 ","$1,630.50 ",$632.28 ,"$1,913.12 ",$632.28 ,"$1,630.50 ","$1,630.50 ","$1,847.90 ","$1,847.90 ",$632.28 ,"$1,847.90 ",$632.28 ,"$1,717.46 ","$1,717.46 ","$1,717.46 ","$1,956.60 ","$1,517.82 ","$1,956.60 ",$632.28 ,$464.28 ,"$1,423.97 ",$632.28 ,$943.52 , N/A ,$661.80 ,"$1,956.60 ","$1,370.23 ","$1,371.79 ","$1,304.40 ","$1,956.60 ",$632.28 ,"$1,956.60 ","$1,956.60 ",$632.28 ,"$1,413.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000088,20206,HC BX MUSCLE NEEDLE PERC,360,1 ,$935.00 ,$607.75 ,$405.79 ,"$3,099.69 ",$696.58 ,$612.43 ,$935.00 ,$492.75 ,$935.00 ,$589.99 ,$589.99 ,$589.99 ,$589.99 ,$841.50 ,$701.25 ,$935.00 ,$822.80 ,$935.00 ,$701.25 ,$701.25 ,$794.75 ,$794.75 ,$935.00 ,$794.75 ,$935.00 ,$738.65 ,$738.65 ,$738.65 ,$841.50 ,$935.00 ,$841.50 ,$935.00 ,$935.00 ,$612.43 ,$935.00 ,$405.79 , N/A ,$935.00 ,$841.50 ,"$3,099.69 ",$589.99 ,$561.00 ,$841.50 ,$935.00 ,$841.50 ,$841.50 ,$935.00 ,$607.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000089,20220,HC BX BONE NEEDLE SUPERFIC FAC,360,1 ,"$2,290.00 ","$1,488.50 ",$993.86 ,"$3,099.69 ","$1,706.05 ","$1,499.95 ","$1,430.32 ","$1,206.83 ","$1,430.32 ","$1,444.99 ","$1,444.99 ","$1,444.99 ","$1,444.99 ","$2,061.00 ","$1,717.50 ","$1,430.32 ","$2,015.20 ","$1,430.32 ","$1,717.50 ","$1,717.50 ","$1,946.50 ","$1,946.50 ","$1,430.32 ","$1,946.50 ","$1,430.32 ","$1,809.10 ","$1,809.10 ","$1,809.10 ","$2,061.00 ","$2,290.00 ","$2,061.00 ","$1,430.32 ","$2,290.00 ","$1,499.95 ","$1,430.32 ",$993.86 , N/A ,"$1,497.09 ","$2,061.00 ","$3,099.69 ","$1,444.99 ","$1,374.00 ","$2,061.00 ","$1,430.32 ","$2,061.00 ","$2,061.00 ","$1,430.32 ","$1,488.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000090,20225,HC BX BONE NEEDLE DEEP,360,1 ,"$3,404.00 ","$2,212.60 ","$1,430.32 ","$3,404.00 ","$2,535.98 ","$2,229.62 ","$1,430.32 ","$1,793.91 ","$1,430.32 ","$2,147.92 ","$2,147.92 ","$2,147.92 ","$2,147.92 ","$3,063.60 ","$2,553.00 ","$1,430.32 ","$2,995.52 ","$1,430.32 ","$2,553.00 ","$2,553.00 ","$2,893.40 ","$2,893.40 ","$1,430.32 ","$2,893.40 ","$1,430.32 ","$2,689.16 ","$2,689.16 ","$2,689.16 ","$3,063.60 ","$3,404.00 ","$3,063.60 ","$1,430.32 ","$3,404.00 ","$2,229.62 ","$1,430.32 ","$1,477.34 ", N/A ,"$1,497.09 ","$3,063.60 ","$3,099.69 ","$2,147.92 ","$2,042.40 ","$3,063.60 ","$1,430.32 ","$3,063.60 ","$3,063.60 ","$1,430.32 ","$2,212.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000108,19082,HC BREAST LOC BX PERC STEREO ADDN LESION,360,1 ,"$1,953.00 ","$1,269.45 ",$494.86 ,"$1,953.00 ","$1,454.99 ","$1,279.22 ", N/A ,"$1,029.23 ", N/A ,"$1,232.34 ","$1,232.34 ","$1,232.34 ","$1,232.34 ","$1,757.70 ","$1,464.75 ", N/A ,"$1,718.64 ", N/A ,"$1,464.75 ","$1,464.75 ","$1,660.05 ","$1,660.05 ", N/A ,"$1,660.05 ", N/A ,"$1,542.87 ","$1,542.87 ","$1,542.87 ","$1,757.70 ", N/A ,"$1,757.70 ", N/A ,$494.86 ,"$1,279.22 ", N/A ,$847.60 , N/A , N/A ,"$1,757.70 ", N/A ,"$1,232.34 ","$1,171.80 ","$1,757.70 ", N/A ,"$1,757.70 ","$1,757.70 ", N/A ,"$1,269.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000109,19084,HC BREAST LOC BX ULTRA ADDN LESION,360,1 ,$986.00 ,$640.90 ,$427.92 ,$986.00 ,$734.57 ,$645.83 , N/A ,$519.62 , N/A ,$622.17 ,$622.17 ,$622.17 ,$622.17 ,$887.40 ,$739.50 , N/A ,$867.68 , N/A ,$739.50 ,$739.50 ,$838.10 ,$838.10 , N/A ,$838.10 , N/A ,$778.94 ,$778.94 ,$778.94 ,$887.40 , N/A ,$887.40 , N/A ,$485.95 ,$645.83 , N/A ,$427.92 , N/A , N/A ,$887.40 , N/A ,$622.17 ,$591.60 ,$887.40 , N/A ,$887.40 ,$887.40 , N/A ,$640.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000109,19084,HC BREAST LOC BX ULTRA ADDN LESION,360,1 ,"$1,479.00 ",$961.35 ,$485.95 ,"$1,479.00 ","$1,101.86 ",$968.75 , N/A ,$779.43 , N/A ,$933.25 ,$933.25 ,$933.25 ,$933.25 ,"$1,331.10 ","$1,109.25 ", N/A ,"$1,301.52 ", N/A ,"$1,109.25 ","$1,109.25 ","$1,257.15 ","$1,257.15 ", N/A ,"$1,257.15 ", N/A ,"$1,168.41 ","$1,168.41 ","$1,168.41 ","$1,331.10 ", N/A ,"$1,331.10 ", N/A ,$485.95 ,$968.75 , N/A ,$641.89 , N/A , N/A ,"$1,331.10 ", N/A ,$933.25 ,$887.40 ,"$1,331.10 ", N/A ,"$1,331.10 ","$1,331.10 ", N/A ,$961.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000116,19286,HC BREAST NDL LOC BX ULTRA ADDN LESION,360,1 ,$640.00 ,$416.00 ,$277.76 ,$640.00 ,$476.80 ,$419.20 , N/A ,$337.28 , N/A ,$403.84 ,$403.84 ,$403.84 ,$403.84 ,$576.00 ,$480.00 , N/A ,$563.20 , N/A ,$480.00 ,$480.00 ,$544.00 ,$544.00 , N/A ,$544.00 , N/A ,$505.60 ,$505.60 ,$505.60 ,$576.00 , N/A ,$576.00 , N/A ,$391.77 ,$419.20 , N/A ,$277.76 , N/A , N/A ,$576.00 , N/A ,$403.84 ,$384.00 ,$576.00 , N/A ,$576.00 ,$576.00 , N/A ,$416.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000116,19286,HC BREAST NDL LOC BX ULTRA ADDN LESION,360,1 ,$959.00 ,$623.35 ,$391.77 ,$959.00 ,$714.46 ,$628.15 , N/A ,$505.39 , N/A ,$605.13 ,$605.13 ,$605.13 ,$605.13 ,$863.10 ,$719.25 , N/A ,$843.92 , N/A ,$719.25 ,$719.25 ,$815.15 ,$815.15 , N/A ,$815.15 , N/A ,$757.61 ,$757.61 ,$757.61 ,$863.10 , N/A ,$863.10 , N/A ,$391.77 ,$628.15 , N/A ,$416.21 , N/A , N/A ,$863.10 , N/A ,$605.13 ,$575.40 ,$863.10 , N/A ,$863.10 ,$863.10 , N/A ,$623.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000118,36470,HC INJ SCLEROSING SOLUTION SINGLE VEIN,360,1 ,"$1,275.00 ",$828.75 ,$351.57 ,"$1,275.00 ",$949.88 ,$835.13 ,$351.57 ,$671.93 ,$351.57 ,$804.53 ,$804.53 ,$804.53 ,$804.53 ,"$1,147.50 ",$956.25 ,$351.57 ,"$1,122.00 ",$351.57 ,$956.25 ,$956.25 ,"$1,083.75 ","$1,083.75 ",$351.57 ,"$1,083.75 ",$351.57 ,"$1,007.25 ","$1,007.25 ","$1,007.25 ","$1,147.50 ",$843.97 ,"$1,147.50 ",$351.57 ,"$1,275.00 ",$835.13 ,$351.57 ,$553.35 , N/A ,$367.98 ,"$1,147.50 ",$761.90 ,$804.53 ,$765.00 ,"$1,147.50 ",$351.57 ,"$1,147.50 ","$1,147.50 ",$351.57 ,$828.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000119,36471,HC INJ SCLEROSING SOLUTN MULT VEIN,360,1 ,"$1,241.00 ",$806.65 ,$351.57 ,"$1,241.00 ",$924.55 ,$812.86 ,$351.57 ,$654.01 ,$351.57 ,$783.07 ,$783.07 ,$783.07 ,$783.07 ,"$1,116.90 ",$930.75 ,$351.57 ,"$1,092.08 ",$351.57 ,$930.75 ,$930.75 ,"$1,054.85 ","$1,054.85 ",$351.57 ,"$1,054.85 ",$351.57 ,$980.39 ,$980.39 ,$980.39 ,"$1,116.90 ",$843.97 ,"$1,116.90 ",$351.57 ,"$1,241.00 ",$812.86 ,$351.57 ,$538.59 , N/A ,$367.98 ,"$1,116.90 ",$761.90 ,$783.07 ,$744.60 ,"$1,116.90 ",$351.57 ,"$1,116.90 ","$1,116.90 ",$351.57 ,$806.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000123,36556,HC INS CATH CV NON-TUNL >5 YR,360,1 ,"$2,984.00 ","$1,939.60 ","$1,295.06 ","$6,304.37 ","$2,223.08 ","$1,954.52 ","$2,909.08 ","$1,572.57 ","$2,909.08 ","$1,882.90 ","$1,882.90 ","$1,882.90 ","$1,882.90 ","$2,685.60 ","$2,238.00 ","$2,909.08 ","$2,625.92 ","$2,909.08 ","$2,238.00 ","$2,238.00 ","$2,536.40 ","$2,536.40 ","$2,909.08 ","$2,536.40 ","$2,909.08 ","$2,357.36 ","$2,357.36 ","$2,357.36 ","$2,685.60 ","$2,984.00 ","$2,685.60 ","$2,909.08 ","$2,984.00 ","$1,954.52 ","$2,909.08 ","$1,295.06 ", N/A ,"$2,984.00 ","$2,685.60 ","$6,304.37 ","$1,882.90 ","$1,790.40 ","$2,685.60 ","$2,909.08 ","$2,685.60 ","$2,685.60 ","$2,909.08 ","$1,939.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000125,36558,HC INSERT TUNNELED CVC > 5 YEARS OLD,360,1 ,"$5,051.00 ","$3,283.15 ","$2,192.13 ","$6,304.37 ","$3,763.00 ","$3,308.41 ","$2,909.08 ","$2,661.88 ","$2,909.08 ","$3,187.18 ","$3,187.18 ","$3,187.18 ","$3,187.18 ","$4,545.90 ","$3,788.25 ","$2,909.08 ","$4,444.88 ","$2,909.08 ","$3,788.25 ","$3,788.25 ","$4,293.35 ","$4,293.35 ","$2,909.08 ","$4,293.35 ","$2,909.08 ","$3,990.29 ","$3,990.29 ","$3,990.29 ","$4,545.90 ","$5,051.00 ","$4,545.90 ","$2,909.08 ","$5,051.00 ","$3,308.41 ","$2,909.08 ","$2,192.13 ", N/A ,"$3,044.89 ","$4,545.90 ","$6,304.37 ","$3,187.18 ","$3,030.60 ","$4,545.90 ","$2,909.08 ","$4,545.90 ","$4,545.90 ","$2,909.08 ","$3,283.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000125,36558,HC INSERT TUNNELED CVC > 5 YEARS OLD,360,1 ,"$7,576.00 ","$4,924.40 ","$3,287.98 ","$10,509.35 ","$5,644.12 ","$4,962.28 ","$4,849.42 ","$3,992.55 ","$4,849.42 ","$4,780.46 ","$4,780.46 ","$4,780.46 ","$4,780.46 ","$6,818.40 ","$5,682.00 ","$4,849.42 ","$6,666.88 ","$4,849.42 ","$5,682.00 ","$5,682.00 ","$6,439.60 ","$6,439.60 ","$4,849.42 ","$6,439.60 ","$4,849.42 ","$5,985.04 ","$5,985.04 ","$5,985.04 ","$6,818.40 ","$7,576.00 ","$6,818.40 ","$4,849.42 ","$7,576.00 ","$4,962.28 ","$4,849.42 ","$3,287.98 ", N/A ,"$5,075.82 ","$6,818.40 ","$10,509.35 ","$4,780.46 ","$4,545.60 ","$6,818.40 ","$4,849.42 ","$6,818.40 ","$6,818.40 ","$4,849.42 ","$4,924.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000127,36561,HC INSERT TUNEL CV CATH>5YR W/PORT,360,1 ,"$6,246.00 ","$4,059.90 ","$2,710.76 ","$6,304.37 ","$4,653.27 ","$4,091.13 ","$2,909.08 ","$3,291.64 ","$2,909.08 ","$3,941.23 ","$3,941.23 ","$3,941.23 ","$3,941.23 ","$5,621.40 ","$4,684.50 ","$2,909.08 ","$5,496.48 ","$2,909.08 ","$4,684.50 ","$4,684.50 ","$5,309.10 ","$5,309.10 ","$2,909.08 ","$5,309.10 ","$2,909.08 ","$4,934.34 ","$4,934.34 ","$4,934.34 ","$5,621.40 ","$6,246.00 ","$5,621.40 ","$2,909.08 ","$6,246.00 ","$4,091.13 ","$2,909.08 ","$2,710.76 ", N/A ,"$3,044.89 ","$5,621.40 ","$6,304.37 ","$3,941.23 ","$3,747.60 ","$5,621.40 ","$2,909.08 ","$5,621.40 ","$5,621.40 ","$2,909.08 ","$4,059.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000127,36561,HC INSERT TUNEL CV CATH>5YR W/PORT,360,1 ,"$1,577.00 ","$1,025.05 ",$684.42 ,"$6,304.37 ","$1,174.87 ","$1,032.94 ","$1,577.00 ",$831.08 ,"$1,577.00 ",$995.09 ,$995.09 ,$995.09 ,$995.09 ,"$1,419.30 ","$1,182.75 ","$1,577.00 ","$1,387.76 ","$1,577.00 ","$1,182.75 ","$1,182.75 ","$1,340.45 ","$1,340.45 ","$1,577.00 ","$1,340.45 ","$1,577.00 ","$1,245.83 ","$1,245.83 ","$1,245.83 ","$1,419.30 ","$1,577.00 ","$1,419.30 ","$1,577.00 ","$1,577.00 ","$1,032.94 ","$1,577.00 ",$684.42 , N/A ,"$1,577.00 ","$1,419.30 ","$6,304.37 ",$995.09 ,$946.20 ,"$1,419.30 ","$1,577.00 ","$1,419.30 ","$1,419.30 ","$1,577.00 ","$1,025.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000132,36569,HC INS PER CV CATH W/O PORT 5>,360,1 ,"$2,153.00 ","$1,399.45 ",$934.40 ,"$3,097.79 ","$1,603.99 ","$1,410.22 ","$1,429.44 ","$1,134.63 ","$1,429.44 ","$1,358.54 ","$1,358.54 ","$1,358.54 ","$1,358.54 ","$1,937.70 ","$1,614.75 ","$1,429.44 ","$1,894.64 ","$1,429.44 ","$1,614.75 ","$1,614.75 ","$1,830.05 ","$1,830.05 ","$1,429.44 ","$1,830.05 ","$1,429.44 ","$1,700.87 ","$1,700.87 ","$1,700.87 ","$1,937.70 ","$2,153.00 ","$1,937.70 ","$1,429.44 ","$2,153.00 ","$1,410.22 ","$1,429.44 ",$934.40 , N/A ,"$1,496.18 ","$1,937.70 ","$3,097.79 ","$1,358.54 ","$1,291.80 ","$1,937.70 ","$1,429.44 ","$1,937.70 ","$1,937.70 ","$1,429.44 ","$1,399.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000135,36580,HC REPL CATH CV NON-TNL W/O PORT,360,1 ,"$3,231.00 ","$2,100.15 ","$1,402.25 ","$3,231.00 ","$2,407.10 ","$2,116.31 ","$1,429.44 ","$1,702.74 ","$1,429.44 ","$2,038.76 ","$2,038.76 ","$2,038.76 ","$2,038.76 ","$2,907.90 ","$2,423.25 ","$1,429.44 ","$2,843.28 ","$1,429.44 ","$2,423.25 ","$2,423.25 ","$2,746.35 ","$2,746.35 ","$1,429.44 ","$2,746.35 ","$1,429.44 ","$2,552.49 ","$2,552.49 ","$2,552.49 ","$2,907.90 ","$3,231.00 ","$2,907.90 ","$1,429.44 ","$3,231.00 ","$2,116.31 ","$1,429.44 ","$1,402.25 ", N/A ,"$1,496.18 ","$2,907.90 ","$3,097.79 ","$2,038.76 ","$1,938.60 ","$2,907.90 ","$1,429.44 ","$2,907.90 ","$2,907.90 ","$1,429.44 ","$2,100.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000136,36581,HC REPL CATH CV TNL W/O PORT,360,1 ,"$4,555.00 ","$2,960.75 ","$1,976.87 ","$6,304.37 ","$3,393.48 ","$2,983.53 ","$2,909.08 ","$2,400.49 ","$2,909.08 ","$2,874.21 ","$2,874.21 ","$2,874.21 ","$2,874.21 ","$4,099.50 ","$3,416.25 ","$2,909.08 ","$4,008.40 ","$2,909.08 ","$3,416.25 ","$3,416.25 ","$3,871.75 ","$3,871.75 ","$2,909.08 ","$3,871.75 ","$2,909.08 ","$3,598.45 ","$3,598.45 ","$3,598.45 ","$4,099.50 ","$4,555.00 ","$4,099.50 ","$2,909.08 ","$4,555.00 ","$2,983.53 ","$2,909.08 ","$1,976.87 ", N/A ,"$3,044.89 ","$4,099.50 ","$6,304.37 ","$2,874.21 ","$2,733.00 ","$4,099.50 ","$2,909.08 ","$4,099.50 ","$4,099.50 ","$2,909.08 ","$2,960.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000137,36582,HC REPL DEVICE CV TNL W/PORT,360,1 ,"$6,673.00 ","$4,337.45 ","$2,896.08 ","$6,673.00 ","$4,971.39 ","$4,370.82 ","$2,909.08 ","$3,516.67 ","$2,909.08 ","$4,210.66 ","$4,210.66 ","$4,210.66 ","$4,210.66 ","$6,005.70 ","$5,004.75 ","$2,909.08 ","$5,872.24 ","$2,909.08 ","$5,004.75 ","$5,004.75 ","$5,672.05 ","$5,672.05 ","$2,909.08 ","$5,672.05 ","$2,909.08 ","$5,271.67 ","$5,271.67 ","$5,271.67 ","$6,005.70 ","$6,673.00 ","$6,005.70 ","$2,909.08 ","$6,673.00 ","$4,370.82 ","$2,909.08 ","$2,896.08 ", N/A ,"$3,044.89 ","$6,005.70 ","$6,304.37 ","$4,210.66 ","$4,003.80 ","$6,005.70 ","$2,909.08 ","$6,005.70 ","$6,005.70 ","$2,909.08 ","$4,337.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000139,36584,HC REPL PICC W/O PORT/PUMP,360,1 ,"$1,409.00 ",$915.85 ,$611.51 ,"$3,097.79 ","$1,049.71 ",$922.90 ,"$1,409.00 ",$742.54 ,"$1,409.00 ",$889.08 ,$889.08 ,$889.08 ,$889.08 ,"$1,268.10 ","$1,056.75 ","$1,409.00 ","$1,239.92 ","$1,409.00 ","$1,056.75 ","$1,056.75 ","$1,197.65 ","$1,197.65 ","$1,409.00 ","$1,197.65 ","$1,409.00 ","$1,113.11 ","$1,113.11 ","$1,113.11 ","$1,268.10 ","$1,409.00 ","$1,268.10 ","$1,409.00 ","$1,409.00 ",$922.90 ,"$1,409.00 ",$611.51 , N/A ,"$1,409.00 ","$1,268.10 ","$3,097.79 ",$889.08 ,$845.40 ,"$1,268.10 ","$1,409.00 ","$1,268.10 ","$1,268.10 ","$1,409.00 ",$915.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000141,36589,HC REMOVE TUNNELED CATH-NO PORT,360,1 ,"$1,783.00 ","$1,158.95 ",$550.60 ,"$1,783.00 ","$1,328.34 ","$1,167.87 ",$550.60 ,$939.64 ,$550.60 ,"$1,125.07 ","$1,125.07 ","$1,125.07 ","$1,125.07 ","$1,604.70 ","$1,337.25 ",$550.60 ,"$1,569.04 ",$550.60 ,"$1,337.25 ","$1,337.25 ","$1,515.55 ","$1,515.55 ",$550.60 ,"$1,515.55 ",$550.60 ,"$1,408.57 ","$1,408.57 ","$1,408.57 ","$1,604.70 ","$1,321.74 ","$1,604.70 ",$550.60 ,"$1,783.00 ","$1,167.87 ",$550.60 ,$773.82 , N/A ,$576.30 ,"$1,604.70 ","$1,193.21 ","$1,125.07 ","$1,069.80 ","$1,604.70 ",$550.60 ,"$1,604.70 ","$1,604.70 ",$550.60 ,"$1,158.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000141,36589,HC REMOVE TUNNELED CATH-NO PORT,360,1 ,"$2,675.00 ","$1,738.75 ",$550.60 ,"$2,675.00 ","$1,992.88 ","$1,752.13 ",$550.60 ,"$1,409.73 ",$550.60 ,"$1,687.93 ","$1,687.93 ","$1,687.93 ","$1,687.93 ","$2,407.50 ","$2,006.25 ",$550.60 ,"$2,354.00 ",$550.60 ,"$2,006.25 ","$2,006.25 ","$2,273.75 ","$2,273.75 ",$550.60 ,"$2,273.75 ",$550.60 ,"$2,113.25 ","$2,113.25 ","$2,113.25 ","$2,407.50 ","$1,321.74 ","$2,407.50 ",$550.60 ,"$2,675.00 ","$1,752.13 ",$550.60 ,"$1,160.95 ", N/A ,$576.30 ,"$2,407.50 ","$1,193.21 ","$1,687.93 ","$1,605.00 ","$2,407.50 ",$550.60 ,"$2,407.50 ","$2,407.50 ",$550.60 ,"$1,738.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000142,36590,HC REM TNL CV ACC W/PORT/PUMP,360,1 ,"$2,133.00 ","$1,386.45 ",$925.72 ,"$3,097.79 ","$1,589.09 ","$1,397.12 ","$1,429.44 ","$1,124.09 ","$1,429.44 ","$1,345.92 ","$1,345.92 ","$1,345.92 ","$1,345.92 ","$1,919.70 ","$1,599.75 ","$1,429.44 ","$1,877.04 ","$1,429.44 ","$1,599.75 ","$1,599.75 ","$1,813.05 ","$1,813.05 ","$1,429.44 ","$1,813.05 ","$1,429.44 ","$1,685.07 ","$1,685.07 ","$1,685.07 ","$1,919.70 ","$2,133.00 ","$1,919.70 ","$1,429.44 ","$2,133.00 ","$1,397.12 ","$1,429.44 ",$925.72 , N/A ,"$1,496.18 ","$1,919.70 ","$3,097.79 ","$1,345.92 ","$1,279.80 ","$1,919.70 ","$1,429.44 ","$1,919.70 ","$1,919.70 ","$1,429.44 ","$1,386.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000148,36620,HC CATH/CANN ARTERY PERC 36620,360,1 ,"$1,603.83 ","$1,042.49 ",$696.06 ,"$1,603.83 ","$1,194.85 ","$1,050.51 ", N/A ,$845.22 , N/A ,"$1,012.02 ","$1,012.02 ","$1,012.02 ","$1,012.02 ","$1,443.45 ","$1,202.87 ", N/A ,"$1,411.37 ", N/A ,"$1,202.87 ","$1,202.87 ","$1,363.26 ","$1,363.26 ", N/A ,"$1,363.26 ", N/A ,"$1,267.03 ","$1,267.03 ","$1,267.03 ","$1,443.45 ", N/A ,"$1,443.45 ", N/A ,"$1,603.83 ","$1,050.51 ", N/A ,$696.06 , N/A , N/A ,"$1,443.45 ", N/A ,"$1,012.02 ",$962.30 ,"$1,443.45 ", N/A ,"$1,443.45 ","$1,443.45 ", N/A ,"$1,042.49 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000159,38505,HC LYMPH NODE BIOPSY SUPERFICIAL,360,1 ,"$1,051.00 ",$683.15 ,$456.13 ,"$3,099.69 ",$783.00 ,$688.41 ,"$1,051.00 ",$553.88 ,"$1,051.00 ",$663.18 ,$663.18 ,$663.18 ,$663.18 ,$945.90 ,$788.25 ,"$1,051.00 ",$924.88 ,"$1,051.00 ",$788.25 ,$788.25 ,$893.35 ,$893.35 ,"$1,051.00 ",$893.35 ,"$1,051.00 ",$830.29 ,$830.29 ,$830.29 ,$945.90 ,"$1,051.00 ",$945.90 ,"$1,051.00 ","$1,051.00 ",$688.41 ,"$1,051.00 ",$456.13 , N/A ,"$1,051.00 ",$945.90 ,"$3,099.69 ",$663.18 ,$630.60 ,$945.90 ,"$1,051.00 ",$945.90 ,$945.90 ,"$1,051.00 ",$683.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000159,38505,HC LYMPH NODE BIOPSY SUPERFICIAL,360,1 ,"$1,576.50 ","$1,024.73 ",$684.20 ,"$3,099.69 ","$1,174.49 ","$1,032.61 ","$1,430.32 ",$830.82 ,"$1,430.32 ",$994.77 ,$994.77 ,$994.77 ,$994.77 ,"$1,418.85 ","$1,182.38 ","$1,430.32 ","$1,387.32 ","$1,430.32 ","$1,182.38 ","$1,182.38 ","$1,340.03 ","$1,340.03 ","$1,430.32 ","$1,340.03 ","$1,430.32 ","$1,245.44 ","$1,245.44 ","$1,245.44 ","$1,418.85 ","$1,576.50 ","$1,418.85 ","$1,430.32 ","$1,576.50 ","$1,032.61 ","$1,430.32 ",$684.20 , N/A ,"$1,497.09 ","$1,418.85 ","$3,099.69 ",$994.77 ,$945.90 ,"$1,418.85 ","$1,430.32 ","$1,418.85 ","$1,418.85 ","$1,430.32 ","$1,024.73 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000161,38792,HC INJ LYMPH NODE NO IMAGING,360,1 ,$944.00 ,$613.60 ,$383.37 ,$944.00 ,$703.28 ,$618.32 ,$383.37 ,$497.49 ,$383.37 ,$595.66 ,$595.66 ,$595.66 ,$595.66 ,$849.60 ,$708.00 ,$383.37 ,$830.72 ,$383.37 ,$708.00 ,$708.00 ,$802.40 ,$802.40 ,$383.37 ,$802.40 ,$383.37 ,$745.76 ,$745.76 ,$745.76 ,$849.60 ,$920.30 ,$849.60 ,$383.37 ,$944.00 ,$618.32 ,$383.37 ,$409.70 , N/A ,$401.27 ,$849.60 ,$830.81 ,$595.66 ,$566.40 ,$849.60 ,$383.37 ,$849.60 ,$849.60 ,$383.37 ,$613.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000176,49418,HC INSERT INTRAPERITONEAL CATH,360,1 ,"$7,252.00 ","$4,713.80 ","$3,147.37 ","$7,252.00 ","$5,402.74 ","$4,750.06 ","$3,236.16 ","$3,821.80 ","$3,236.16 ","$4,576.01 ","$4,576.01 ","$4,576.01 ","$4,576.01 ","$6,526.80 ","$5,439.00 ","$3,236.16 ","$6,381.76 ","$3,236.16 ","$5,439.00 ","$5,439.00 ","$6,164.20 ","$6,164.20 ","$3,236.16 ","$6,164.20 ","$3,236.16 ","$5,729.08 ","$5,729.08 ","$5,729.08 ","$6,526.80 ","$7,252.00 ","$6,526.80 ","$3,236.16 ","$7,252.00 ","$4,750.06 ","$3,236.16 ","$3,147.37 ", N/A ,"$3,387.25 ","$6,526.80 ","$7,013.20 ","$4,576.01 ","$4,351.20 ","$6,526.80 ","$3,236.16 ","$6,526.80 ","$6,526.80 ","$3,236.16 ","$4,713.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000177,49421,HC INS CATH DRAIN PERITONEAL PERM,360,1 ,"$6,089.00 ","$3,957.85 ","$2,642.63 ","$7,013.20 ","$4,536.31 ","$3,988.30 ","$3,236.16 ","$3,208.90 ","$3,236.16 ","$3,842.16 ","$3,842.16 ","$3,842.16 ","$3,842.16 ","$5,480.10 ","$4,566.75 ","$3,236.16 ","$5,358.32 ","$3,236.16 ","$4,566.75 ","$4,566.75 ","$5,175.65 ","$5,175.65 ","$3,236.16 ","$5,175.65 ","$3,236.16 ","$4,810.31 ","$4,810.31 ","$4,810.31 ","$5,480.10 ","$6,089.00 ","$5,480.10 ","$3,236.16 ","$6,089.00 ","$3,988.30 ","$3,236.16 ","$2,642.63 ", N/A ,"$3,387.25 ","$5,480.10 ","$7,013.20 ","$3,842.16 ","$3,653.40 ","$5,480.10 ","$3,236.16 ","$5,480.10 ","$5,480.10 ","$3,236.16 ","$3,957.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000178,49422,HC REM CATH INTRAPERITONEAL,360,1 ,"$5,537.00 ","$3,599.05 ","$2,403.06 ","$6,304.37 ","$4,125.07 ","$3,626.74 ","$2,909.08 ","$2,918.00 ","$2,909.08 ","$3,493.85 ","$3,493.85 ","$3,493.85 ","$3,493.85 ","$4,983.30 ","$4,152.75 ","$2,909.08 ","$4,872.56 ","$2,909.08 ","$4,152.75 ","$4,152.75 ","$4,706.45 ","$4,706.45 ","$2,909.08 ","$4,706.45 ","$2,909.08 ","$4,374.23 ","$4,374.23 ","$4,374.23 ","$4,983.30 ","$5,537.00 ","$4,983.30 ","$2,909.08 ","$5,537.00 ","$3,626.74 ","$2,909.08 ","$2,403.06 ", N/A ,"$3,044.89 ","$4,983.30 ","$6,304.37 ","$3,493.85 ","$3,322.20 ","$4,983.30 ","$2,909.08 ","$4,983.30 ","$4,983.30 ","$2,909.08 ","$3,599.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000187,54150,HC CIRCUMCISION OP,360,1 ,$745.00 ,$484.25 ,$323.33 ,"$3,950.04 ",$555.03 ,$487.98 ,$745.00 ,$392.62 ,$745.00 ,$470.10 ,$470.10 ,$470.10 ,$470.10 ,$670.50 ,$558.75 ,$745.00 ,$655.60 ,$745.00 ,$558.75 ,$558.75 ,$633.25 ,$633.25 ,$745.00 ,$633.25 ,$745.00 ,$588.55 ,$588.55 ,$588.55 ,$670.50 ,$745.00 ,$670.50 ,$745.00 ,$745.00 ,$487.98 ,$745.00 ,$323.33 , N/A ,$745.00 ,$670.50 ,"$3,950.04 ",$470.10 ,$447.00 ,$670.50 ,$745.00 ,$670.50 ,$670.50 ,$745.00 ,$484.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000194,62270,HC LUMBAR PUNCTURE,360,1 ,"$1,319.00 ",$857.35 ,$572.45 ,"$1,398.03 ",$982.66 ,$863.95 ,$645.11 ,$695.11 ,$645.11 ,$832.29 ,$832.29 ,$832.29 ,$832.29 ,"$1,187.10 ",$989.25 ,$645.11 ,"$1,160.72 ",$645.11 ,$989.25 ,$989.25 ,"$1,121.15 ","$1,121.15 ",$645.11 ,"$1,121.15 ",$645.11 ,"$1,042.01 ","$1,042.01 ","$1,042.01 ","$1,187.10 ","$1,319.00 ","$1,187.10 ",$645.11 ,"$1,319.00 ",$863.95 ,$645.11 ,$572.45 , N/A ,$675.22 ,"$1,187.10 ","$1,398.03 ",$832.29 ,$791.40 ,"$1,187.10 ",$645.11 ,"$1,187.10 ","$1,187.10 ",$645.11 ,$857.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000222,36571,HC INS CATH PERIPH CV W/PORT >5,360,1 ,"$4,205.00 ","$2,733.25 ","$1,824.97 ","$6,304.37 ","$3,132.73 ","$2,754.28 ","$2,909.08 ","$2,216.04 ","$2,909.08 ","$2,653.36 ","$2,653.36 ","$2,653.36 ","$2,653.36 ","$3,784.50 ","$3,153.75 ","$2,909.08 ","$3,700.40 ","$2,909.08 ","$3,153.75 ","$3,153.75 ","$3,574.25 ","$3,574.25 ","$2,909.08 ","$3,574.25 ","$2,909.08 ","$3,321.95 ","$3,321.95 ","$3,321.95 ","$3,784.50 ","$4,205.00 ","$3,784.50 ","$2,909.08 ","$4,205.00 ","$2,754.28 ","$2,909.08 ","$1,824.97 ", N/A ,"$3,044.89 ","$3,784.50 ","$6,304.37 ","$2,653.36 ","$2,523.00 ","$3,784.50 ","$2,909.08 ","$3,784.50 ","$3,784.50 ","$2,909.08 ","$2,733.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000222,36571,HC INS CATH PERIPH CV W/PORT >5,360,1 ,"$6,308.00 ","$4,100.20 ","$2,737.67 ","$6,308.00 ","$4,699.46 ","$4,131.74 ","$2,909.08 ","$3,324.32 ","$2,909.08 ","$3,980.35 ","$3,980.35 ","$3,980.35 ","$3,980.35 ","$5,677.20 ","$4,731.00 ","$2,909.08 ","$5,551.04 ","$2,909.08 ","$4,731.00 ","$4,731.00 ","$5,361.80 ","$5,361.80 ","$2,909.08 ","$5,361.80 ","$2,909.08 ","$4,983.32 ","$4,983.32 ","$4,983.32 ","$5,677.20 ","$6,308.00 ","$5,677.20 ","$2,909.08 ","$6,308.00 ","$4,131.74 ","$2,909.08 ","$2,737.67 ", N/A ,"$3,044.89 ","$5,677.20 ","$6,304.37 ","$3,980.35 ","$3,784.80 ","$5,677.20 ","$2,909.08 ","$5,677.20 ","$5,677.20 ","$2,909.08 ","$4,100.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000310,64421,HC INJ ANES INTERCOSTAL NERVE EA ADDNT LEVEL,360,1 ,"$4,569.00 ","$2,969.85 ",$836.09 ,"$4,569.00 ","$3,403.91 ","$2,992.70 ",$836.09 ,"$2,407.86 ",$836.09 ,"$2,883.04 ","$2,883.04 ","$2,883.04 ","$2,883.04 ","$4,112.10 ","$3,426.75 ",$836.09 ,"$4,020.72 ",$836.09 ,"$3,426.75 ","$3,426.75 ","$3,883.65 ","$3,883.65 ",$836.09 ,"$3,883.65 ",$836.09 ,"$3,609.51 ","$3,609.51 ","$3,609.51 ","$4,112.10 ","$2,007.08 ","$4,112.10 ",$836.09 ,"$4,569.00 ","$2,992.70 ",$836.09 ,"$1,982.95 ", N/A ,$875.12 ,"$4,112.10 ","$1,811.92 ","$2,883.04 ","$2,741.40 ","$4,112.10 ",$836.09 ,"$4,112.10 ","$4,112.10 ",$836.09 ,"$2,969.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000311,64420,HC INJ INTERCOSTAL NERVE;SINGLE,360,1 ,"$1,875.15 ","$1,218.85 ",$645.11 ,"$1,875.15 ","$1,396.99 ","$1,228.22 ",$645.11 ,$988.20 ,$645.11 ,"$1,183.22 ","$1,183.22 ","$1,183.22 ","$1,183.22 ","$1,687.64 ","$1,406.36 ",$645.11 ,"$1,650.13 ",$645.11 ,"$1,406.36 ","$1,406.36 ","$1,593.88 ","$1,593.88 ",$645.11 ,"$1,593.88 ",$645.11 ,"$1,481.37 ","$1,481.37 ","$1,481.37 ","$1,687.64 ","$1,548.62 ","$1,687.64 ",$645.11 ,"$1,875.15 ","$1,228.22 ",$645.11 ,$813.82 , N/A ,$675.22 ,"$1,687.64 ","$1,398.03 ","$1,183.22 ","$1,125.09 ","$1,687.64 ",$645.11 ,"$1,687.64 ","$1,687.64 ",$645.11 ,"$1,218.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000327,64445,HC NERVE BLOCK;SCIATIC SINGLE,360,1 ,"$2,248.00 ","$1,461.20 ",$645.11 ,"$2,248.00 ","$1,674.76 ","$1,472.44 ",$645.11 ,"$1,184.70 ",$645.11 ,"$1,418.49 ","$1,418.49 ","$1,418.49 ","$1,418.49 ","$2,023.20 ","$1,686.00 ",$645.11 ,"$1,978.24 ",$645.11 ,"$1,686.00 ","$1,686.00 ","$1,910.80 ","$1,910.80 ",$645.11 ,"$1,910.80 ",$645.11 ,"$1,775.92 ","$1,775.92 ","$1,775.92 ","$2,023.20 ","$1,548.62 ","$2,023.20 ",$645.11 ,"$2,248.00 ","$1,472.44 ",$645.11 ,$975.63 , N/A ,$675.22 ,"$2,023.20 ","$1,398.03 ","$1,418.49 ","$1,348.80 ","$2,023.20 ",$645.11 ,"$2,023.20 ","$2,023.20 ",$645.11 ,"$1,461.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000327,64445,HC NERVE BLOCK;SCIATIC SINGLE,360,1 ,"$3,372.00 ","$2,191.80 ",$967.66 ,"$3,372.00 ","$2,512.14 ","$2,208.66 ",$967.66 ,"$1,777.04 ",$967.66 ,"$2,127.73 ","$2,127.73 ","$2,127.73 ","$2,127.73 ","$3,034.80 ","$2,529.00 ",$967.66 ,"$2,967.36 ",$967.66 ,"$2,529.00 ","$2,529.00 ","$2,866.20 ","$2,866.20 ",$967.66 ,"$2,866.20 ",$967.66 ,"$2,663.88 ","$2,663.88 ","$2,663.88 ","$3,034.80 ","$2,322.92 ","$3,034.80 ",$967.66 ,"$3,372.00 ","$2,208.66 ",$967.66 ,"$1,463.45 ", N/A ,"$1,012.83 ","$3,034.80 ","$2,097.05 ","$2,127.73 ","$2,023.20 ","$3,034.80 ",$967.66 ,"$3,034.80 ","$3,034.80 ",$967.66 ,"$2,191.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000331,64520,HC NERVE BLOCK;L/S PARAVERTEBAL SYMP,360,1 ,"$4,569.00 ","$2,969.85 ",$836.09 ,"$4,569.00 ","$3,403.91 ","$2,992.70 ",$836.09 ,"$2,407.86 ",$836.09 ,"$2,883.04 ","$2,883.04 ","$2,883.04 ","$2,883.04 ","$4,112.10 ","$3,426.75 ",$836.09 ,"$4,020.72 ",$836.09 ,"$3,426.75 ","$3,426.75 ","$3,883.65 ","$3,883.65 ",$836.09 ,"$3,883.65 ",$836.09 ,"$3,609.51 ","$3,609.51 ","$3,609.51 ","$4,112.10 ","$2,007.08 ","$4,112.10 ",$836.09 ,"$4,569.00 ","$2,992.70 ",$836.09 ,"$1,982.95 ", N/A ,$875.12 ,"$4,112.10 ","$1,811.92 ","$2,883.04 ","$2,741.40 ","$4,112.10 ",$836.09 ,"$4,112.10 ","$4,112.10 ",$836.09 ,"$2,969.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000334,63650,HC IMPLANT NEUROELECTRODES,360,1 ,"$17,089.00 ","$11,107.85 ","$6,262.77 ","$17,089.00 ","$12,731.31 ","$11,193.30 ","$6,262.77 ","$9,005.90 ","$6,262.77 ","$10,783.16 ","$10,783.16 ","$10,783.16 ","$10,783.16 ","$15,380.10 ","$12,816.75 ","$6,262.77 ","$15,038.32 ","$6,262.77 ","$12,816.75 ","$12,816.75 ","$14,525.65 ","$14,525.65 ","$6,262.77 ","$14,525.65 ","$6,262.77 ","$13,500.31 ","$13,500.31 ","$13,500.31 ","$15,380.10 ","$15,034.16 ","$15,380.10 ","$6,262.77 ","$17,089.00 ","$11,193.30 ","$6,262.77 ","$7,416.63 ", N/A ,"$6,555.15 ","$15,380.10 ","$13,572.27 ","$10,783.16 ","$10,253.40 ","$15,380.10 ","$6,262.77 ","$15,380.10 ","$15,380.10 ","$6,262.77 ","$11,107.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000352,37192,HC IVC FILTER REPOSITIONING 37192,360,1 ,"$3,225.00 ","$2,096.25 ","$1,399.65 ","$6,304.37 ","$2,402.63 ","$2,112.38 ","$2,909.08 ","$1,699.58 ","$2,909.08 ","$2,034.98 ","$2,034.98 ","$2,034.98 ","$2,034.98 ","$2,902.50 ","$2,418.75 ","$2,909.08 ","$2,838.00 ","$2,909.08 ","$2,418.75 ","$2,418.75 ","$2,741.25 ","$2,741.25 ","$2,909.08 ","$2,741.25 ","$2,909.08 ","$2,547.75 ","$2,547.75 ","$2,547.75 ","$2,902.50 ","$3,225.00 ","$2,902.50 ","$2,909.08 ","$3,225.00 ","$2,112.38 ","$2,909.08 ","$1,399.65 ", N/A ,"$3,044.89 ","$2,902.50 ","$6,304.37 ","$2,034.98 ","$1,935.00 ","$2,902.50 ","$2,909.08 ","$2,902.50 ","$2,902.50 ","$2,909.08 ","$2,096.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000397,27301,HC I AND D ABSC/BURSA THIGH/KNEE,360,1 ,"$6,647.79 ","$4,321.06 ","$2,409.29 ","$6,647.79 ","$4,952.60 ","$4,354.30 ","$2,409.29 ","$3,503.39 ","$2,409.29 ","$4,194.76 ","$4,194.76 ","$4,194.76 ","$4,194.76 ","$5,983.01 ","$4,985.84 ","$2,409.29 ","$5,850.06 ","$2,409.29 ","$4,985.84 ","$4,985.84 ","$5,650.62 ","$5,650.62 ","$2,409.29 ","$5,650.62 ","$2,409.29 ","$5,251.75 ","$5,251.75 ","$5,251.75 ","$5,983.01 ","$5,783.63 ","$5,983.01 ","$2,409.29 ","$6,647.79 ","$4,354.30 ","$2,409.29 ","$2,885.14 ", N/A ,"$2,521.76 ","$5,983.01 ","$5,221.24 ","$4,194.76 ","$3,988.67 ","$5,983.01 ","$2,409.29 ","$5,983.01 ","$5,983.01 ","$2,409.29 ","$4,321.06 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000420,26735,HC TX FX OPEN SHAFT FINGER/THUMB W/INT FIX EACH,360,1 ,"$7,847.73 ","$5,101.02 ","$2,877.30 ","$7,847.73 ","$5,846.56 ","$5,140.26 ","$2,877.30 ","$4,135.75 ","$2,877.30 ","$4,951.92 ","$4,951.92 ","$4,951.92 ","$4,951.92 ","$7,062.96 ","$5,885.80 ","$2,877.30 ","$6,906.00 ","$2,877.30 ","$5,885.80 ","$5,885.80 ","$6,670.57 ","$6,670.57 ","$2,877.30 ","$6,670.57 ","$2,877.30 ","$6,199.71 ","$6,199.71 ","$6,199.71 ","$7,062.96 ","$6,907.14 ","$7,062.96 ","$2,877.30 ","$7,847.73 ","$5,140.26 ","$2,877.30 ","$3,405.91 ", N/A ,"$3,011.63 ","$7,062.96 ","$6,235.50 ","$4,951.92 ","$4,708.64 ","$7,062.96 ","$2,877.30 ","$7,062.96 ","$7,062.96 ","$2,877.30 ","$5,101.02 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000465,54161,HC CIRCUMCISION W/O DEVICE >28 DAYS,360,1 ,"$5,325.00 ","$3,461.25 ","$1,822.70 ","$5,325.00 ","$3,967.13 ","$3,487.88 ","$1,822.70 ","$2,806.28 ","$1,822.70 ","$3,360.08 ","$3,360.08 ","$3,360.08 ","$3,360.08 ","$4,792.50 ","$3,993.75 ","$1,822.70 ","$4,686.00 ","$1,822.70 ","$3,993.75 ","$3,993.75 ","$4,526.25 ","$4,526.25 ","$1,822.70 ","$4,526.25 ","$1,822.70 ","$4,206.75 ","$4,206.75 ","$4,206.75 ","$4,792.50 ","$4,375.51 ","$4,792.50 ","$1,822.70 ","$5,325.00 ","$3,487.88 ","$1,822.70 ","$2,311.05 ", N/A ,"$1,907.80 ","$4,792.50 ","$3,950.04 ","$3,360.08 ","$3,195.00 ","$4,792.50 ","$1,822.70 ","$4,792.50 ","$4,792.50 ","$1,822.70 ","$3,461.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000569,64486,HC TAP BLOCK W/INJ UNILT,360,1 ,"$2,248.00 ","$1,461.20 ",$975.63 ,"$2,248.00 ","$1,674.76 ","$1,472.44 ", N/A ,"$1,184.70 ", N/A ,"$1,418.49 ","$1,418.49 ","$1,418.49 ","$1,418.49 ","$2,023.20 ","$1,686.00 ", N/A ,"$1,978.24 ", N/A ,"$1,686.00 ","$1,686.00 ","$1,910.80 ","$1,910.80 ", N/A ,"$1,910.80 ", N/A ,"$1,775.92 ","$1,775.92 ","$1,775.92 ","$2,023.20 ", N/A ,"$2,023.20 ", N/A ,"$2,248.00 ","$1,472.44 ", N/A ,$975.63 , N/A , N/A ,"$2,023.20 ", N/A ,"$1,418.49 ","$1,348.80 ","$2,023.20 ", N/A ,"$2,023.20 ","$2,023.20 ", N/A ,"$1,461.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000583,33221,HC INSERT PACEMAKER PULSE GENERATOR MULT LEADS,360,1 ,"$50,203.00 ","$32,631.95 ","$18,919.68 ","$50,203.00 ","$37,401.24 ","$32,882.97 ","$18,919.68 ","$26,456.98 ","$18,919.68 ","$31,678.09 ","$31,678.09 ","$31,678.09 ","$31,678.09 ","$45,182.70 ","$37,652.25 ","$18,919.68 ","$44,178.64 ","$18,919.68 ","$37,652.25 ","$37,652.25 ","$42,672.55 ","$42,672.55 ","$18,919.68 ","$42,672.55 ","$18,919.68 ","$39,660.37 ","$39,660.37 ","$39,660.37 ","$45,182.70 ","$45,417.84 ","$45,182.70 ","$18,919.68 ","$50,203.00 ","$32,882.97 ","$18,919.68 ","$21,788.10 ", N/A ,"$19,802.95 ","$45,182.70 ","$41,001.48 ","$31,678.09 ","$30,121.80 ","$45,182.70 ","$18,919.68 ","$45,182.70 ","$45,182.70 ","$18,919.68 ","$32,631.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000642,36002,HC INJ TX PSEUDOANEURYSM EXTREMITY PERC-LT,360,1 ,$936.00 ,$608.40 ,$406.22 ,"$1,193.21 ",$697.32 ,$613.08 ,$550.60 ,$493.27 ,$550.60 ,$590.62 ,$590.62 ,$590.62 ,$590.62 ,$842.40 ,$702.00 ,$550.60 ,$823.68 ,$550.60 ,$702.00 ,$702.00 ,$795.60 ,$795.60 ,$550.60 ,$795.60 ,$550.60 ,$739.44 ,$739.44 ,$739.44 ,$842.40 ,$936.00 ,$842.40 ,$550.60 ,$936.00 ,$613.08 ,$550.60 ,$406.22 , N/A ,$576.30 ,$842.40 ,"$1,193.21 ",$590.62 ,$561.60 ,$842.40 ,$550.60 ,$842.40 ,$842.40 ,$550.60 ,$608.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000643,36002,HC INJ TX PSEUDOANEURYSM EXTREMITY PERC-RT,360,1 ,$936.00 ,$608.40 ,$406.22 ,"$1,193.21 ",$697.32 ,$613.08 ,$550.60 ,$493.27 ,$550.60 ,$590.62 ,$590.62 ,$590.62 ,$590.62 ,$842.40 ,$702.00 ,$550.60 ,$823.68 ,$550.60 ,$702.00 ,$702.00 ,$795.60 ,$795.60 ,$550.60 ,$795.60 ,$550.60 ,$739.44 ,$739.44 ,$739.44 ,$842.40 ,$936.00 ,$842.40 ,$550.60 ,$936.00 ,$613.08 ,$550.60 ,$406.22 , N/A ,$576.30 ,$842.40 ,"$1,193.21 ",$590.62 ,$561.60 ,$842.40 ,$550.60 ,$842.40 ,$842.40 ,$550.60 ,$608.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000644,36002,HC INJ TX PSEUDOANEURYSM EXTREMITY PERC-BIL,360,1 ,"$1,310.00 ",$851.50 ,$550.60 ,"$1,310.00 ",$975.95 ,$858.05 ,$550.60 ,$690.37 ,$550.60 ,$826.61 ,$826.61 ,$826.61 ,$826.61 ,"$1,179.00 ",$982.50 ,$550.60 ,"$1,152.80 ",$550.60 ,$982.50 ,$982.50 ,"$1,113.50 ","$1,113.50 ",$550.60 ,"$1,113.50 ",$550.60 ,"$1,034.90 ","$1,034.90 ","$1,034.90 ","$1,179.00 ","$1,310.00 ","$1,179.00 ",$550.60 ,"$1,310.00 ",$858.05 ,$550.60 ,$568.54 , N/A ,$576.30 ,"$1,179.00 ","$1,193.21 ",$826.61 ,$786.00 ,"$1,179.00 ",$550.60 ,"$1,179.00 ","$1,179.00 ",$550.60 ,$851.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000650,36475,HC ABLATION THPY EXTREM PERC RADFQ INIT VEIN,360,1 ,"$8,695.00 ","$5,651.75 ","$2,909.08 ","$8,695.00 ","$6,477.78 ","$5,695.23 ","$2,909.08 ","$4,582.27 ","$2,909.08 ","$5,486.55 ","$5,486.55 ","$5,486.55 ","$5,486.55 ","$7,825.50 ","$6,521.25 ","$2,909.08 ","$7,651.60 ","$2,909.08 ","$6,521.25 ","$6,521.25 ","$7,390.75 ","$7,390.75 ","$2,909.08 ","$7,390.75 ","$2,909.08 ","$6,869.05 ","$6,869.05 ","$6,869.05 ","$7,825.50 ","$6,983.43 ","$7,825.50 ","$2,909.08 ","$8,695.00 ","$5,695.23 ","$2,909.08 ","$3,773.63 ", N/A ,"$3,044.89 ","$7,825.50 ","$6,304.37 ","$5,486.55 ","$5,217.00 ","$7,825.50 ","$2,909.08 ","$7,825.50 ","$7,825.50 ","$2,909.08 ","$5,651.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000651,36476,HC ABLATION THPY EXTREM PERC RADFQ ADDL VEIN,360,1 ,"$3,733.00 ","$2,426.45 ","$1,620.12 ","$3,733.00 ","$2,781.09 ","$2,445.12 ", N/A ,"$1,967.29 ", N/A ,"$2,355.52 ","$2,355.52 ","$2,355.52 ","$2,355.52 ","$3,359.70 ","$2,799.75 ", N/A ,"$3,285.04 ", N/A ,"$2,799.75 ","$2,799.75 ","$3,173.05 ","$3,173.05 ", N/A ,"$3,173.05 ", N/A ,"$2,949.07 ","$2,949.07 ","$2,949.07 ","$3,359.70 ", N/A ,"$3,359.70 ", N/A ,"$3,733.00 ","$2,445.12 ", N/A ,"$1,620.12 ", N/A , N/A ,"$3,359.70 ", N/A ,"$2,355.52 ","$2,239.80 ","$3,359.70 ", N/A ,"$3,359.70 ","$3,359.70 ", N/A ,"$2,426.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000652,36478,HC ABLATION THPY EXTREM PERC LASER INIT VEIN,360,1 ,"$7,500.00 ","$4,875.00 ","$2,909.08 ","$7,500.00 ","$5,587.50 ","$4,912.50 ","$2,909.08 ","$3,952.50 ","$2,909.08 ","$4,732.50 ","$4,732.50 ","$4,732.50 ","$4,732.50 ","$6,750.00 ","$5,625.00 ","$2,909.08 ","$6,600.00 ","$2,909.08 ","$5,625.00 ","$5,625.00 ","$6,375.00 ","$6,375.00 ","$2,909.08 ","$6,375.00 ","$2,909.08 ","$5,925.00 ","$5,925.00 ","$5,925.00 ","$6,750.00 ","$6,983.43 ","$6,750.00 ","$2,909.08 ","$7,500.00 ","$4,912.50 ","$2,909.08 ","$3,255.00 ", N/A ,"$3,044.89 ","$6,750.00 ","$6,304.37 ","$4,732.50 ","$4,500.00 ","$6,750.00 ","$2,909.08 ","$6,750.00 ","$6,750.00 ","$2,909.08 ","$4,875.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000653,36479,HC ABLATION THPY EXTREM PERC LASER ADDL VEIN,360,1 ,"$3,750.00 ","$2,437.50 ","$1,627.50 ","$3,750.00 ","$2,793.75 ","$2,456.25 ", N/A ,"$1,976.25 ", N/A ,"$2,366.25 ","$2,366.25 ","$2,366.25 ","$2,366.25 ","$3,375.00 ","$2,812.50 ", N/A ,"$3,300.00 ", N/A ,"$2,812.50 ","$2,812.50 ","$3,187.50 ","$3,187.50 ", N/A ,"$3,187.50 ", N/A ,"$2,962.50 ","$2,962.50 ","$2,962.50 ","$3,375.00 ", N/A ,"$3,375.00 ", N/A ,"$3,750.00 ","$2,456.25 ", N/A ,"$1,627.50 ", N/A , N/A ,"$3,375.00 ", N/A ,"$2,366.25 ","$2,250.00 ","$3,375.00 ", N/A ,"$3,375.00 ","$3,375.00 ", N/A ,"$2,437.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000656,36660,HC CATHERIZATION UMBILICAL ARTERY NEWBORN,360,1 ,$153.00 ,$99.45 ,$66.40 ,$153.00 ,$113.99 ,$100.22 , N/A ,$80.63 , N/A ,$96.54 ,$96.54 ,$96.54 ,$96.54 ,$137.70 ,$114.75 , N/A ,$134.64 , N/A ,$114.75 ,$114.75 ,$130.05 ,$130.05 , N/A ,$130.05 , N/A ,$120.87 ,$120.87 ,$120.87 ,$137.70 , N/A ,$137.70 , N/A ,$153.00 ,$100.22 , N/A ,$66.40 , N/A , N/A ,$137.70 , N/A ,$96.54 ,$91.80 ,$137.70 , N/A ,$137.70 ,$137.70 , N/A ,$99.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000667,37765,HC STAB PHLEBECTOMRY VEINS EXTREM 10-20 INCISIONS,360,1 ,"$7,582.00 ","$4,928.30 ","$2,909.08 ","$7,582.00 ","$5,648.59 ","$4,966.21 ","$2,909.08 ","$3,995.71 ","$2,909.08 ","$4,784.24 ","$4,784.24 ","$4,784.24 ","$4,784.24 ","$6,823.80 ","$5,686.50 ","$2,909.08 ","$6,672.16 ","$2,909.08 ","$5,686.50 ","$5,686.50 ","$6,444.70 ","$6,444.70 ","$2,909.08 ","$6,444.70 ","$2,909.08 ","$5,989.78 ","$5,989.78 ","$5,989.78 ","$6,823.80 ","$6,983.43 ","$6,823.80 ","$2,909.08 ","$7,582.00 ","$4,966.21 ","$2,909.08 ","$3,290.59 ", N/A ,"$3,044.89 ","$6,823.80 ","$6,304.37 ","$4,784.24 ","$4,549.20 ","$6,823.80 ","$2,909.08 ","$6,823.80 ","$6,823.80 ","$2,909.08 ","$4,928.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000668,37766,HC STAB PHLEBECTOMRY VEINS EXTREM >20 INCISIONS,360,1 ,"$8,488.00 ","$5,517.20 ","$2,909.08 ","$8,488.00 ","$6,323.56 ","$5,559.64 ","$2,909.08 ","$4,473.18 ","$2,909.08 ","$5,355.93 ","$5,355.93 ","$5,355.93 ","$5,355.93 ","$7,639.20 ","$6,366.00 ","$2,909.08 ","$7,469.44 ","$2,909.08 ","$6,366.00 ","$6,366.00 ","$7,214.80 ","$7,214.80 ","$2,909.08 ","$7,214.80 ","$2,909.08 ","$6,705.52 ","$6,705.52 ","$6,705.52 ","$7,639.20 ","$6,983.43 ","$7,639.20 ","$2,909.08 ","$8,488.00 ","$5,559.64 ","$2,909.08 ","$3,683.79 ", N/A ,"$3,044.89 ","$7,639.20 ","$6,304.37 ","$5,355.93 ","$5,092.80 ","$7,639.20 ","$2,909.08 ","$7,639.20 ","$7,639.20 ","$2,909.08 ","$5,517.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000680,50590,HC LITHOTRIPSY EXTRCORPOREAL SHOCK WAVE UNI,360,1 ,"$17,848.00 ","$11,601.20 ","$3,127.32 ","$17,848.00 ","$13,296.76 ","$11,690.44 ","$3,127.32 ","$9,405.90 ","$3,127.32 ","$11,262.09 ","$11,262.09 ","$11,262.09 ","$11,262.09 ","$16,063.20 ","$13,386.00 ","$3,127.32 ","$15,706.24 ","$3,127.32 ","$13,386.00 ","$13,386.00 ","$15,170.80 ","$15,170.80 ","$3,127.32 ","$15,170.80 ","$3,127.32 ","$14,099.92 ","$14,099.92 ","$14,099.92 ","$16,063.20 ","$7,507.32 ","$16,063.20 ","$3,127.32 ","$17,848.00 ","$11,690.44 ","$3,127.32 ","$7,746.03 ", N/A ,"$3,273.32 ","$16,063.20 ","$6,777.32 ","$11,262.09 ","$10,708.80 ","$16,063.20 ","$3,127.32 ","$16,063.20 ","$16,063.20 ","$3,127.32 ","$11,601.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000681,50590,HC LITHOTRIPSY EXTRCORPOREAL SHOCK WAVE BIL,360,1 ,"$16,225.00 ","$10,546.25 ","$3,127.32 ","$16,225.00 ","$12,087.63 ","$10,627.38 ","$3,127.32 ","$8,550.58 ","$3,127.32 ","$10,237.98 ","$10,237.98 ","$10,237.98 ","$10,237.98 ","$14,602.50 ","$12,168.75 ","$3,127.32 ","$14,278.00 ","$3,127.32 ","$12,168.75 ","$12,168.75 ","$13,791.25 ","$13,791.25 ","$3,127.32 ","$13,791.25 ","$3,127.32 ","$12,817.75 ","$12,817.75 ","$12,817.75 ","$14,602.50 ","$7,507.32 ","$14,602.50 ","$3,127.32 ","$16,225.00 ","$10,627.38 ","$3,127.32 ","$7,041.65 ", N/A ,"$3,273.32 ","$14,602.50 ","$6,777.32 ","$10,237.98 ","$9,735.00 ","$14,602.50 ","$3,127.32 ","$14,602.50 ","$14,602.50 ","$3,127.32 ","$10,546.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36000685,28825,HC AMPUTATION INTERPHALANGEAL JOINT,360,1 ,"$7,609.00 ","$4,945.85 ","$2,877.30 ","$7,609.00 ","$5,668.71 ","$4,983.90 ","$2,877.30 ","$4,009.94 ","$2,877.30 ","$4,801.28 ","$4,801.28 ","$4,801.28 ","$4,801.28 ","$6,848.10 ","$5,706.75 ","$2,877.30 ","$6,695.92 ","$2,877.30 ","$5,706.75 ","$5,706.75 ","$6,467.65 ","$6,467.65 ","$2,877.30 ","$6,467.65 ","$2,877.30 ","$6,011.11 ","$6,011.11 ","$6,011.11 ","$6,848.10 ","$6,907.14 ","$6,848.10 ","$2,877.30 ","$7,609.00 ","$4,983.90 ","$2,877.30 ","$3,302.31 ", N/A ,"$3,011.63 ","$6,848.10 ","$6,235.50 ","$4,801.28 ","$4,565.40 ","$6,848.10 ","$2,877.30 ","$6,848.10 ","$6,848.10 ","$2,877.30 ","$4,945.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36060014,N/A,HC OR LEVEL 1 ADDL 15MIN,360,1 ,$917.00 ,$596.05 ,$397.98 ,$917.00 ,$683.17 ,$600.64 , N/A ,$483.26 , N/A ,$578.63 ,$578.63 ,$578.63 ,$578.63 ,$825.30 ,$687.75 , N/A ,$806.96 , N/A ,$687.75 ,$687.75 ,$779.45 ,$779.45 , N/A ,$779.45 , N/A ,$724.43 ,$724.43 ,$724.43 ,$825.30 , N/A ,$825.30 , N/A ,$917.00 ,$600.64 , N/A ,$397.98 , N/A , N/A ,$825.30 , N/A ,$578.63 ,$550.20 ,$825.30 , N/A ,$825.30 ,$825.30 , N/A ,$596.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36060016,N/A,HC OR LEVEL 2 ADDL 15MIN,360,1 ,"$1,045.00 ",$679.25 ,$453.53 ,"$1,045.00 ",$778.53 ,$684.48 , N/A ,$550.72 , N/A ,$659.40 ,$659.40 ,$659.40 ,$659.40 ,$940.50 ,$783.75 , N/A ,$919.60 , N/A ,$783.75 ,$783.75 ,$888.25 ,$888.25 , N/A ,$888.25 , N/A ,$825.55 ,$825.55 ,$825.55 ,$940.50 , N/A ,$940.50 , N/A ,"$1,045.00 ",$684.48 , N/A ,$453.53 , N/A , N/A ,$940.50 , N/A ,$659.40 ,$627.00 ,$940.50 , N/A ,$940.50 ,$940.50 , N/A ,$679.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36060018,N/A,HC OR LEVEL 3 ADDL 15MIN,360,1 ,"$1,219.00 ",$792.35 ,$529.05 ,"$1,219.00 ",$908.16 ,$798.45 , N/A ,$642.41 , N/A ,$769.19 ,$769.19 ,$769.19 ,$769.19 ,"$1,097.10 ",$914.25 , N/A ,"$1,072.72 ", N/A ,$914.25 ,$914.25 ,"$1,036.15 ","$1,036.15 ", N/A ,"$1,036.15 ", N/A ,$963.01 ,$963.01 ,$963.01 ,"$1,097.10 ", N/A ,"$1,097.10 ", N/A ,"$1,219.00 ",$798.45 , N/A ,$529.05 , N/A , N/A ,"$1,097.10 ", N/A ,$769.19 ,$731.40 ,"$1,097.10 ", N/A ,"$1,097.10 ","$1,097.10 ", N/A ,$792.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36060020,N/A,HC OR LEVEL 4 ADDL 15MIN,360,1 ,"$1,376.00 ",$894.40 ,$597.18 ,"$1,376.00 ","$1,025.12 ",$901.28 , N/A ,$725.15 , N/A ,$868.26 ,$868.26 ,$868.26 ,$868.26 ,"$1,238.40 ","$1,032.00 ", N/A ,"$1,210.88 ", N/A ,"$1,032.00 ","$1,032.00 ","$1,169.60 ","$1,169.60 ", N/A ,"$1,169.60 ", N/A ,"$1,087.04 ","$1,087.04 ","$1,087.04 ","$1,238.40 ", N/A ,"$1,238.40 ", N/A ,"$1,376.00 ",$901.28 , N/A ,$597.18 , N/A , N/A ,"$1,238.40 ", N/A ,$868.26 ,$825.60 ,"$1,238.40 ", N/A ,"$1,238.40 ","$1,238.40 ", N/A ,$894.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36060022,N/A,HC OR LEVEL 5 ADDL 15MIN,360,1 ,"$1,534.00 ",$997.10 ,$665.76 ,"$1,534.00 ","$1,142.83 ","$1,004.77 ", N/A ,$808.42 , N/A ,$967.95 ,$967.95 ,$967.95 ,$967.95 ,"$1,380.60 ","$1,150.50 ", N/A ,"$1,349.92 ", N/A ,"$1,150.50 ","$1,150.50 ","$1,303.90 ","$1,303.90 ", N/A ,"$1,303.90 ", N/A ,"$1,211.86 ","$1,211.86 ","$1,211.86 ","$1,380.60 ", N/A ,"$1,380.60 ", N/A ,"$1,534.00 ","$1,004.77 ", N/A ,$665.76 , N/A , N/A ,"$1,380.60 ", N/A ,$967.95 ,$920.40 ,"$1,380.60 ", N/A ,"$1,380.60 ","$1,380.60 ", N/A ,$997.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36060024,N/A,HC OR LEVEL 6 ADDL 15MIN,360,1 ,"$1,692.00 ","$1,099.80 ",$734.33 ,"$1,692.00 ","$1,260.54 ","$1,108.26 ", N/A ,$891.68 , N/A ,"$1,067.65 ","$1,067.65 ","$1,067.65 ","$1,067.65 ","$1,522.80 ","$1,269.00 ", N/A ,"$1,488.96 ", N/A ,"$1,269.00 ","$1,269.00 ","$1,438.20 ","$1,438.20 ", N/A ,"$1,438.20 ", N/A ,"$1,336.68 ","$1,336.68 ","$1,336.68 ","$1,522.80 ", N/A ,"$1,522.80 ", N/A ,"$1,692.00 ","$1,108.26 ", N/A ,$734.33 , N/A , N/A ,"$1,522.80 ", N/A ,"$1,067.65 ","$1,015.20 ","$1,522.80 ", N/A ,"$1,522.80 ","$1,522.80 ", N/A ,"$1,099.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36060025,N/A,HC OR LEVEL 1 INITIAL 30MIN,360,1 ,"$1,913.00 ","$1,243.45 ",$830.24 ,"$1,913.00 ","$1,425.19 ","$1,253.02 ", N/A ,"$1,008.15 ", N/A ,"$1,207.10 ","$1,207.10 ","$1,207.10 ","$1,207.10 ","$1,721.70 ","$1,434.75 ", N/A ,"$1,683.44 ", N/A ,"$1,434.75 ","$1,434.75 ","$1,626.05 ","$1,626.05 ", N/A ,"$1,626.05 ", N/A ,"$1,511.27 ","$1,511.27 ","$1,511.27 ","$1,721.70 ", N/A ,"$1,721.70 ", N/A ,"$1,913.00 ","$1,253.02 ", N/A ,$830.24 , N/A , N/A ,"$1,721.70 ", N/A ,"$1,207.10 ","$1,147.80 ","$1,721.70 ", N/A ,"$1,721.70 ","$1,721.70 ", N/A ,"$1,243.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36060026,N/A,HC OR LEVEL 2 INITIAL 30MIN,360,1 ,"$2,089.00 ","$1,357.85 ",$906.63 ,"$2,089.00 ","$1,556.31 ","$1,368.30 ", N/A ,"$1,100.90 ", N/A ,"$1,318.16 ","$1,318.16 ","$1,318.16 ","$1,318.16 ","$1,880.10 ","$1,566.75 ", N/A ,"$1,838.32 ", N/A ,"$1,566.75 ","$1,566.75 ","$1,775.65 ","$1,775.65 ", N/A ,"$1,775.65 ", N/A ,"$1,650.31 ","$1,650.31 ","$1,650.31 ","$1,880.10 ", N/A ,"$1,880.10 ", N/A ,"$2,089.00 ","$1,368.30 ", N/A ,$906.63 , N/A , N/A ,"$1,880.10 ", N/A ,"$1,318.16 ","$1,253.40 ","$1,880.10 ", N/A ,"$1,880.10 ","$1,880.10 ", N/A ,"$1,357.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36060027,N/A,HC OR LEVEL 3 INITIAL 30MIN,360,1 ,"$2,722.00 ","$1,769.30 ","$1,181.35 ","$2,722.00 ","$2,027.89 ","$1,782.91 ", N/A ,"$1,434.49 ", N/A ,"$1,717.58 ","$1,717.58 ","$1,717.58 ","$1,717.58 ","$2,449.80 ","$2,041.50 ", N/A ,"$2,395.36 ", N/A ,"$2,041.50 ","$2,041.50 ","$2,313.70 ","$2,313.70 ", N/A ,"$2,313.70 ", N/A ,"$2,150.38 ","$2,150.38 ","$2,150.38 ","$2,449.80 ", N/A ,"$2,449.80 ", N/A ,"$2,722.00 ","$1,782.91 ", N/A ,"$1,181.35 ", N/A , N/A ,"$2,449.80 ", N/A ,"$1,717.58 ","$1,633.20 ","$2,449.80 ", N/A ,"$2,449.80 ","$2,449.80 ", N/A ,"$1,769.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36060028,N/A,HC OR LEVEL 4 INITIAL 30MIN,360,1 ,"$3,918.00 ","$2,546.70 ","$1,700.41 ","$3,918.00 ","$2,918.91 ","$2,566.29 ", N/A ,"$2,064.79 ", N/A ,"$2,472.26 ","$2,472.26 ","$2,472.26 ","$2,472.26 ","$3,526.20 ","$2,938.50 ", N/A ,"$3,447.84 ", N/A ,"$2,938.50 ","$2,938.50 ","$3,330.30 ","$3,330.30 ", N/A ,"$3,330.30 ", N/A ,"$3,095.22 ","$3,095.22 ","$3,095.22 ","$3,526.20 ", N/A ,"$3,526.20 ", N/A ,"$3,918.00 ","$2,566.29 ", N/A ,"$1,700.41 ", N/A , N/A ,"$3,526.20 ", N/A ,"$2,472.26 ","$2,350.80 ","$3,526.20 ", N/A ,"$3,526.20 ","$3,526.20 ", N/A ,"$2,546.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36060029,N/A,HC OR LEVEL 5 INITIAL 30MIN,360,1 ,"$4,971.00 ","$3,231.15 ","$2,157.41 ","$4,971.00 ","$3,703.40 ","$3,256.01 ", N/A ,"$2,619.72 ", N/A ,"$3,136.70 ","$3,136.70 ","$3,136.70 ","$3,136.70 ","$4,473.90 ","$3,728.25 ", N/A ,"$4,374.48 ", N/A ,"$3,728.25 ","$3,728.25 ","$4,225.35 ","$4,225.35 ", N/A ,"$4,225.35 ", N/A ,"$3,927.09 ","$3,927.09 ","$3,927.09 ","$4,473.90 ", N/A ,"$4,473.90 ", N/A ,"$4,971.00 ","$3,256.01 ", N/A ,"$2,157.41 ", N/A , N/A ,"$4,473.90 ", N/A ,"$3,136.70 ","$2,982.60 ","$4,473.90 ", N/A ,"$4,473.90 ","$4,473.90 ", N/A ,"$3,231.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36060030,N/A,HC OR LEVEL 6 INITIAL 30MIN,360,1 ,"$5,818.00 ","$3,781.70 ","$2,525.01 ","$5,818.00 ","$4,334.41 ","$3,810.79 ", N/A ,"$3,066.09 ", N/A ,"$3,671.16 ","$3,671.16 ","$3,671.16 ","$3,671.16 ","$5,236.20 ","$4,363.50 ", N/A ,"$5,119.84 ", N/A ,"$4,363.50 ","$4,363.50 ","$4,945.30 ","$4,945.30 ", N/A ,"$4,945.30 ", N/A ,"$4,596.22 ","$4,596.22 ","$4,596.22 ","$5,236.20 ", N/A ,"$5,236.20 ", N/A ,"$5,818.00 ","$3,810.79 ", N/A ,"$2,525.01 ", N/A , N/A ,"$5,236.20 ", N/A ,"$3,671.16 ","$3,490.80 ","$5,236.20 ", N/A ,"$5,236.20 ","$5,236.20 ", N/A ,"$3,781.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36060040,N/A,HC OR LEVEL LITHOTRIPSY INITIAL 45 MIN,360,1 ,"$16,225.00 ","$10,546.25 ","$7,041.65 ","$16,225.00 ","$12,087.63 ","$10,627.38 ", N/A ,"$8,550.58 ", N/A ,"$10,237.98 ","$10,237.98 ","$10,237.98 ","$10,237.98 ","$14,602.50 ","$12,168.75 ", N/A ,"$14,278.00 ", N/A ,"$12,168.75 ","$12,168.75 ","$13,791.25 ","$13,791.25 ", N/A ,"$13,791.25 ", N/A ,"$12,817.75 ","$12,817.75 ","$12,817.75 ","$14,602.50 ", N/A ,"$14,602.50 ", N/A ,"$16,225.00 ","$10,627.38 ", N/A ,"$7,041.65 ", N/A , N/A ,"$14,602.50 ", N/A ,"$10,237.98 ","$9,735.00 ","$14,602.50 ", N/A ,"$14,602.50 ","$14,602.50 ", N/A ,"$10,546.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36060041,N/A,HC OR LEVEL LITHOTRIPSY ADDL 15 MIN,360,1 ,"$1,128.00 ",$733.20 ,$489.55 ,"$1,128.00 ",$840.36 ,$738.84 , N/A ,$594.46 , N/A ,$711.77 ,$711.77 ,$711.77 ,$711.77 ,"$1,015.20 ",$846.00 , N/A ,$992.64 , N/A ,$846.00 ,$846.00 ,$958.80 ,$958.80 , N/A ,$958.80 , N/A ,$891.12 ,$891.12 ,$891.12 ,"$1,015.20 ", N/A ,"$1,015.20 ", N/A ,"$1,128.00 ",$738.84 , N/A ,$489.55 , N/A , N/A ,"$1,015.20 ", N/A ,$711.77 ,$676.80 ,"$1,015.20 ", N/A ,"$1,015.20 ","$1,015.20 ", N/A ,$733.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36080006,64400,HC NERVE BLOCK TRIGEMINAL,360,1 ,$758.00 ,$492.70 ,$265.50 ,$758.00 ,$564.71 ,$496.49 ,$265.50 ,$399.47 ,$265.50 ,$478.30 ,$478.30 ,$478.30 ,$478.30 ,$682.20 ,$568.50 ,$265.50 ,$667.04 ,$265.50 ,$568.50 ,$568.50 ,$644.30 ,$644.30 ,$265.50 ,$644.30 ,$265.50 ,$598.82 ,$598.82 ,$598.82 ,$682.20 ,$637.34 ,$682.20 ,$265.50 ,$758.00 ,$496.49 ,$265.50 ,$328.97 , N/A ,$277.89 ,$682.20 ,$575.37 ,$478.30 ,$454.80 ,$682.20 ,$265.50 ,$682.20 ,$682.20 ,$265.50 ,$492.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36080008,64417,HC NERVE BLOCK AXILLARY NERVE,360,1 ,"$2,248.00 ","$1,461.20 ",$836.09 ,"$2,248.00 ","$1,674.76 ","$1,472.44 ",$836.09 ,"$1,184.70 ",$836.09 ,"$1,418.49 ","$1,418.49 ","$1,418.49 ","$1,418.49 ","$2,023.20 ","$1,686.00 ",$836.09 ,"$1,978.24 ",$836.09 ,"$1,686.00 ","$1,686.00 ","$1,910.80 ","$1,910.80 ",$836.09 ,"$1,910.80 ",$836.09 ,"$1,775.92 ","$1,775.92 ","$1,775.92 ","$2,023.20 ","$2,007.08 ","$2,023.20 ",$836.09 ,"$2,248.00 ","$1,472.44 ",$836.09 ,$975.63 , N/A ,$875.12 ,"$2,023.20 ","$1,811.92 ","$1,418.49 ","$1,348.80 ","$2,023.20 ",$836.09 ,"$2,023.20 ","$2,023.20 ",$836.09 ,"$1,461.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100004,50430,HC INJ NEPH URET W G SI NEW ACCESS,361,1 ,"$4,889.00 ","$3,177.85 ",$584.29 ,"$4,889.00 ","$3,642.31 ","$3,202.30 ",$584.29 ,"$2,576.50 ",$584.29 ,"$3,084.96 ","$3,084.96 ","$3,084.96 ","$3,084.96 ","$4,400.10 ","$3,666.75 ",$584.29 ,"$4,302.32 ",$584.29 ,"$3,666.75 ","$3,666.75 ","$4,155.65 ","$4,155.65 ",$584.29 ,"$4,155.65 ",$584.29 ,"$3,862.31 ","$3,862.31 ","$3,862.31 ","$4,400.10 ","$1,402.64 ","$4,400.10 ",$584.29 ,"$4,889.00 ","$3,202.30 ",$584.29 ,"$2,121.83 ", N/A ,$611.57 ,"$4,400.10 ","$1,266.25 ","$3,084.96 ","$2,933.40 ","$4,400.10 ",$584.29 ,"$4,400.10 ","$4,400.10 ",$584.29 ,"$3,177.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100004,50430,HC INJ NEPH URET W G SI NEW ACCESS,361,1 ,"$7,332.00 ","$4,765.80 ",$584.29 ,"$7,332.00 ","$5,462.34 ","$4,802.46 ",$584.29 ,"$3,863.96 ",$584.29 ,"$4,626.49 ","$4,626.49 ","$4,626.49 ","$4,626.49 ","$6,598.80 ","$5,499.00 ",$584.29 ,"$6,452.16 ",$584.29 ,"$5,499.00 ","$5,499.00 ","$6,232.20 ","$6,232.20 ",$584.29 ,"$6,232.20 ",$584.29 ,"$5,792.28 ","$5,792.28 ","$5,792.28 ","$6,598.80 ","$1,402.64 ","$6,598.80 ",$584.29 ,"$7,332.00 ","$4,802.46 ",$584.29 ,"$3,182.09 ", N/A ,$611.57 ,"$6,598.80 ","$1,266.25 ","$4,626.49 ","$4,399.20 ","$6,598.80 ",$584.29 ,"$6,598.80 ","$6,598.80 ",$584.29 ,"$4,765.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100006,50434,HC CONVERT NEPH CTH NEPHUR CTH WG S AND I EXST TRACT,361,1 ,"$4,251.00 ","$2,763.15 ","$1,822.70 ","$4,251.00 ","$3,167.00 ","$2,784.41 ","$1,822.70 ","$2,240.28 ","$1,822.70 ","$2,682.38 ","$2,682.38 ","$2,682.38 ","$2,682.38 ","$3,825.90 ","$3,188.25 ","$1,822.70 ","$3,740.88 ","$1,822.70 ","$3,188.25 ","$3,188.25 ","$3,613.35 ","$3,613.35 ","$1,822.70 ","$3,613.35 ","$1,822.70 ","$3,358.29 ","$3,358.29 ","$3,358.29 ","$3,825.90 ","$4,251.00 ","$3,825.90 ","$1,822.70 ","$4,251.00 ","$2,784.41 ","$1,822.70 ","$1,844.93 ", N/A ,"$1,907.80 ","$3,825.90 ","$3,950.04 ","$2,682.38 ","$2,550.60 ","$3,825.90 ","$1,822.70 ","$3,825.90 ","$3,825.90 ","$1,822.70 ","$2,763.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100009,50695,HC PL URT STNT W G SI NEW ACCESS WITH NEPH CATH,361,1 ,"$6,331.00 ","$4,115.15 ","$2,747.65 ","$6,777.32 ","$4,716.60 ","$4,146.81 ","$3,127.32 ","$3,336.44 ","$3,127.32 ","$3,994.86 ","$3,994.86 ","$3,994.86 ","$3,994.86 ","$5,697.90 ","$4,748.25 ","$3,127.32 ","$5,571.28 ","$3,127.32 ","$4,748.25 ","$4,748.25 ","$5,381.35 ","$5,381.35 ","$3,127.32 ","$5,381.35 ","$3,127.32 ","$5,001.49 ","$5,001.49 ","$5,001.49 ","$5,697.90 ","$6,331.00 ","$5,697.90 ","$3,127.32 ","$6,331.00 ","$4,146.81 ","$3,127.32 ","$2,747.65 ", N/A ,"$3,273.32 ","$5,697.90 ","$6,777.32 ","$3,994.86 ","$3,798.60 ","$5,697.90 ","$3,127.32 ","$5,697.90 ","$5,697.90 ","$3,127.32 ","$4,115.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100026,36510,HC UMBILICAL CATHETER INSERTION NEWBORN,361,1 ,$153.00 ,$99.45 ,$66.40 ,$153.00 ,$113.99 ,$100.22 , N/A ,$80.63 , N/A ,$96.54 ,$96.54 ,$96.54 ,$96.54 ,$137.70 ,$114.75 , N/A ,$134.64 , N/A ,$114.75 ,$114.75 ,$130.05 ,$130.05 , N/A ,$130.05 , N/A ,$120.87 ,$120.87 ,$120.87 ,$137.70 , N/A ,$137.70 , N/A ,$153.00 ,$100.22 , N/A ,$66.40 , N/A , N/A ,$137.70 , N/A ,$96.54 ,$91.80 ,$137.70 , N/A ,$137.70 ,$137.70 , N/A ,$99.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100039,63663,HC REVISE SPINE ELECTRD PERQ ARRAY W/FLUORO,361,1 ,"$14,799.00 ","$9,619.35 ","$6,262.77 ","$14,799.00 ","$11,025.26 ","$9,693.35 ","$6,262.77 ","$7,799.07 ","$6,262.77 ","$9,338.17 ","$9,338.17 ","$9,338.17 ","$9,338.17 ","$13,319.10 ","$11,099.25 ","$6,262.77 ","$13,023.12 ","$6,262.77 ","$11,099.25 ","$11,099.25 ","$12,579.15 ","$12,579.15 ","$6,262.77 ","$12,579.15 ","$6,262.77 ","$11,691.21 ","$11,691.21 ","$11,691.21 ","$13,319.10 ","$14,799.00 ","$13,319.10 ","$6,262.77 ","$14,799.00 ","$9,693.35 ","$6,262.77 ","$6,422.77 ", N/A ,"$6,555.15 ","$13,319.10 ","$13,572.27 ","$9,338.17 ","$8,879.40 ","$13,319.10 ","$6,262.77 ","$13,319.10 ","$13,319.10 ","$6,262.77 ","$9,619.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100040,63685,HC INSERT/REPLACE SPINAL NEURO GEN/RECR,361,1 ,"$78,710.00 ","$51,161.50 ","$29,932.47 ","$78,710.00 ","$58,638.95 ","$51,555.05 ","$29,932.47 ","$41,480.17 ","$29,932.47 ","$49,666.01 ","$49,666.01 ","$49,666.01 ","$49,666.01 ","$70,839.00 ","$59,032.50 ","$29,932.47 ","$69,264.80 ","$29,932.47 ","$59,032.50 ","$59,032.50 ","$66,903.50 ","$66,903.50 ","$29,932.47 ","$66,903.50 ","$29,932.47 ","$62,180.90 ","$62,180.90 ","$62,180.90 ","$70,839.00 ","$71,854.69 ","$70,839.00 ","$29,932.47 ","$78,710.00 ","$51,555.05 ","$29,932.47 ","$34,160.14 ", N/A ,"$31,329.88 ","$70,839.00 ","$64,867.65 ","$49,666.01 ","$47,226.00 ","$70,839.00 ","$29,932.47 ","$70,839.00 ","$70,839.00 ","$29,932.47 ","$51,161.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100042,20600,HC ARTHROCNT/ASP/INJ JNT SMALL W/O US GUID-BIL,361,1 ,"$1,121.00 ",$728.65 ,$265.50 ,"$1,121.00 ",$835.15 ,$734.26 ,$265.50 ,$590.77 ,$265.50 ,$707.35 ,$707.35 ,$707.35 ,$707.35 ,"$1,008.90 ",$840.75 ,$265.50 ,$986.48 ,$265.50 ,$840.75 ,$840.75 ,$952.85 ,$952.85 ,$265.50 ,$952.85 ,$265.50 ,$885.59 ,$885.59 ,$885.59 ,"$1,008.90 ",$637.34 ,"$1,008.90 ",$265.50 ,"$1,121.00 ",$734.26 ,$265.50 ,$486.51 , N/A ,$277.89 ,"$1,008.90 ",$575.37 ,$707.35 ,$672.60 ,"$1,008.90 ",$265.50 ,"$1,008.90 ","$1,008.90 ",$265.50 ,$728.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100043,20605,HC ARTHROCNT/ASP/INJ JNT INTRM W/O US GUID-BIL,361,1 ,"$1,382.00 ",$898.30 ,$265.50 ,"$1,382.00 ","$1,029.59 ",$905.21 ,$265.50 ,$728.31 ,$265.50 ,$872.04 ,$872.04 ,$872.04 ,$872.04 ,"$1,243.80 ","$1,036.50 ",$265.50 ,"$1,216.16 ",$265.50 ,"$1,036.50 ","$1,036.50 ","$1,174.70 ","$1,174.70 ",$265.50 ,"$1,174.70 ",$265.50 ,"$1,091.78 ","$1,091.78 ","$1,091.78 ","$1,243.80 ",$637.34 ,"$1,243.80 ",$265.50 ,"$1,382.00 ",$905.21 ,$265.50 ,$599.79 , N/A ,$277.89 ,"$1,243.80 ",$575.37 ,$872.04 ,$829.20 ,"$1,243.80 ",$265.50 ,"$1,243.80 ","$1,243.80 ",$265.50 ,$898.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100044,20610,HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-BIL,361,1 ,"$1,382.00 ",$898.30 ,$265.50 ,"$1,382.00 ","$1,029.59 ",$905.21 ,$265.50 ,$728.31 ,$265.50 ,$872.04 ,$872.04 ,$872.04 ,$872.04 ,"$1,243.80 ","$1,036.50 ",$265.50 ,"$1,216.16 ",$265.50 ,"$1,036.50 ","$1,036.50 ","$1,174.70 ","$1,174.70 ",$265.50 ,"$1,174.70 ",$265.50 ,"$1,091.78 ","$1,091.78 ","$1,091.78 ","$1,243.80 ",$637.34 ,"$1,243.80 ",$265.50 ,"$1,382.00 ",$905.21 ,$265.50 ,$599.79 , N/A ,$277.89 ,"$1,243.80 ",$575.37 ,$872.04 ,$829.20 ,"$1,243.80 ",$265.50 ,"$1,243.80 ","$1,243.80 ",$265.50 ,$898.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100046,15271,HC APPL SKIN SUB TAL <100 INIT 25CM-LT,361,1 ,$994.00 ,$646.10 ,$431.40 ,"$3,779.02 ",$740.53 ,$651.07 ,$994.00 ,$523.84 ,$994.00 ,$627.21 ,$627.21 ,$627.21 ,$627.21 ,$894.60 ,$745.50 ,$994.00 ,$874.72 ,$994.00 ,$745.50 ,$745.50 ,$844.90 ,$844.90 ,$994.00 ,$844.90 ,$994.00 ,$785.26 ,$785.26 ,$785.26 ,$894.60 ,$994.00 ,$894.60 ,$994.00 ,$994.00 ,$651.07 ,$994.00 ,$431.40 , N/A ,$994.00 ,$894.60 ,"$3,779.02 ",$627.21 ,$596.40 ,$894.60 ,$994.00 ,$894.60 ,$894.60 ,$994.00 ,$646.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100047,15271,HC APPL SKIN SUB TAL <100 INIT 25CM-RT,361,1 ,$994.00 ,$646.10 ,$431.40 ,"$3,779.02 ",$740.53 ,$651.07 ,$994.00 ,$523.84 ,$994.00 ,$627.21 ,$627.21 ,$627.21 ,$627.21 ,$894.60 ,$745.50 ,$994.00 ,$874.72 ,$994.00 ,$745.50 ,$745.50 ,$844.90 ,$844.90 ,$994.00 ,$844.90 ,$994.00 ,$785.26 ,$785.26 ,$785.26 ,$894.60 ,$994.00 ,$894.60 ,$994.00 ,$994.00 ,$651.07 ,$994.00 ,$431.40 , N/A ,$994.00 ,$894.60 ,"$3,779.02 ",$627.21 ,$596.40 ,$894.60 ,$994.00 ,$894.60 ,$894.60 ,$994.00 ,$646.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100048,15272,HC APPL SKIN SUB TAL <100 ADDL 25CM-LT,361,1 ,$366.00 ,$237.90 ,$158.84 ,$366.00 ,$272.67 ,$239.73 , N/A ,$192.88 , N/A ,$230.95 ,$230.95 ,$230.95 ,$230.95 ,$329.40 ,$274.50 , N/A ,$322.08 , N/A ,$274.50 ,$274.50 ,$311.10 ,$311.10 , N/A ,$311.10 , N/A ,$289.14 ,$289.14 ,$289.14 ,$329.40 , N/A ,$329.40 , N/A ,$366.00 ,$239.73 , N/A ,$158.84 , N/A , N/A ,$329.40 , N/A ,$230.95 ,$219.60 ,$329.40 , N/A ,$329.40 ,$329.40 , N/A ,$237.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100049,15272,HC APPL SKIN SUB TAL <100 ADDL 25CM-RT,361,1 ,$366.00 ,$237.90 ,$158.84 ,$366.00 ,$272.67 ,$239.73 , N/A ,$192.88 , N/A ,$230.95 ,$230.95 ,$230.95 ,$230.95 ,$329.40 ,$274.50 , N/A ,$322.08 , N/A ,$274.50 ,$274.50 ,$311.10 ,$311.10 , N/A ,$311.10 , N/A ,$289.14 ,$289.14 ,$289.14 ,$329.40 , N/A ,$329.40 , N/A ,$366.00 ,$239.73 , N/A ,$158.84 , N/A , N/A ,$329.40 , N/A ,$230.95 ,$219.60 ,$329.40 , N/A ,$329.40 ,$329.40 , N/A ,$237.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100050,15273,HC APPL SKIN SUB TAL >100 INIT 100CM-LT,361,1 ,"$1,514.00 ",$984.10 ,$657.08 ,"$7,759.46 ","$1,127.93 ",$991.67 ,"$1,514.00 ",$797.88 ,"$1,514.00 ",$955.33 ,$955.33 ,$955.33 ,$955.33 ,"$1,362.60 ","$1,135.50 ","$1,514.00 ","$1,332.32 ","$1,514.00 ","$1,135.50 ","$1,135.50 ","$1,286.90 ","$1,286.90 ","$1,514.00 ","$1,286.90 ","$1,514.00 ","$1,196.06 ","$1,196.06 ","$1,196.06 ","$1,362.60 ","$1,514.00 ","$1,362.60 ","$1,514.00 ","$1,514.00 ",$991.67 ,"$1,514.00 ",$657.08 , N/A ,"$1,514.00 ","$1,362.60 ","$7,759.46 ",$955.33 ,$908.40 ,"$1,362.60 ","$1,514.00 ","$1,362.60 ","$1,362.60 ","$1,514.00 ",$984.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100051,15273,HC APPL SKIN SUB TAL >100 INIT 100CM-RT,361,1 ,"$1,514.00 ",$984.10 ,$657.08 ,"$7,759.46 ","$1,127.93 ",$991.67 ,"$1,514.00 ",$797.88 ,"$1,514.00 ",$955.33 ,$955.33 ,$955.33 ,$955.33 ,"$1,362.60 ","$1,135.50 ","$1,514.00 ","$1,332.32 ","$1,514.00 ","$1,135.50 ","$1,135.50 ","$1,286.90 ","$1,286.90 ","$1,514.00 ","$1,286.90 ","$1,514.00 ","$1,196.06 ","$1,196.06 ","$1,196.06 ","$1,362.60 ","$1,514.00 ","$1,362.60 ","$1,514.00 ","$1,514.00 ",$991.67 ,"$1,514.00 ",$657.08 , N/A ,"$1,514.00 ","$1,362.60 ","$7,759.46 ",$955.33 ,$908.40 ,"$1,362.60 ","$1,514.00 ","$1,362.60 ","$1,362.60 ","$1,514.00 ",$984.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100052,15274,HC APPL SKIN SUB TAL >100 ADDL 100CM-LT,361,1 ,$994.00 ,$646.10 ,$431.40 ,$994.00 ,$740.53 ,$651.07 , N/A ,$523.84 , N/A ,$627.21 ,$627.21 ,$627.21 ,$627.21 ,$894.60 ,$745.50 , N/A ,$874.72 , N/A ,$745.50 ,$745.50 ,$844.90 ,$844.90 , N/A ,$844.90 , N/A ,$785.26 ,$785.26 ,$785.26 ,$894.60 , N/A ,$894.60 , N/A ,$994.00 ,$651.07 , N/A ,$431.40 , N/A , N/A ,$894.60 , N/A ,$627.21 ,$596.40 ,$894.60 , N/A ,$894.60 ,$894.60 , N/A ,$646.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100053,15274,HC APPL SKIN SUB TAL >100 ADDL 100CM-RT,361,1 ,$994.00 ,$646.10 ,$431.40 ,$994.00 ,$740.53 ,$651.07 , N/A ,$523.84 , N/A ,$627.21 ,$627.21 ,$627.21 ,$627.21 ,$894.60 ,$745.50 , N/A ,$874.72 , N/A ,$745.50 ,$745.50 ,$844.90 ,$844.90 , N/A ,$844.90 , N/A ,$785.26 ,$785.26 ,$785.26 ,$894.60 , N/A ,$894.60 , N/A ,$994.00 ,$651.07 , N/A ,$431.40 , N/A , N/A ,$894.60 , N/A ,$627.21 ,$596.40 ,$894.60 , N/A ,$894.60 ,$894.60 , N/A ,$646.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100054,15275,HC APPL SKIN SUB OTH <100 INIT 25CM-LT,361,1 ,$994.00 ,$646.10 ,$431.40 ,"$3,779.02 ",$740.53 ,$651.07 ,$994.00 ,$523.84 ,$994.00 ,$627.21 ,$627.21 ,$627.21 ,$627.21 ,$894.60 ,$745.50 ,$994.00 ,$874.72 ,$994.00 ,$745.50 ,$745.50 ,$844.90 ,$844.90 ,$994.00 ,$844.90 ,$994.00 ,$785.26 ,$785.26 ,$785.26 ,$894.60 ,$994.00 ,$894.60 ,$994.00 ,$994.00 ,$651.07 ,$994.00 ,$431.40 , N/A ,$994.00 ,$894.60 ,"$3,779.02 ",$627.21 ,$596.40 ,$894.60 ,$994.00 ,$894.60 ,$894.60 ,$994.00 ,$646.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100055,15275,HC APPL SKIN SUB OTH <100 INIT 25CM-RT,361,1 ,$994.00 ,$646.10 ,$431.40 ,"$3,779.02 ",$740.53 ,$651.07 ,$994.00 ,$523.84 ,$994.00 ,$627.21 ,$627.21 ,$627.21 ,$627.21 ,$894.60 ,$745.50 ,$994.00 ,$874.72 ,$994.00 ,$745.50 ,$745.50 ,$844.90 ,$844.90 ,$994.00 ,$844.90 ,$994.00 ,$785.26 ,$785.26 ,$785.26 ,$894.60 ,$994.00 ,$894.60 ,$994.00 ,$994.00 ,$651.07 ,$994.00 ,$431.40 , N/A ,$994.00 ,$894.60 ,"$3,779.02 ",$627.21 ,$596.40 ,$894.60 ,$994.00 ,$894.60 ,$894.60 ,$994.00 ,$646.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100056,15276,HC APPL SKIN SUB OTH <100 ADDL 25CM-LT,361,1 ,$366.00 ,$237.90 ,$158.84 ,$366.00 ,$272.67 ,$239.73 , N/A ,$192.88 , N/A ,$230.95 ,$230.95 ,$230.95 ,$230.95 ,$329.40 ,$274.50 , N/A ,$322.08 , N/A ,$274.50 ,$274.50 ,$311.10 ,$311.10 , N/A ,$311.10 , N/A ,$289.14 ,$289.14 ,$289.14 ,$329.40 , N/A ,$329.40 , N/A ,$366.00 ,$239.73 , N/A ,$158.84 , N/A , N/A ,$329.40 , N/A ,$230.95 ,$219.60 ,$329.40 , N/A ,$329.40 ,$329.40 , N/A ,$237.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100057,15276,HC APPL SKIN SUB OTH <100 ADDL 25CM-RT,361,1 ,$366.00 ,$237.90 ,$158.84 ,$366.00 ,$272.67 ,$239.73 , N/A ,$192.88 , N/A ,$230.95 ,$230.95 ,$230.95 ,$230.95 ,$329.40 ,$274.50 , N/A ,$322.08 , N/A ,$274.50 ,$274.50 ,$311.10 ,$311.10 , N/A ,$311.10 , N/A ,$289.14 ,$289.14 ,$289.14 ,$329.40 , N/A ,$329.40 , N/A ,$366.00 ,$239.73 , N/A ,$158.84 , N/A , N/A ,$329.40 , N/A ,$230.95 ,$219.60 ,$329.40 , N/A ,$329.40 ,$329.40 , N/A ,$237.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100058,15277,HC APPL SKIN SUB OTH >100 INIT 100CM-LT,361,1 ,"$1,514.00 ",$984.10 ,$657.08 ,"$3,779.02 ","$1,127.93 ",$991.67 ,"$1,514.00 ",$797.88 ,"$1,514.00 ",$955.33 ,$955.33 ,$955.33 ,$955.33 ,"$1,362.60 ","$1,135.50 ","$1,514.00 ","$1,332.32 ","$1,514.00 ","$1,135.50 ","$1,135.50 ","$1,286.90 ","$1,286.90 ","$1,514.00 ","$1,286.90 ","$1,514.00 ","$1,196.06 ","$1,196.06 ","$1,196.06 ","$1,362.60 ","$1,514.00 ","$1,362.60 ","$1,514.00 ","$1,514.00 ",$991.67 ,"$1,514.00 ",$657.08 , N/A ,"$1,514.00 ","$1,362.60 ","$3,779.02 ",$955.33 ,$908.40 ,"$1,362.60 ","$1,514.00 ","$1,362.60 ","$1,362.60 ","$1,514.00 ",$984.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100059,15277,HC APPL SKIN SUB OTH >100 INIT 100CM-RT,361,1 ,"$1,514.00 ",$984.10 ,$657.08 ,"$3,779.02 ","$1,127.93 ",$991.67 ,"$1,514.00 ",$797.88 ,"$1,514.00 ",$955.33 ,$955.33 ,$955.33 ,$955.33 ,"$1,362.60 ","$1,135.50 ","$1,514.00 ","$1,332.32 ","$1,514.00 ","$1,135.50 ","$1,135.50 ","$1,286.90 ","$1,286.90 ","$1,514.00 ","$1,286.90 ","$1,514.00 ","$1,196.06 ","$1,196.06 ","$1,196.06 ","$1,362.60 ","$1,514.00 ","$1,362.60 ","$1,514.00 ","$1,514.00 ",$991.67 ,"$1,514.00 ",$657.08 , N/A ,"$1,514.00 ","$1,362.60 ","$3,779.02 ",$955.33 ,$908.40 ,"$1,362.60 ","$1,514.00 ","$1,362.60 ","$1,362.60 ","$1,514.00 ",$984.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100060,15278,HC APPL SKIN SUB OTH >100 ADDL 100CM-LT,361,1 ,$994.00 ,$646.10 ,$431.40 ,$994.00 ,$740.53 ,$651.07 , N/A ,$523.84 , N/A ,$627.21 ,$627.21 ,$627.21 ,$627.21 ,$894.60 ,$745.50 , N/A ,$874.72 , N/A ,$745.50 ,$745.50 ,$844.90 ,$844.90 , N/A ,$844.90 , N/A ,$785.26 ,$785.26 ,$785.26 ,$894.60 , N/A ,$894.60 , N/A ,$994.00 ,$651.07 , N/A ,$431.40 , N/A , N/A ,$894.60 , N/A ,$627.21 ,$596.40 ,$894.60 , N/A ,$894.60 ,$894.60 , N/A ,$646.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100061,15278,HC APPL SKIN SUB OTH >100 ADDL 100CM-RT,361,1 ,$994.00 ,$646.10 ,$431.40 ,$994.00 ,$740.53 ,$651.07 , N/A ,$523.84 , N/A ,$627.21 ,$627.21 ,$627.21 ,$627.21 ,$894.60 ,$745.50 , N/A ,$874.72 , N/A ,$745.50 ,$745.50 ,$844.90 ,$844.90 , N/A ,$844.90 , N/A ,$785.26 ,$785.26 ,$785.26 ,$894.60 , N/A ,$894.60 , N/A ,$994.00 ,$651.07 , N/A ,$431.40 , N/A , N/A ,$894.60 , N/A ,$627.21 ,$596.40 ,$894.60 , N/A ,$894.60 ,$894.60 , N/A ,$646.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100065,20605,HC ARTHROCNT/ASP/INJ JNT INTRM W/O US GUID-LT,361,1 ,$921.00 ,$598.65 ,$265.50 ,$921.00 ,$686.15 ,$603.26 ,$265.50 ,$485.37 ,$265.50 ,$581.15 ,$581.15 ,$581.15 ,$581.15 ,$828.90 ,$690.75 ,$265.50 ,$810.48 ,$265.50 ,$690.75 ,$690.75 ,$782.85 ,$782.85 ,$265.50 ,$782.85 ,$265.50 ,$727.59 ,$727.59 ,$727.59 ,$828.90 ,$637.34 ,$828.90 ,$265.50 ,$921.00 ,$603.26 ,$265.50 ,$399.71 , N/A ,$277.89 ,$828.90 ,$575.37 ,$581.15 ,$552.60 ,$828.90 ,$265.50 ,$828.90 ,$828.90 ,$265.50 ,$598.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100066,20605,HC ARTHROCNT/ASP/INJ JNT INTRM W/O US GUID-RT,361,1 ,$921.00 ,$598.65 ,$265.50 ,$921.00 ,$686.15 ,$603.26 ,$265.50 ,$485.37 ,$265.50 ,$581.15 ,$581.15 ,$581.15 ,$581.15 ,$828.90 ,$690.75 ,$265.50 ,$810.48 ,$265.50 ,$690.75 ,$690.75 ,$782.85 ,$782.85 ,$265.50 ,$782.85 ,$265.50 ,$727.59 ,$727.59 ,$727.59 ,$828.90 ,$637.34 ,$828.90 ,$265.50 ,$921.00 ,$603.26 ,$265.50 ,$399.71 , N/A ,$277.89 ,$828.90 ,$575.37 ,$581.15 ,$552.60 ,$828.90 ,$265.50 ,$828.90 ,$828.90 ,$265.50 ,$598.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100067,20610,HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-LT,361,1 ,$921.00 ,$598.65 ,$265.50 ,$921.00 ,$686.15 ,$603.26 ,$265.50 ,$485.37 ,$265.50 ,$581.15 ,$581.15 ,$581.15 ,$581.15 ,$828.90 ,$690.75 ,$265.50 ,$810.48 ,$265.50 ,$690.75 ,$690.75 ,$782.85 ,$782.85 ,$265.50 ,$782.85 ,$265.50 ,$727.59 ,$727.59 ,$727.59 ,$828.90 ,$637.34 ,$828.90 ,$265.50 ,$921.00 ,$603.26 ,$265.50 ,$399.71 , N/A ,$277.89 ,$828.90 ,$575.37 ,$581.15 ,$552.60 ,$828.90 ,$265.50 ,$828.90 ,$828.90 ,$265.50 ,$598.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100068,20610,HC ARTHROCNT/ASP/INJ JNT MAJOR W/O US GUID-RT,361,1 ,$921.00 ,$598.65 ,$265.50 ,$921.00 ,$686.15 ,$603.26 ,$265.50 ,$485.37 ,$265.50 ,$581.15 ,$581.15 ,$581.15 ,$581.15 ,$828.90 ,$690.75 ,$265.50 ,$810.48 ,$265.50 ,$690.75 ,$690.75 ,$782.85 ,$782.85 ,$265.50 ,$782.85 ,$265.50 ,$727.59 ,$727.59 ,$727.59 ,$828.90 ,$637.34 ,$828.90 ,$265.50 ,$921.00 ,$603.26 ,$265.50 ,$399.71 , N/A ,$277.89 ,$828.90 ,$575.37 ,$581.15 ,$552.60 ,$828.90 ,$265.50 ,$828.90 ,$828.90 ,$265.50 ,$598.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100074,64616,HC CHEM/DEST NERVE MUSCLE NECK-LT,361,1 ,$758.00 ,$492.70 ,$265.50 ,$758.00 ,$564.71 ,$496.49 ,$265.50 ,$399.47 ,$265.50 ,$478.30 ,$478.30 ,$478.30 ,$478.30 ,$682.20 ,$568.50 ,$265.50 ,$667.04 ,$265.50 ,$568.50 ,$568.50 ,$644.30 ,$644.30 ,$265.50 ,$644.30 ,$265.50 ,$598.82 ,$598.82 ,$598.82 ,$682.20 ,$637.34 ,$682.20 ,$265.50 ,$758.00 ,$496.49 ,$265.50 ,$328.97 , N/A ,$277.89 ,$682.20 ,$575.37 ,$478.30 ,$454.80 ,$682.20 ,$265.50 ,$682.20 ,$682.20 ,$265.50 ,$492.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100075,64616,HC CHEM/DEST NERVE MUSCLE NECK-RT,361,1 ,$758.00 ,$492.70 ,$265.50 ,$758.00 ,$564.71 ,$496.49 ,$265.50 ,$399.47 ,$265.50 ,$478.30 ,$478.30 ,$478.30 ,$478.30 ,$682.20 ,$568.50 ,$265.50 ,$667.04 ,$265.50 ,$568.50 ,$568.50 ,$644.30 ,$644.30 ,$265.50 ,$644.30 ,$265.50 ,$598.82 ,$598.82 ,$598.82 ,$682.20 ,$637.34 ,$682.20 ,$265.50 ,$758.00 ,$496.49 ,$265.50 ,$328.97 , N/A ,$277.89 ,$682.20 ,$575.37 ,$478.30 ,$454.80 ,$682.20 ,$265.50 ,$682.20 ,$682.20 ,$265.50 ,$492.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100076,C5271,HC APPL SKIN SUB TAL LOW <100 INIT 25CM-LT,361,1 ,"$2,201.00 ","$1,430.65 ",$532.86 ,"$2,201.00 ","$1,639.75 ","$1,441.66 ",$532.86 ,"$1,159.93 ",$532.86 ,"$1,388.83 ","$1,388.83 ","$1,388.83 ","$1,388.83 ","$1,980.90 ","$1,650.75 ",$532.86 ,"$1,936.88 ",$532.86 ,"$1,650.75 ","$1,650.75 ","$1,870.85 ","$1,870.85 ",$532.86 ,"$1,870.85 ",$532.86 ,"$1,738.79 ","$1,738.79 ","$1,738.79 ","$1,980.90 ","$1,279.15 ","$1,980.90 ",$532.86 ,"$2,201.00 ","$1,441.66 ",$532.86 ,$955.23 , N/A ,$557.73 ,"$1,980.90 ","$1,154.77 ","$1,388.83 ","$1,320.60 ","$1,980.90 ",$532.86 ,"$1,980.90 ","$1,980.90 ",$532.86 ,"$1,430.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100077,C5271,HC APPL SKIN SUB TAL LOW <100 INIT 25CM-RT,361,1 ,"$2,201.00 ","$1,430.65 ",$532.86 ,"$2,201.00 ","$1,639.75 ","$1,441.66 ",$532.86 ,"$1,159.93 ",$532.86 ,"$1,388.83 ","$1,388.83 ","$1,388.83 ","$1,388.83 ","$1,980.90 ","$1,650.75 ",$532.86 ,"$1,936.88 ",$532.86 ,"$1,650.75 ","$1,650.75 ","$1,870.85 ","$1,870.85 ",$532.86 ,"$1,870.85 ",$532.86 ,"$1,738.79 ","$1,738.79 ","$1,738.79 ","$1,980.90 ","$1,279.15 ","$1,980.90 ",$532.86 ,"$2,201.00 ","$1,441.66 ",$532.86 ,$955.23 , N/A ,$557.73 ,"$1,980.90 ","$1,154.77 ","$1,388.83 ","$1,320.60 ","$1,980.90 ",$532.86 ,"$1,980.90 ","$1,980.90 ",$532.86 ,"$1,430.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100078,C5272,HC APPL SKIN SUB TAL LOW<100 ADDL 25CM-LT,361,1 ,$751.00 ,$488.15 ,$325.93 ,$751.00 ,$559.50 ,$491.91 , N/A ,$395.78 , N/A ,$473.88 ,$473.88 ,$473.88 ,$473.88 ,$675.90 ,$563.25 , N/A ,$660.88 , N/A ,$563.25 ,$563.25 ,$638.35 ,$638.35 , N/A ,$638.35 , N/A ,$593.29 ,$593.29 ,$593.29 ,$675.90 , N/A ,$675.90 , N/A ,$751.00 ,$491.91 , N/A ,$325.93 , N/A , N/A ,$675.90 , N/A ,$473.88 ,$450.60 ,$675.90 , N/A ,$675.90 ,$675.90 , N/A ,$488.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100079,C5272,HC APPL SKIN SUB TAL LOW<100 ADDL 25CM-RT,361,1 ,$751.00 ,$488.15 ,$325.93 ,$751.00 ,$559.50 ,$491.91 , N/A ,$395.78 , N/A ,$473.88 ,$473.88 ,$473.88 ,$473.88 ,$675.90 ,$563.25 , N/A ,$660.88 , N/A ,$563.25 ,$563.25 ,$638.35 ,$638.35 , N/A ,$638.35 , N/A ,$593.29 ,$593.29 ,$593.29 ,$675.90 , N/A ,$675.90 , N/A ,$751.00 ,$491.91 , N/A ,$325.93 , N/A , N/A ,$675.90 , N/A ,$473.88 ,$450.60 ,$675.90 , N/A ,$675.90 ,$675.90 , N/A ,$488.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100080,C5273,HC APPL SKIN SUB TAL LOW>100 INIT 100CM-LT,361,1 ,"$7,372.00 ","$4,791.80 ","$1,743.79 ","$7,372.00 ","$5,492.14 ","$4,828.66 ","$1,743.79 ","$3,885.04 ","$1,743.79 ","$4,651.73 ","$4,651.73 ","$4,651.73 ","$4,651.73 ","$6,634.80 ","$5,529.00 ","$1,743.79 ","$6,487.36 ","$1,743.79 ","$5,529.00 ","$5,529.00 ","$6,266.20 ","$6,266.20 ","$1,743.79 ","$6,266.20 ","$1,743.79 ","$5,823.88 ","$5,823.88 ","$5,823.88 ","$6,634.80 ","$4,186.06 ","$6,634.80 ","$1,743.79 ","$7,372.00 ","$4,828.66 ","$1,743.79 ","$3,199.45 ", N/A ,"$1,825.20 ","$6,634.80 ","$3,779.02 ","$4,651.73 ","$4,423.20 ","$6,634.80 ","$1,743.79 ","$6,634.80 ","$6,634.80 ","$1,743.79 ","$4,791.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100081,C5273,HC APPL SKIN SUB TAL LOW>100 INIT 100CM-RT,361,1 ,"$7,372.00 ","$4,791.80 ","$1,743.79 ","$7,372.00 ","$5,492.14 ","$4,828.66 ","$1,743.79 ","$3,885.04 ","$1,743.79 ","$4,651.73 ","$4,651.73 ","$4,651.73 ","$4,651.73 ","$6,634.80 ","$5,529.00 ","$1,743.79 ","$6,487.36 ","$1,743.79 ","$5,529.00 ","$5,529.00 ","$6,266.20 ","$6,266.20 ","$1,743.79 ","$6,266.20 ","$1,743.79 ","$5,823.88 ","$5,823.88 ","$5,823.88 ","$6,634.80 ","$4,186.06 ","$6,634.80 ","$1,743.79 ","$7,372.00 ","$4,828.66 ","$1,743.79 ","$3,199.45 ", N/A ,"$1,825.20 ","$6,634.80 ","$3,779.02 ","$4,651.73 ","$4,423.20 ","$6,634.80 ","$1,743.79 ","$6,634.80 ","$6,634.80 ","$1,743.79 ","$4,791.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100082,C5274,HC APPL SKIN SUB TAL LOW>100 ADDL 100CM-LT,361,1 ,"$4,713.00 ","$3,063.45 ","$2,045.44 ","$4,713.00 ","$3,511.19 ","$3,087.02 ", N/A ,"$2,483.75 ", N/A ,"$2,973.90 ","$2,973.90 ","$2,973.90 ","$2,973.90 ","$4,241.70 ","$3,534.75 ", N/A ,"$4,147.44 ", N/A ,"$3,534.75 ","$3,534.75 ","$4,006.05 ","$4,006.05 ", N/A ,"$4,006.05 ", N/A ,"$3,723.27 ","$3,723.27 ","$3,723.27 ","$4,241.70 ", N/A ,"$4,241.70 ", N/A ,"$4,713.00 ","$3,087.02 ", N/A ,"$2,045.44 ", N/A , N/A ,"$4,241.70 ", N/A ,"$2,973.90 ","$2,827.80 ","$4,241.70 ", N/A ,"$4,241.70 ","$4,241.70 ", N/A ,"$3,063.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100083,C5274,HC APPL SKIN SUB TAL LOW>100 ADDL 100CM-RT,361,1 ,"$4,713.00 ","$3,063.45 ","$2,045.44 ","$4,713.00 ","$3,511.19 ","$3,087.02 ", N/A ,"$2,483.75 ", N/A ,"$2,973.90 ","$2,973.90 ","$2,973.90 ","$2,973.90 ","$4,241.70 ","$3,534.75 ", N/A ,"$4,147.44 ", N/A ,"$3,534.75 ","$3,534.75 ","$4,006.05 ","$4,006.05 ", N/A ,"$4,006.05 ", N/A ,"$3,723.27 ","$3,723.27 ","$3,723.27 ","$4,241.70 ", N/A ,"$4,241.70 ", N/A ,"$4,713.00 ","$3,087.02 ", N/A ,"$2,045.44 ", N/A , N/A ,"$4,241.70 ", N/A ,"$2,973.90 ","$2,827.80 ","$4,241.70 ", N/A ,"$4,241.70 ","$4,241.70 ", N/A ,"$3,063.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100084,C5275,HC APPL SKIN SUB OTH LOW<100 INIT 25CM-LT,361,1 ,"$2,201.00 ","$1,430.65 ",$532.86 ,"$2,201.00 ","$1,639.75 ","$1,441.66 ",$532.86 ,"$1,159.93 ",$532.86 ,"$1,388.83 ","$1,388.83 ","$1,388.83 ","$1,388.83 ","$1,980.90 ","$1,650.75 ",$532.86 ,"$1,936.88 ",$532.86 ,"$1,650.75 ","$1,650.75 ","$1,870.85 ","$1,870.85 ",$532.86 ,"$1,870.85 ",$532.86 ,"$1,738.79 ","$1,738.79 ","$1,738.79 ","$1,980.90 ","$1,279.15 ","$1,980.90 ",$532.86 ,"$2,201.00 ","$1,441.66 ",$532.86 ,$955.23 , N/A ,$557.73 ,"$1,980.90 ","$1,154.77 ","$1,388.83 ","$1,320.60 ","$1,980.90 ",$532.86 ,"$1,980.90 ","$1,980.90 ",$532.86 ,"$1,430.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100085,C5275,HC APPL SKIN SUB OTH LOW<100 INIT 25CM-RT,361,1 ,"$2,201.00 ","$1,430.65 ",$532.86 ,"$2,201.00 ","$1,639.75 ","$1,441.66 ",$532.86 ,"$1,159.93 ",$532.86 ,"$1,388.83 ","$1,388.83 ","$1,388.83 ","$1,388.83 ","$1,980.90 ","$1,650.75 ",$532.86 ,"$1,936.88 ",$532.86 ,"$1,650.75 ","$1,650.75 ","$1,870.85 ","$1,870.85 ",$532.86 ,"$1,870.85 ",$532.86 ,"$1,738.79 ","$1,738.79 ","$1,738.79 ","$1,980.90 ","$1,279.15 ","$1,980.90 ",$532.86 ,"$2,201.00 ","$1,441.66 ",$532.86 ,$955.23 , N/A ,$557.73 ,"$1,980.90 ","$1,154.77 ","$1,388.83 ","$1,320.60 ","$1,980.90 ",$532.86 ,"$1,980.90 ","$1,980.90 ",$532.86 ,"$1,430.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100086,C5276,HC APPL SKIN SUB OTH LOW<100 ADDL 25CM-LT,361,1 ,$751.00 ,$488.15 ,$325.93 ,$751.00 ,$559.50 ,$491.91 , N/A ,$395.78 , N/A ,$473.88 ,$473.88 ,$473.88 ,$473.88 ,$675.90 ,$563.25 , N/A ,$660.88 , N/A ,$563.25 ,$563.25 ,$638.35 ,$638.35 , N/A ,$638.35 , N/A ,$593.29 ,$593.29 ,$593.29 ,$675.90 , N/A ,$675.90 , N/A ,$751.00 ,$491.91 , N/A ,$325.93 , N/A , N/A ,$675.90 , N/A ,$473.88 ,$450.60 ,$675.90 , N/A ,$675.90 ,$675.90 , N/A ,$488.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100087,C5276,HC APPL SKIN SUB OTH LOW<100 ADDL 25CM-RT,361,1 ,$751.00 ,$488.15 ,$325.93 ,$751.00 ,$559.50 ,$491.91 , N/A ,$395.78 , N/A ,$473.88 ,$473.88 ,$473.88 ,$473.88 ,$675.90 ,$563.25 , N/A ,$660.88 , N/A ,$563.25 ,$563.25 ,$638.35 ,$638.35 , N/A ,$638.35 , N/A ,$593.29 ,$593.29 ,$593.29 ,$675.90 , N/A ,$675.90 , N/A ,$751.00 ,$491.91 , N/A ,$325.93 , N/A , N/A ,$675.90 , N/A ,$473.88 ,$450.60 ,$675.90 , N/A ,$675.90 ,$675.90 , N/A ,$488.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100088,C5277,HC APPL SKIN SUB OTH LOW>100 INIT 100CM-LT,361,1 ,"$2,201.00 ","$1,430.65 ",$532.86 ,"$2,201.00 ","$1,639.75 ","$1,441.66 ",$532.86 ,"$1,159.93 ",$532.86 ,"$1,388.83 ","$1,388.83 ","$1,388.83 ","$1,388.83 ","$1,980.90 ","$1,650.75 ",$532.86 ,"$1,936.88 ",$532.86 ,"$1,650.75 ","$1,650.75 ","$1,870.85 ","$1,870.85 ",$532.86 ,"$1,870.85 ",$532.86 ,"$1,738.79 ","$1,738.79 ","$1,738.79 ","$1,980.90 ","$1,279.15 ","$1,980.90 ",$532.86 ,"$2,201.00 ","$1,441.66 ",$532.86 ,$955.23 , N/A ,$557.73 ,"$1,980.90 ","$1,154.77 ","$1,388.83 ","$1,320.60 ","$1,980.90 ",$532.86 ,"$1,980.90 ","$1,980.90 ",$532.86 ,"$1,430.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100089,C5277,HC APPL SKIN SUB OTH LOW>100 INIT 100CM-RT,361,1 ,"$2,201.00 ","$1,430.65 ",$532.86 ,"$2,201.00 ","$1,639.75 ","$1,441.66 ",$532.86 ,"$1,159.93 ",$532.86 ,"$1,388.83 ","$1,388.83 ","$1,388.83 ","$1,388.83 ","$1,980.90 ","$1,650.75 ",$532.86 ,"$1,936.88 ",$532.86 ,"$1,650.75 ","$1,650.75 ","$1,870.85 ","$1,870.85 ",$532.86 ,"$1,870.85 ",$532.86 ,"$1,738.79 ","$1,738.79 ","$1,738.79 ","$1,980.90 ","$1,279.15 ","$1,980.90 ",$532.86 ,"$2,201.00 ","$1,441.66 ",$532.86 ,$955.23 , N/A ,$557.73 ,"$1,980.90 ","$1,154.77 ","$1,388.83 ","$1,320.60 ","$1,980.90 ",$532.86 ,"$1,980.90 ","$1,980.90 ",$532.86 ,"$1,430.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100090,C5278,HC APPL SKIN SUB OTH LOW>100 ADDL 100CM-LT,361,1 ,"$1,407.00 ",$914.55 ,$610.64 ,"$1,407.00 ","$1,048.22 ",$921.59 , N/A ,$741.49 , N/A ,$887.82 ,$887.82 ,$887.82 ,$887.82 ,"$1,266.30 ","$1,055.25 ", N/A ,"$1,238.16 ", N/A ,"$1,055.25 ","$1,055.25 ","$1,195.95 ","$1,195.95 ", N/A ,"$1,195.95 ", N/A ,"$1,111.53 ","$1,111.53 ","$1,111.53 ","$1,266.30 ", N/A ,"$1,266.30 ", N/A ,"$1,407.00 ",$921.59 , N/A ,$610.64 , N/A , N/A ,"$1,266.30 ", N/A ,$887.82 ,$844.20 ,"$1,266.30 ", N/A ,"$1,266.30 ","$1,266.30 ", N/A ,$914.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100091,C5278,HC APPL SKIN SUB OTH LOW>100 ADDL 100CM-RT,361,1 ,"$1,407.00 ",$914.55 ,$610.64 ,"$1,407.00 ","$1,048.22 ",$921.59 , N/A ,$741.49 , N/A ,$887.82 ,$887.82 ,$887.82 ,$887.82 ,"$1,266.30 ","$1,055.25 ", N/A ,"$1,238.16 ", N/A ,"$1,055.25 ","$1,055.25 ","$1,195.95 ","$1,195.95 ", N/A ,"$1,195.95 ", N/A ,"$1,111.53 ","$1,111.53 ","$1,111.53 ","$1,266.30 ", N/A ,"$1,266.30 ", N/A ,"$1,407.00 ",$921.59 , N/A ,$610.64 , N/A , N/A ,"$1,266.30 ", N/A ,$887.82 ,$844.20 ,"$1,266.30 ", N/A ,"$1,266.30 ","$1,266.30 ", N/A ,$914.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100092,N/A,HC BEDSIDE SURG PROC LEVEL 1,361,1 ,$552.00 ,$358.80 ,$239.57 ,$552.00 ,$411.24 ,$361.56 , N/A ,$290.90 , N/A ,$348.31 ,$348.31 ,$348.31 ,$348.31 ,$496.80 ,$414.00 , N/A ,$485.76 , N/A ,$414.00 ,$414.00 ,$469.20 ,$469.20 , N/A ,$469.20 , N/A ,$436.08 ,$436.08 ,$436.08 ,$496.80 , N/A ,$496.80 , N/A ,$552.00 ,$361.56 , N/A ,$239.57 , N/A , N/A ,$496.80 , N/A ,$348.31 ,$331.20 ,$496.80 , N/A ,$496.80 ,$496.80 , N/A ,$358.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100100,62320,HC INJ INTRLAMNR CERV/THOR W/O GUIDE,361,1 ,"$1,833.00 ","$1,191.45 ",$645.11 ,"$1,833.00 ","$1,365.59 ","$1,200.62 ",$645.11 ,$965.99 ,$645.11 ,"$1,156.62 ","$1,156.62 ","$1,156.62 ","$1,156.62 ","$1,649.70 ","$1,374.75 ",$645.11 ,"$1,613.04 ",$645.11 ,"$1,374.75 ","$1,374.75 ","$1,558.05 ","$1,558.05 ",$645.11 ,"$1,558.05 ",$645.11 ,"$1,448.07 ","$1,448.07 ","$1,448.07 ","$1,649.70 ","$1,548.62 ","$1,649.70 ",$645.11 ,"$1,833.00 ","$1,200.62 ",$645.11 ,$795.52 , N/A ,$675.22 ,"$1,649.70 ","$1,398.03 ","$1,156.62 ","$1,099.80 ","$1,649.70 ",$645.11 ,"$1,649.70 ","$1,649.70 ",$645.11 ,"$1,191.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100101,62321,HC INJ INTRLAMNR CERV/THOR W/GUIDE,361,1 ,"$3,894.00 ","$2,531.10 ",$645.11 ,"$3,894.00 ","$2,901.03 ","$2,550.57 ",$645.11 ,"$2,052.14 ",$645.11 ,"$2,457.11 ","$2,457.11 ","$2,457.11 ","$2,457.11 ","$3,504.60 ","$2,920.50 ",$645.11 ,"$3,426.72 ",$645.11 ,"$2,920.50 ","$2,920.50 ","$3,309.90 ","$3,309.90 ",$645.11 ,"$3,309.90 ",$645.11 ,"$3,076.26 ","$3,076.26 ","$3,076.26 ","$3,504.60 ","$1,548.62 ","$3,504.60 ",$645.11 ,"$3,894.00 ","$2,550.57 ",$645.11 ,"$1,690.00 ", N/A ,$675.22 ,"$3,504.60 ","$1,398.03 ","$2,457.11 ","$2,336.40 ","$3,504.60 ",$645.11 ,"$3,504.60 ","$3,504.60 ",$645.11 ,"$2,531.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100102,62322,HC INJ INTRLAMNR LUM/SAC W/O GUIDE,361,1 ,"$3,461.00 ","$2,249.65 ",$645.11 ,"$3,461.00 ","$2,578.45 ","$2,266.96 ",$645.11 ,"$1,823.95 ",$645.11 ,"$2,183.89 ","$2,183.89 ","$2,183.89 ","$2,183.89 ","$3,114.90 ","$2,595.75 ",$645.11 ,"$3,045.68 ",$645.11 ,"$2,595.75 ","$2,595.75 ","$2,941.85 ","$2,941.85 ",$645.11 ,"$2,941.85 ",$645.11 ,"$2,734.19 ","$2,734.19 ","$2,734.19 ","$3,114.90 ","$1,548.62 ","$3,114.90 ",$645.11 ,"$3,461.00 ","$2,266.96 ",$645.11 ,"$1,502.07 ", N/A ,$675.22 ,"$3,114.90 ","$1,398.03 ","$2,183.89 ","$2,076.60 ","$3,114.90 ",$645.11 ,"$3,114.90 ","$3,114.90 ",$645.11 ,"$2,249.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100103,62323,HC INJ INTRLAMNR LUM/SAC W/GUIDE,361,1 ,"$3,790.00 ","$2,463.50 ",$645.11 ,"$3,790.00 ","$2,823.55 ","$2,482.45 ",$645.11 ,"$1,997.33 ",$645.11 ,"$2,391.49 ","$2,391.49 ","$2,391.49 ","$2,391.49 ","$3,411.00 ","$2,842.50 ",$645.11 ,"$3,335.20 ",$645.11 ,"$2,842.50 ","$2,842.50 ","$3,221.50 ","$3,221.50 ",$645.11 ,"$3,221.50 ",$645.11 ,"$2,994.10 ","$2,994.10 ","$2,994.10 ","$3,411.00 ","$1,548.62 ","$3,411.00 ",$645.11 ,"$3,790.00 ","$2,482.45 ",$645.11 ,"$1,644.86 ", N/A ,$675.22 ,"$3,411.00 ","$1,398.03 ","$2,391.49 ","$2,274.00 ","$3,411.00 ",$645.11 ,"$3,411.00 ","$3,411.00 ",$645.11 ,"$2,463.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100106,62326,HC INJ W/CATH LUM/SAC W/O GUIDE,361,1 ,"$1,322.00 ",$859.30 ,$573.75 ,"$1,811.92 ",$984.89 ,$865.91 ,$836.09 ,$696.69 ,$836.09 ,$834.18 ,$834.18 ,$834.18 ,$834.18 ,"$1,189.80 ",$991.50 ,$836.09 ,"$1,163.36 ",$836.09 ,$991.50 ,$991.50 ,"$1,123.70 ","$1,123.70 ",$836.09 ,"$1,123.70 ",$836.09 ,"$1,044.38 ","$1,044.38 ","$1,044.38 ","$1,189.80 ","$1,322.00 ","$1,189.80 ",$836.09 ,"$1,322.00 ",$865.91 ,$836.09 ,$573.75 , N/A ,$875.12 ,"$1,189.80 ","$1,811.92 ",$834.18 ,$793.20 ,"$1,189.80 ",$836.09 ,"$1,189.80 ","$1,189.80 ",$836.09 ,$859.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100109,29445,HC APPL CAST LEG RIGID CONTACT -LT,361,1 ,$905.00 ,$588.25 ,$245.17 ,$905.00 ,$674.23 ,$592.78 ,$245.17 ,$476.94 ,$245.17 ,$571.06 ,$571.06 ,$571.06 ,$571.06 ,$814.50 ,$678.75 ,$245.17 ,$796.40 ,$245.17 ,$678.75 ,$678.75 ,$769.25 ,$769.25 ,$245.17 ,$769.25 ,$245.17 ,$714.95 ,$714.95 ,$714.95 ,$814.50 ,$588.54 ,$814.50 ,$245.17 ,$905.00 ,$592.78 ,$245.17 ,$392.77 , N/A ,$256.61 ,$814.50 ,$531.31 ,$571.06 ,$543.00 ,$814.50 ,$245.17 ,$814.50 ,$814.50 ,$245.17 ,$588.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100110,29445,HC APPL CAST LEG RIGID CONTACT -RT,361,1 ,$905.00 ,$588.25 ,$245.17 ,$905.00 ,$674.23 ,$592.78 ,$245.17 ,$476.94 ,$245.17 ,$571.06 ,$571.06 ,$571.06 ,$571.06 ,$814.50 ,$678.75 ,$245.17 ,$796.40 ,$245.17 ,$678.75 ,$678.75 ,$769.25 ,$769.25 ,$245.17 ,$769.25 ,$245.17 ,$714.95 ,$714.95 ,$714.95 ,$814.50 ,$588.54 ,$814.50 ,$245.17 ,$905.00 ,$592.78 ,$245.17 ,$392.77 , N/A ,$256.61 ,$814.50 ,$531.31 ,$571.06 ,$543.00 ,$814.50 ,$245.17 ,$814.50 ,$814.50 ,$245.17 ,$588.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100119,64634,HC DESTROY NERVE CERVICAL/THORACIC EA ADDL-BIL,361,1 ,$878.00 ,$570.70 ,$381.05 ,$878.00 ,$654.11 ,$575.09 , N/A ,$462.71 , N/A ,$554.02 ,$554.02 ,$554.02 ,$554.02 ,$790.20 ,$658.50 , N/A ,$772.64 , N/A ,$658.50 ,$658.50 ,$746.30 ,$746.30 , N/A ,$746.30 , N/A ,$693.62 ,$693.62 ,$693.62 ,$790.20 , N/A ,$790.20 , N/A ,$878.00 ,$575.09 , N/A ,$381.05 , N/A , N/A ,$790.20 , N/A ,$554.02 ,$526.80 ,$790.20 , N/A ,$790.20 ,$790.20 , N/A ,$570.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100120,64634,HC DESTROY NERVE CERVICAL/THORACIC EA ADDL-LT,361,1 ,$585.00 ,$380.25 ,$253.89 ,$585.00 ,$435.83 ,$383.18 , N/A ,$308.30 , N/A ,$369.14 ,$369.14 ,$369.14 ,$369.14 ,$526.50 ,$438.75 , N/A ,$514.80 , N/A ,$438.75 ,$438.75 ,$497.25 ,$497.25 , N/A ,$497.25 , N/A ,$462.15 ,$462.15 ,$462.15 ,$526.50 , N/A ,$526.50 , N/A ,$585.00 ,$383.18 , N/A ,$253.89 , N/A , N/A ,$526.50 , N/A ,$369.14 ,$351.00 ,$526.50 , N/A ,$526.50 ,$526.50 , N/A ,$380.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100121,64634,HC DESTROY NERVE CERVICAL/THORACIC EA ADDL-RT,361,1 ,$585.00 ,$380.25 ,$253.89 ,$585.00 ,$435.83 ,$383.18 , N/A ,$308.30 , N/A ,$369.14 ,$369.14 ,$369.14 ,$369.14 ,$526.50 ,$438.75 , N/A ,$514.80 , N/A ,$438.75 ,$438.75 ,$497.25 ,$497.25 , N/A ,$497.25 , N/A ,$462.15 ,$462.15 ,$462.15 ,$526.50 , N/A ,$526.50 , N/A ,$585.00 ,$383.18 , N/A ,$253.89 , N/A , N/A ,$526.50 , N/A ,$369.14 ,$351.00 ,$526.50 , N/A ,$526.50 ,$526.50 , N/A ,$380.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100122,64633,HC DESTROY NERVE CERVICAL/THORACIC SGL-BIL,361,1 ,"$6,817.00 ","$4,431.05 ","$1,783.46 ","$6,817.00 ","$5,078.67 ","$4,465.14 ","$1,783.46 ","$3,592.56 ","$1,783.46 ","$4,301.53 ","$4,301.53 ","$4,301.53 ","$4,301.53 ","$6,135.30 ","$5,112.75 ","$1,783.46 ","$5,998.96 ","$1,783.46 ","$5,112.75 ","$5,112.75 ","$5,794.45 ","$5,794.45 ","$1,783.46 ","$5,794.45 ","$1,783.46 ","$5,385.43 ","$5,385.43 ","$5,385.43 ","$6,135.30 ","$4,281.31 ","$6,135.30 ","$1,783.46 ","$6,817.00 ","$4,465.14 ","$1,783.46 ","$2,958.58 ", N/A ,"$1,866.72 ","$6,135.30 ","$3,865.00 ","$4,301.53 ","$4,090.20 ","$6,135.30 ","$1,783.46 ","$6,135.30 ","$6,135.30 ","$1,783.46 ","$4,431.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100123,64633,HC DESTROY NERVE CERVICAL/THORACIC SGL-LT,361,1 ,"$4,545.00 ","$2,954.25 ","$1,783.46 ","$4,545.00 ","$3,386.03 ","$2,976.98 ","$1,783.46 ","$2,395.22 ","$1,783.46 ","$2,867.90 ","$2,867.90 ","$2,867.90 ","$2,867.90 ","$4,090.50 ","$3,408.75 ","$1,783.46 ","$3,999.60 ","$1,783.46 ","$3,408.75 ","$3,408.75 ","$3,863.25 ","$3,863.25 ","$1,783.46 ","$3,863.25 ","$1,783.46 ","$3,590.55 ","$3,590.55 ","$3,590.55 ","$4,090.50 ","$4,281.31 ","$4,090.50 ","$1,783.46 ","$4,545.00 ","$2,976.98 ","$1,783.46 ","$1,972.53 ", N/A ,"$1,866.72 ","$4,090.50 ","$3,865.00 ","$2,867.90 ","$2,727.00 ","$4,090.50 ","$1,783.46 ","$4,090.50 ","$4,090.50 ","$1,783.46 ","$2,954.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100124,64633,HC DESTROY NERVE CERVICAL/THORACIC SGL-RT,361,1 ,"$4,545.00 ","$2,954.25 ","$1,783.46 ","$4,545.00 ","$3,386.03 ","$2,976.98 ","$1,783.46 ","$2,395.22 ","$1,783.46 ","$2,867.90 ","$2,867.90 ","$2,867.90 ","$2,867.90 ","$4,090.50 ","$3,408.75 ","$1,783.46 ","$3,999.60 ","$1,783.46 ","$3,408.75 ","$3,408.75 ","$3,863.25 ","$3,863.25 ","$1,783.46 ","$3,863.25 ","$1,783.46 ","$3,590.55 ","$3,590.55 ","$3,590.55 ","$4,090.50 ","$4,281.31 ","$4,090.50 ","$1,783.46 ","$4,545.00 ","$2,976.98 ","$1,783.46 ","$1,972.53 ", N/A ,"$1,866.72 ","$4,090.50 ","$3,865.00 ","$2,867.90 ","$2,727.00 ","$4,090.50 ","$1,783.46 ","$4,090.50 ","$4,090.50 ","$1,783.46 ","$2,954.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100125,64636,HC DESTROY NERVE LUMBAR/SACRAL EA ADDL-BIL,361,1 ,"$1,218.00 ",$791.70 ,$528.61 ,"$1,218.00 ",$907.41 ,$797.79 , N/A ,$641.89 , N/A ,$768.56 ,$768.56 ,$768.56 ,$768.56 ,"$1,096.20 ",$913.50 , N/A ,"$1,071.84 ", N/A ,$913.50 ,$913.50 ,"$1,035.30 ","$1,035.30 ", N/A ,"$1,035.30 ", N/A ,$962.22 ,$962.22 ,$962.22 ,"$1,096.20 ", N/A ,"$1,096.20 ", N/A ,"$1,218.00 ",$797.79 , N/A ,$528.61 , N/A , N/A ,"$1,096.20 ", N/A ,$768.56 ,$730.80 ,"$1,096.20 ", N/A ,"$1,096.20 ","$1,096.20 ", N/A ,$791.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100126,64636,HC DESTROY NERVE LUMBAR/SACRAL EA ADDL-LT,361,1 ,$812.00 ,$527.80 ,$352.41 ,$812.00 ,$604.94 ,$531.86 , N/A ,$427.92 , N/A ,$512.37 ,$512.37 ,$512.37 ,$512.37 ,$730.80 ,$609.00 , N/A ,$714.56 , N/A ,$609.00 ,$609.00 ,$690.20 ,$690.20 , N/A ,$690.20 , N/A ,$641.48 ,$641.48 ,$641.48 ,$730.80 , N/A ,$730.80 , N/A ,$812.00 ,$531.86 , N/A ,$352.41 , N/A , N/A ,$730.80 , N/A ,$512.37 ,$487.20 ,$730.80 , N/A ,$730.80 ,$730.80 , N/A ,$527.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100127,64636,HC DESTROY NERVE LUMBAR/SACRAL EA ADDL-RT,361,1 ,$812.00 ,$527.80 ,$352.41 ,$812.00 ,$604.94 ,$531.86 , N/A ,$427.92 , N/A ,$512.37 ,$512.37 ,$512.37 ,$512.37 ,$730.80 ,$609.00 , N/A ,$714.56 , N/A ,$609.00 ,$609.00 ,$690.20 ,$690.20 , N/A ,$690.20 , N/A ,$641.48 ,$641.48 ,$641.48 ,$730.80 , N/A ,$730.80 , N/A ,$812.00 ,$531.86 , N/A ,$352.41 , N/A , N/A ,$730.80 , N/A ,$512.37 ,$487.20 ,$730.80 , N/A ,$730.80 ,$730.80 , N/A ,$527.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100128,64635,HC DESTROY NERVE LUMBAR/SACRAL SGL-BIL,361,1 ,"$6,817.00 ","$4,431.05 ","$1,783.46 ","$6,817.00 ","$5,078.67 ","$4,465.14 ","$1,783.46 ","$3,592.56 ","$1,783.46 ","$4,301.53 ","$4,301.53 ","$4,301.53 ","$4,301.53 ","$6,135.30 ","$5,112.75 ","$1,783.46 ","$5,998.96 ","$1,783.46 ","$5,112.75 ","$5,112.75 ","$5,794.45 ","$5,794.45 ","$1,783.46 ","$5,794.45 ","$1,783.46 ","$5,385.43 ","$5,385.43 ","$5,385.43 ","$6,135.30 ","$4,281.31 ","$6,135.30 ","$1,783.46 ","$6,817.00 ","$4,465.14 ","$1,783.46 ","$2,958.58 ", N/A ,"$1,866.72 ","$6,135.30 ","$3,865.00 ","$4,301.53 ","$4,090.20 ","$6,135.30 ","$1,783.46 ","$6,135.30 ","$6,135.30 ","$1,783.46 ","$4,431.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100129,64635,HC DESTROY NERVE LUMBAR/SACRAL SGL-LT,361,1 ,"$4,545.00 ","$2,954.25 ","$1,783.46 ","$4,545.00 ","$3,386.03 ","$2,976.98 ","$1,783.46 ","$2,395.22 ","$1,783.46 ","$2,867.90 ","$2,867.90 ","$2,867.90 ","$2,867.90 ","$4,090.50 ","$3,408.75 ","$1,783.46 ","$3,999.60 ","$1,783.46 ","$3,408.75 ","$3,408.75 ","$3,863.25 ","$3,863.25 ","$1,783.46 ","$3,863.25 ","$1,783.46 ","$3,590.55 ","$3,590.55 ","$3,590.55 ","$4,090.50 ","$4,281.31 ","$4,090.50 ","$1,783.46 ","$4,545.00 ","$2,976.98 ","$1,783.46 ","$1,972.53 ", N/A ,"$1,866.72 ","$4,090.50 ","$3,865.00 ","$2,867.90 ","$2,727.00 ","$4,090.50 ","$1,783.46 ","$4,090.50 ","$4,090.50 ","$1,783.46 ","$2,954.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100130,64635,HC DESTROY NERVE LUMBAR/SACRAL SGL-RT,361,1 ,"$4,545.00 ","$2,954.25 ","$1,783.46 ","$4,545.00 ","$3,386.03 ","$2,976.98 ","$1,783.46 ","$2,395.22 ","$1,783.46 ","$2,867.90 ","$2,867.90 ","$2,867.90 ","$2,867.90 ","$4,090.50 ","$3,408.75 ","$1,783.46 ","$3,999.60 ","$1,783.46 ","$3,408.75 ","$3,408.75 ","$3,863.25 ","$3,863.25 ","$1,783.46 ","$3,863.25 ","$1,783.46 ","$3,590.55 ","$3,590.55 ","$3,590.55 ","$4,090.50 ","$4,281.31 ","$4,090.50 ","$1,783.46 ","$4,545.00 ","$2,976.98 ","$1,783.46 ","$1,972.53 ", N/A ,"$1,866.72 ","$4,090.50 ","$3,865.00 ","$2,867.90 ","$2,727.00 ","$4,090.50 ","$1,783.46 ","$4,090.50 ","$4,090.50 ","$1,783.46 ","$2,954.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100132,64640,HC DESTROY NERVE PERIPHERAL-LT,361,1 ,"$4,317.00 ","$2,806.05 ",$836.09 ,"$4,317.00 ","$3,216.17 ","$2,827.64 ",$836.09 ,"$2,275.06 ",$836.09 ,"$2,724.03 ","$2,724.03 ","$2,724.03 ","$2,724.03 ","$3,885.30 ","$3,237.75 ",$836.09 ,"$3,798.96 ",$836.09 ,"$3,237.75 ","$3,237.75 ","$3,669.45 ","$3,669.45 ",$836.09 ,"$3,669.45 ",$836.09 ,"$3,410.43 ","$3,410.43 ","$3,410.43 ","$3,885.30 ","$2,007.08 ","$3,885.30 ",$836.09 ,"$4,317.00 ","$2,827.64 ",$836.09 ,"$1,873.58 ", N/A ,$875.12 ,"$3,885.30 ","$1,811.92 ","$2,724.03 ","$2,590.20 ","$3,885.30 ",$836.09 ,"$3,885.30 ","$3,885.30 ",$836.09 ,"$2,806.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100133,64640,HC DESTROY NERVE PERIPHERAL-RT,361,1 ,"$4,317.00 ","$2,806.05 ",$836.09 ,"$4,317.00 ","$3,216.17 ","$2,827.64 ",$836.09 ,"$2,275.06 ",$836.09 ,"$2,724.03 ","$2,724.03 ","$2,724.03 ","$2,724.03 ","$3,885.30 ","$3,237.75 ",$836.09 ,"$3,798.96 ",$836.09 ,"$3,237.75 ","$3,237.75 ","$3,669.45 ","$3,669.45 ",$836.09 ,"$3,669.45 ",$836.09 ,"$3,410.43 ","$3,410.43 ","$3,410.43 ","$3,885.30 ","$2,007.08 ","$3,885.30 ",$836.09 ,"$4,317.00 ","$2,827.64 ",$836.09 ,"$1,873.58 ", N/A ,$875.12 ,"$3,885.30 ","$1,811.92 ","$2,724.03 ","$2,590.20 ","$3,885.30 ",$836.09 ,"$3,885.30 ","$3,885.30 ",$836.09 ,"$2,806.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100146,51720,HC INSTILL ANTICARCINOG BLADDER,361,1 ,$657.00 ,$427.05 ,$270.55 ,$657.00 ,$489.47 ,$430.34 ,$270.55 ,$346.24 ,$270.55 ,$414.57 ,$414.57 ,$414.57 ,$414.57 ,$591.30 ,$492.75 ,$270.55 ,$578.16 ,$270.55 ,$492.75 ,$492.75 ,$558.45 ,$558.45 ,$270.55 ,$558.45 ,$270.55 ,$519.03 ,$519.03 ,$519.03 ,$591.30 ,$649.47 ,$591.30 ,$270.55 ,$657.00 ,$430.34 ,$270.55 ,$285.14 , N/A ,$283.18 ,$591.30 ,$586.32 ,$414.57 ,$394.20 ,$591.30 ,$270.55 ,$591.30 ,$591.30 ,$270.55 ,$427.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100148,64488,HC INJ TAP BLOCK W/GUIDE- BIL,361,1 ,"$3,372.00 ","$2,191.80 ","$1,463.45 ","$3,372.00 ","$2,512.14 ","$2,208.66 ", N/A ,"$1,777.04 ", N/A ,"$2,127.73 ","$2,127.73 ","$2,127.73 ","$2,127.73 ","$3,034.80 ","$2,529.00 ", N/A ,"$2,967.36 ", N/A ,"$2,529.00 ","$2,529.00 ","$2,866.20 ","$2,866.20 ", N/A ,"$2,866.20 ", N/A ,"$2,663.88 ","$2,663.88 ","$2,663.88 ","$3,034.80 ", N/A ,"$3,034.80 ", N/A ,"$3,372.00 ","$2,208.66 ", N/A ,"$1,463.45 ", N/A , N/A ,"$3,034.80 ", N/A ,"$2,127.73 ","$2,023.20 ","$3,034.80 ", N/A ,"$3,034.80 ","$3,034.80 ", N/A ,"$2,191.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100164,N/A,HC BEDSIDE SURG PROC LEVEL 2,361,1 ,"$1,104.00 ",$717.60 ,$479.14 ,"$1,104.00 ",$822.48 ,$723.12 , N/A ,$581.81 , N/A ,$696.62 ,$696.62 ,$696.62 ,$696.62 ,$993.60 ,$828.00 , N/A ,$971.52 , N/A ,$828.00 ,$828.00 ,$938.40 ,$938.40 , N/A ,$938.40 , N/A ,$872.16 ,$872.16 ,$872.16 ,$993.60 , N/A ,$993.60 , N/A ,"$1,104.00 ",$723.12 , N/A ,$479.14 , N/A , N/A ,$993.60 , N/A ,$696.62 ,$662.40 ,$993.60 , N/A ,$993.60 ,$993.60 , N/A ,$717.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100165,N/A,HC BEDSIDE SURG PROC LEVEL 3,361,1 ,"$1,656.00 ","$1,076.40 ",$718.70 ,"$1,656.00 ","$1,233.72 ","$1,084.68 ", N/A ,$872.71 , N/A ,"$1,044.94 ","$1,044.94 ","$1,044.94 ","$1,044.94 ","$1,490.40 ","$1,242.00 ", N/A ,"$1,457.28 ", N/A ,"$1,242.00 ","$1,242.00 ","$1,407.60 ","$1,407.60 ", N/A ,"$1,407.60 ", N/A ,"$1,308.24 ","$1,308.24 ","$1,308.24 ","$1,490.40 ", N/A ,"$1,490.40 ", N/A ,"$1,656.00 ","$1,084.68 ", N/A ,$718.70 , N/A , N/A ,"$1,490.40 ", N/A ,"$1,044.94 ",$993.60 ,"$1,490.40 ", N/A ,"$1,490.40 ","$1,490.40 ", N/A ,"$1,076.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100166,N/A,HC BEDSIDE SURG PROC LEVEL 4,361,1 ,"$2,208.00 ","$1,435.20 ",$958.27 ,"$2,208.00 ","$1,644.96 ","$1,446.24 ", N/A ,"$1,163.62 ", N/A ,"$1,393.25 ","$1,393.25 ","$1,393.25 ","$1,393.25 ","$1,987.20 ","$1,656.00 ", N/A ,"$1,943.04 ", N/A ,"$1,656.00 ","$1,656.00 ","$1,876.80 ","$1,876.80 ", N/A ,"$1,876.80 ", N/A ,"$1,744.32 ","$1,744.32 ","$1,744.32 ","$1,987.20 ", N/A ,"$1,987.20 ", N/A ,"$2,208.00 ","$1,446.24 ", N/A ,$958.27 , N/A , N/A ,"$1,987.20 ", N/A ,"$1,393.25 ","$1,324.80 ","$1,987.20 ", N/A ,"$1,987.20 ","$1,987.20 ", N/A ,"$1,435.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100167,N/A,HC BEDSIDE SURG PROC LEVEL 5,361,1 ,"$2,760.00 ","$1,794.00 ","$1,197.84 ","$2,760.00 ","$2,056.20 ","$1,807.80 ", N/A ,"$1,454.52 ", N/A ,"$1,741.56 ","$1,741.56 ","$1,741.56 ","$1,741.56 ","$2,484.00 ","$2,070.00 ", N/A ,"$2,428.80 ", N/A ,"$2,070.00 ","$2,070.00 ","$2,346.00 ","$2,346.00 ", N/A ,"$2,346.00 ", N/A ,"$2,180.40 ","$2,180.40 ","$2,180.40 ","$2,484.00 ", N/A ,"$2,484.00 ", N/A ,"$2,760.00 ","$1,807.80 ", N/A ,"$1,197.84 ", N/A , N/A ,"$2,484.00 ", N/A ,"$1,741.56 ","$1,656.00 ","$2,484.00 ", N/A ,"$2,484.00 ","$2,484.00 ", N/A ,"$1,794.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100187,64415,HC INTRASCALENE BLOCK SINGLE-LT,361,1 ,"$3,634.00 ","$2,362.10 ",$836.09 ,"$3,634.00 ","$2,707.33 ","$2,380.27 ",$836.09 ,"$1,915.12 ",$836.09 ,"$2,293.05 ","$2,293.05 ","$2,293.05 ","$2,293.05 ","$3,270.60 ","$2,725.50 ",$836.09 ,"$3,197.92 ",$836.09 ,"$2,725.50 ","$2,725.50 ","$3,088.90 ","$3,088.90 ",$836.09 ,"$3,088.90 ",$836.09 ,"$2,870.86 ","$2,870.86 ","$2,870.86 ","$3,270.60 ","$2,007.08 ","$3,270.60 ",$836.09 ,"$3,634.00 ","$2,380.27 ",$836.09 ,"$1,577.16 ", N/A ,$875.12 ,"$3,270.60 ","$1,811.92 ","$2,293.05 ","$2,180.40 ","$3,270.60 ",$836.09 ,"$3,270.60 ","$3,270.60 ",$836.09 ,"$2,362.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100188,64415,HC INTRASCALENE BLOCK SINGLE-RT,361,1 ,"$3,634.00 ","$2,362.10 ",$836.09 ,"$3,634.00 ","$2,707.33 ","$2,380.27 ",$836.09 ,"$1,915.12 ",$836.09 ,"$2,293.05 ","$2,293.05 ","$2,293.05 ","$2,293.05 ","$3,270.60 ","$2,725.50 ",$836.09 ,"$3,197.92 ",$836.09 ,"$2,725.50 ","$2,725.50 ","$3,088.90 ","$3,088.90 ",$836.09 ,"$3,088.90 ",$836.09 ,"$2,870.86 ","$2,870.86 ","$2,870.86 ","$3,270.60 ","$2,007.08 ","$3,270.60 ",$836.09 ,"$3,634.00 ","$2,380.27 ",$836.09 ,"$1,577.16 ", N/A ,$875.12 ,"$3,270.60 ","$1,811.92 ","$2,293.05 ","$2,180.40 ","$3,270.60 ",$836.09 ,"$3,270.60 ","$3,270.60 ",$836.09 ,"$2,362.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100189,64415,HC INTRASCALENE BLOCK SINGLE,361,1 ,"$3,634.00 ","$2,362.10 ",$836.09 ,"$3,634.00 ","$2,707.33 ","$2,380.27 ",$836.09 ,"$1,915.12 ",$836.09 ,"$2,293.05 ","$2,293.05 ","$2,293.05 ","$2,293.05 ","$3,270.60 ","$2,725.50 ",$836.09 ,"$3,197.92 ",$836.09 ,"$2,725.50 ","$2,725.50 ","$3,088.90 ","$3,088.90 ",$836.09 ,"$3,088.90 ",$836.09 ,"$2,870.86 ","$2,870.86 ","$2,870.86 ","$3,270.60 ","$2,007.08 ","$3,270.60 ",$836.09 ,"$3,634.00 ","$2,380.27 ",$836.09 ,"$1,577.16 ", N/A ,$875.12 ,"$3,270.60 ","$1,811.92 ","$2,293.05 ","$2,180.40 ","$3,270.60 ",$836.09 ,"$3,270.60 ","$3,270.60 ",$836.09 ,"$2,362.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100191,64418,HC NERVE BLOCK;SUPRACAPULAR-LT,361,1 ,"$3,634.00 ","$2,362.10 ",$645.11 ,"$3,634.00 ","$2,707.33 ","$2,380.27 ",$645.11 ,"$1,915.12 ",$645.11 ,"$2,293.05 ","$2,293.05 ","$2,293.05 ","$2,293.05 ","$3,270.60 ","$2,725.50 ",$645.11 ,"$3,197.92 ",$645.11 ,"$2,725.50 ","$2,725.50 ","$3,088.90 ","$3,088.90 ",$645.11 ,"$3,088.90 ",$645.11 ,"$2,870.86 ","$2,870.86 ","$2,870.86 ","$3,270.60 ","$1,548.62 ","$3,270.60 ",$645.11 ,"$3,634.00 ","$2,380.27 ",$645.11 ,"$1,577.16 ", N/A ,$675.22 ,"$3,270.60 ","$1,398.03 ","$2,293.05 ","$2,180.40 ","$3,270.60 ",$645.11 ,"$3,270.60 ","$3,270.60 ",$645.11 ,"$2,362.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100197,64450,HC INJ ANES NERVE PERIPHERAL,361,1 ,"$1,698.00 ","$1,103.70 ",$645.11 ,"$1,698.00 ","$1,265.01 ","$1,112.19 ",$645.11 ,$894.85 ,$645.11 ,"$1,071.44 ","$1,071.44 ","$1,071.44 ","$1,071.44 ","$1,528.20 ","$1,273.50 ",$645.11 ,"$1,494.24 ",$645.11 ,"$1,273.50 ","$1,273.50 ","$1,443.30 ","$1,443.30 ",$645.11 ,"$1,443.30 ",$645.11 ,"$1,341.42 ","$1,341.42 ","$1,341.42 ","$1,528.20 ","$1,548.62 ","$1,528.20 ",$645.11 ,"$1,698.00 ","$1,112.19 ",$645.11 ,$736.93 , N/A ,$675.22 ,"$1,528.20 ","$1,398.03 ","$1,071.44 ","$1,018.80 ","$1,528.20 ",$645.11 ,"$1,528.20 ","$1,528.20 ",$645.11 ,"$1,103.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100229,45020,HC I AND D ABSCESS RECTAL,361,1 ,"$2,124.00 ","$1,380.60 ",$921.82 ,"$5,382.90 ","$1,582.38 ","$1,391.22 ","$2,124.00 ","$1,119.35 ","$2,124.00 ","$1,340.24 ","$1,340.24 ","$1,340.24 ","$1,340.24 ","$1,911.60 ","$1,593.00 ","$2,124.00 ","$1,869.12 ","$2,124.00 ","$1,593.00 ","$1,593.00 ","$1,805.40 ","$1,805.40 ","$2,124.00 ","$1,805.40 ","$2,124.00 ","$1,677.96 ","$1,677.96 ","$1,677.96 ","$1,911.60 ","$2,124.00 ","$1,911.60 ","$2,124.00 ","$2,124.00 ","$1,391.22 ","$2,124.00 ",$921.82 , N/A ,"$2,124.00 ","$1,911.60 ","$5,382.90 ","$1,340.24 ","$1,274.40 ","$1,911.60 ","$2,124.00 ","$1,911.60 ","$1,911.60 ","$2,124.00 ","$1,380.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100231,50437,HC DILATION EXIST TRACT ENDOURAL W/GUIDE AND NEW RENAL ACCESS,361,1 ,"$4,036.00 ","$2,623.40 ","$1,751.62 ","$6,777.32 ","$3,006.82 ","$2,643.58 ","$3,127.32 ","$2,126.97 ","$3,127.32 ","$2,546.72 ","$2,546.72 ","$2,546.72 ","$2,546.72 ","$3,632.40 ","$3,027.00 ","$3,127.32 ","$3,551.68 ","$3,127.32 ","$3,027.00 ","$3,027.00 ","$3,430.60 ","$3,430.60 ","$3,127.32 ","$3,430.60 ","$3,127.32 ","$3,188.44 ","$3,188.44 ","$3,188.44 ","$3,632.40 ","$4,036.00 ","$3,632.40 ","$3,127.32 ","$4,036.00 ","$2,643.58 ","$3,127.32 ","$1,751.62 ", N/A ,"$3,273.32 ","$3,632.40 ","$6,777.32 ","$2,546.72 ","$2,421.60 ","$3,632.40 ","$3,127.32 ","$3,632.40 ","$3,632.40 ","$3,127.32 ","$2,623.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100232,11103,HC BIOPSY SKIN TANGENTIAL ADDL LESN,361,1 ,$306.00 ,$198.90 ,$132.80 ,$306.00 ,$227.97 ,$200.43 , N/A ,$161.26 , N/A ,$193.09 ,$193.09 ,$193.09 ,$193.09 ,$275.40 ,$229.50 , N/A ,$269.28 , N/A ,$229.50 ,$229.50 ,$260.10 ,$260.10 , N/A ,$260.10 , N/A ,$241.74 ,$241.74 ,$241.74 ,$275.40 , N/A ,$275.40 , N/A ,$306.00 ,$200.43 , N/A ,$132.80 , N/A , N/A ,$275.40 , N/A ,$193.09 ,$183.60 ,$275.40 , N/A ,$275.40 ,$275.40 , N/A ,$198.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100233,11105,HC BIOPSY SKIN PUNCH ADDL LESN,361,1 ,$352.00 ,$228.80 ,$152.77 ,$352.00 ,$262.24 ,$230.56 , N/A ,$185.50 , N/A ,$222.11 ,$222.11 ,$222.11 ,$222.11 ,$316.80 ,$264.00 , N/A ,$309.76 , N/A ,$264.00 ,$264.00 ,$299.20 ,$299.20 , N/A ,$299.20 , N/A ,$278.08 ,$278.08 ,$278.08 ,$316.80 , N/A ,$316.80 , N/A ,$352.00 ,$230.56 , N/A ,$152.77 , N/A , N/A ,$316.80 , N/A ,$222.11 ,$211.20 ,$316.80 , N/A ,$316.80 ,$316.80 , N/A ,$228.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100234,11107,HC BIOPSY SKIN INCISIONAL ADDL LESN,361,1 ,$306.00 ,$198.90 ,$132.80 ,$306.00 ,$227.97 ,$200.43 , N/A ,$161.26 , N/A ,$193.09 ,$193.09 ,$193.09 ,$193.09 ,$275.40 ,$229.50 , N/A ,$269.28 , N/A ,$229.50 ,$229.50 ,$260.10 ,$260.10 , N/A ,$260.10 , N/A ,$241.74 ,$241.74 ,$241.74 ,$275.40 , N/A ,$275.40 , N/A ,$306.00 ,$200.43 , N/A ,$132.80 , N/A , N/A ,$275.40 , N/A ,$193.09 ,$183.60 ,$275.40 , N/A ,$275.40 ,$275.40 , N/A ,$198.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100235,11102,HC BIOPSY SKIN TANGENTIAL INIT LESN,361,1 ,$605.00 ,$393.25 ,$182.53 ,$605.00 ,$450.73 ,$396.28 ,$182.53 ,$318.84 ,$182.53 ,$381.76 ,$381.76 ,$381.76 ,$381.76 ,$544.50 ,$453.75 ,$182.53 ,$532.40 ,$182.53 ,$453.75 ,$453.75 ,$514.25 ,$514.25 ,$182.53 ,$514.25 ,$182.53 ,$477.95 ,$477.95 ,$477.95 ,$544.50 ,$438.16 ,$544.50 ,$182.53 ,$605.00 ,$396.28 ,$182.53 ,$262.57 , N/A ,$191.05 ,$544.50 ,$395.56 ,$381.76 ,$363.00 ,$544.50 ,$182.53 ,$544.50 ,$544.50 ,$182.53 ,$393.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100236,11104,HC BIOPSY SKIN PUNCH INIT LESN,361,1 ,$695.00 ,$451.75 ,$301.63 ,$761.90 ,$517.78 ,$455.23 ,$351.57 ,$366.27 ,$351.57 ,$438.55 ,$438.55 ,$438.55 ,$438.55 ,$625.50 ,$521.25 ,$351.57 ,$611.60 ,$351.57 ,$521.25 ,$521.25 ,$590.75 ,$590.75 ,$351.57 ,$590.75 ,$351.57 ,$549.05 ,$549.05 ,$549.05 ,$625.50 ,$695.00 ,$625.50 ,$351.57 ,$695.00 ,$455.23 ,$351.57 ,$301.63 , N/A ,$367.98 ,$625.50 ,$761.90 ,$438.55 ,$417.00 ,$625.50 ,$351.57 ,$625.50 ,$625.50 ,$351.57 ,$451.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100237,11106,HC BIOPSY SKIN INCISIONAL INIT LESN,361,1 ,$605.00 ,$393.25 ,$262.57 ,"$1,154.77 ",$450.73 ,$396.28 ,$532.86 ,$318.84 ,$532.86 ,$381.76 ,$381.76 ,$381.76 ,$381.76 ,$544.50 ,$453.75 ,$532.86 ,$532.40 ,$532.86 ,$453.75 ,$453.75 ,$514.25 ,$514.25 ,$532.86 ,$514.25 ,$532.86 ,$477.95 ,$477.95 ,$477.95 ,$544.50 ,$605.00 ,$544.50 ,$532.86 ,$605.00 ,$396.28 ,$532.86 ,$262.57 , N/A ,$557.73 ,$544.50 ,"$1,154.77 ",$381.76 ,$363.00 ,$544.50 ,$532.86 ,$544.50 ,$544.50 ,$532.86 ,$393.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100238,10005,HC ASP FINE NDL W/US GUIDE INIT LESN,361,1 ,"$1,322.00 ",$859.30 ,$148.00 ,"$1,370.23 ",$984.89 ,$865.91 ,$632.28 ,$696.69 ,$632.28 ,$834.18 ,$834.18 ,$834.18 ,$834.18 ,"$1,189.80 ",$991.50 ,$632.28 ,"$1,163.36 ",$632.28 ,$991.50 ,$991.50 ,"$1,123.70 ","$1,123.70 ",$632.28 ,"$1,123.70 ",$632.28 ,"$1,044.38 ","$1,044.38 ","$1,044.38 ","$1,189.80 ","$1,322.00 ","$1,189.80 ",$632.28 ,$148.00 ,$865.91 ,$632.28 ,$573.75 , N/A ,$661.80 ,"$1,189.80 ","$1,370.23 ",$834.18 ,$793.20 ,"$1,189.80 ",$632.28 ,"$1,189.80 ","$1,189.80 ",$632.28 ,$859.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100239,10006,HC ASP FINE NDL W/US GUIDE EA ADDL LESN,361,1 ,$862.00 ,$560.30 ,$66.21 ,$862.00 ,$642.19 ,$564.61 , N/A ,$454.27 , N/A ,$543.92 ,$543.92 ,$543.92 ,$543.92 ,$775.80 ,$646.50 , N/A ,$758.56 , N/A ,$646.50 ,$646.50 ,$732.70 ,$732.70 , N/A ,$732.70 , N/A ,$680.98 ,$680.98 ,$680.98 ,$775.80 , N/A ,$775.80 , N/A ,$66.21 ,$564.61 , N/A ,$374.11 , N/A , N/A ,$775.80 , N/A ,$543.92 ,$517.20 ,$775.80 , N/A ,$775.80 ,$775.80 , N/A ,$560.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100242,10009,HC ASP FINE NDL W/CT GUIDE INIT LESN,361,1 ,"$1,322.00 ",$859.30 ,$510.18 ,"$1,370.23 ",$984.89 ,$865.91 ,$632.28 ,$696.69 ,$632.28 ,$834.18 ,$834.18 ,$834.18 ,$834.18 ,"$1,189.80 ",$991.50 ,$632.28 ,"$1,163.36 ",$632.28 ,$991.50 ,$991.50 ,"$1,123.70 ","$1,123.70 ",$632.28 ,"$1,123.70 ",$632.28 ,"$1,044.38 ","$1,044.38 ","$1,044.38 ","$1,189.80 ","$1,322.00 ","$1,189.80 ",$632.28 ,$510.18 ,$865.91 ,$632.28 ,$573.75 , N/A ,$661.80 ,"$1,189.80 ","$1,370.23 ",$834.18 ,$793.20 ,"$1,189.80 ",$632.28 ,"$1,189.80 ","$1,189.80 ",$632.28 ,$859.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100247,36573,HC INS PER CV CATH W/O PORT W/GUIDANCE 5>,361,1 ,$389.00 ,$252.85 ,$168.83 ,"$3,097.79 ",$289.81 ,$254.80 ,$389.00 ,$205.00 ,$389.00 ,$245.46 ,$245.46 ,$245.46 ,$245.46 ,$350.10 ,$291.75 ,$389.00 ,$342.32 ,$389.00 ,$291.75 ,$291.75 ,$330.65 ,$330.65 ,$389.00 ,$330.65 ,$389.00 ,$307.31 ,$307.31 ,$307.31 ,$350.10 ,$389.00 ,$350.10 ,$389.00 ,$389.00 ,$254.80 ,$389.00 ,$168.83 , N/A ,$389.00 ,$350.10 ,"$3,097.79 ",$245.46 ,$233.40 ,$350.10 ,$389.00 ,$350.10 ,$350.10 ,$389.00 ,$252.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100259,66821,HC LASER (YAG) POST CATARACT,361,1 ,"$1,643.00 ","$1,067.95 ",$512.21 ,"$1,643.00 ","$1,224.04 ","$1,076.17 ",$512.21 ,$865.86 ,$512.21 ,"$1,036.73 ","$1,036.73 ","$1,036.73 ","$1,036.73 ","$1,478.70 ","$1,232.25 ",$512.21 ,"$1,445.84 ",$512.21 ,"$1,232.25 ","$1,232.25 ","$1,396.55 ","$1,396.55 ",$512.21 ,"$1,396.55 ",$512.21 ,"$1,297.97 ","$1,297.97 ","$1,297.97 ","$1,478.70 ","$1,229.59 ","$1,478.70 ",$512.21 ,"$1,643.00 ","$1,076.17 ",$512.21 ,$713.06 , N/A ,$536.12 ,"$1,478.70 ","$1,110.03 ","$1,036.73 ",$985.80 ,"$1,478.70 ",$512.21 ,"$1,478.70 ","$1,478.70 ",$512.21 ,"$1,067.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100262,64616,HC CHEM/DEST NERVE MUSCLE NECK,361,1 ,$758.00 ,$492.70 ,$265.50 ,$758.00 ,$564.71 ,$496.49 ,$265.50 ,$399.47 ,$265.50 ,$478.30 ,$478.30 ,$478.30 ,$478.30 ,$682.20 ,$568.50 ,$265.50 ,$667.04 ,$265.50 ,$568.50 ,$568.50 ,$644.30 ,$644.30 ,$265.50 ,$644.30 ,$265.50 ,$598.82 ,$598.82 ,$598.82 ,$682.20 ,$637.34 ,$682.20 ,$265.50 ,$758.00 ,$496.49 ,$265.50 ,$328.97 , N/A ,$277.89 ,$682.20 ,$575.37 ,$478.30 ,$454.80 ,$682.20 ,$265.50 ,$682.20 ,$682.20 ,$265.50 ,$492.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100270,62328,HC LUMBAR PUNCTURE DIAGNOSTIC W/FLUORO OR CT GUID,361,1 ,"$1,932.00 ","$1,255.80 ",$645.11 ,"$1,932.00 ","$1,439.34 ","$1,265.46 ",$645.11 ,"$1,018.16 ",$645.11 ,"$1,219.09 ","$1,219.09 ","$1,219.09 ","$1,219.09 ","$1,738.80 ","$1,449.00 ",$645.11 ,"$1,700.16 ",$645.11 ,"$1,449.00 ","$1,449.00 ","$1,642.20 ","$1,642.20 ",$645.11 ,"$1,642.20 ",$645.11 ,"$1,526.28 ","$1,526.28 ","$1,526.28 ","$1,738.80 ","$1,548.62 ","$1,738.80 ",$645.11 ,"$1,932.00 ","$1,265.46 ",$645.11 ,$838.49 , N/A ,$675.22 ,"$1,738.80 ","$1,398.03 ","$1,219.09 ","$1,159.20 ","$1,738.80 ",$645.11 ,"$1,738.80 ","$1,738.80 ",$645.11 ,"$1,255.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100273,64454,HC INJ ANESTHETIC/STEROID GENICULAR NERVES W/FLUORO OR CT GUID,361,1 ,"$1,791.90 ","$1,164.74 ",$645.11 ,"$1,791.90 ","$1,334.97 ","$1,173.69 ",$645.11 ,$944.33 ,$645.11 ,"$1,130.69 ","$1,130.69 ","$1,130.69 ","$1,130.69 ","$1,612.71 ","$1,343.93 ",$645.11 ,"$1,576.87 ",$645.11 ,"$1,343.93 ","$1,343.93 ","$1,523.12 ","$1,523.12 ",$645.11 ,"$1,523.12 ",$645.11 ,"$1,415.60 ","$1,415.60 ","$1,415.60 ","$1,612.71 ","$1,548.62 ","$1,612.71 ",$645.11 ,"$1,791.90 ","$1,173.69 ",$645.11 ,$777.68 , N/A ,$675.22 ,"$1,612.71 ","$1,398.03 ","$1,130.69 ","$1,075.14 ","$1,612.71 ",$645.11 ,"$1,612.71 ","$1,612.71 ",$645.11 ,"$1,164.74 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),36100274,64624,HC DESTRUST NEUROLYTIC AGENT GENICULAR NERVE W/IMG GUID,361,1 ,"$5,313.00 ","$3,453.45 ","$1,783.46 ","$5,313.00 ","$3,958.19 ","$3,480.02 ","$1,783.46 ","$2,799.95 ","$1,783.46 ","$3,352.50 ","$3,352.50 ","$3,352.50 ","$3,352.50 ","$4,781.70 ","$3,984.75 ","$1,783.46 ","$4,675.44 ","$1,783.46 ","$3,984.75 ","$3,984.75 ","$4,516.05 ","$4,516.05 ","$1,783.46 ","$4,516.05 ","$1,783.46 ","$4,197.27 ","$4,197.27 ","$4,197.27 ","$4,781.70 ","$4,281.31 ","$4,781.70 ","$1,783.46 ","$5,313.00 ","$3,480.02 ","$1,783.46 ","$2,305.84 ", N/A ,"$1,866.72 ","$4,781.70 ","$3,865.00 ","$3,352.50 ","$3,187.80 ","$4,781.70 ","$1,783.46 ","$4,781.70 ","$4,781.70 ","$1,783.46 ","$3,453.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),37000013,31500,HC INTUBATION ENDOTRACHEAL,361,1 ,$389.00 ,$252.85 ,$168.83 ,$466.16 ,$289.81 ,$254.80 ,$215.11 ,$205.00 ,$215.11 ,$245.46 ,$245.46 ,$245.46 ,$245.46 ,$350.10 ,$291.75 ,$215.11 ,$342.32 ,$215.11 ,$291.75 ,$291.75 ,$330.65 ,$330.65 ,$215.11 ,$330.65 ,$215.11 ,$307.31 ,$307.31 ,$307.31 ,$350.10 ,$389.00 ,$350.10 ,$215.11 ,$389.00 ,$254.80 ,$215.11 ,$168.83 , N/A ,$225.15 ,$350.10 ,$466.16 ,$245.46 ,$233.40 ,$350.10 ,$215.11 ,$350.10 ,$350.10 ,$215.11 ,$252.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),37000014,64448,HC FEMORAL NERVE BLOCK CONTINUOUS,370,1 ,"$2,248.00 ","$1,461.20 ",$836.09 ,"$2,248.00 ","$1,674.76 ","$1,472.44 ",$836.09 ,"$1,184.70 ",$836.09 ,"$1,418.49 ","$1,418.49 ","$1,418.49 ","$1,418.49 ","$2,023.20 ","$1,686.00 ",$836.09 ,"$1,978.24 ",$836.09 ,"$1,686.00 ","$1,686.00 ","$1,910.80 ","$1,910.80 ",$836.09 ,"$1,910.80 ",$836.09 ,"$1,775.92 ","$1,775.92 ","$1,775.92 ","$2,023.20 ","$2,007.08 ","$2,023.20 ",$836.09 ,"$2,248.00 ","$1,472.44 ",$836.09 ,$975.63 , N/A ,$875.12 ,"$2,023.20 ","$1,811.92 ","$1,418.49 ","$1,348.80 ","$2,023.20 ",$836.09 ,"$2,023.20 ","$2,023.20 ",$836.09 ,"$1,461.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),37000014,64448,HC FEMORAL NERVE BLOCK CONTINUOUS,370,1 ,"$3,372.00 ","$2,191.80 ","$1,254.13 ","$3,372.00 ","$2,512.14 ","$2,208.66 ","$1,254.13 ","$1,777.04 ","$1,254.13 ","$2,127.73 ","$2,127.73 ","$2,127.73 ","$2,127.73 ","$3,034.80 ","$2,529.00 ","$1,254.13 ","$2,967.36 ","$1,254.13 ","$2,529.00 ","$2,529.00 ","$2,866.20 ","$2,866.20 ","$1,254.13 ","$2,866.20 ","$1,254.13 ","$2,663.88 ","$2,663.88 ","$2,663.88 ","$3,034.80 ","$3,010.63 ","$3,034.80 ","$1,254.13 ","$3,372.00 ","$2,208.66 ","$1,254.13 ","$1,463.45 ", N/A ,"$1,312.68 ","$3,034.80 ","$2,717.88 ","$2,127.73 ","$2,023.20 ","$3,034.80 ","$1,254.13 ","$3,034.80 ","$3,034.80 ","$1,254.13 ","$2,191.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),37000017,99153,HC MODERATE SEDATION SAME PHY EA ADDL 15MIN,370,1 ,$497.00 ,$323.05 ,$215.70 ,$497.00 ,$370.27 ,$325.54 , N/A ,$261.92 , N/A ,$313.61 ,$313.61 ,$313.61 ,$313.61 ,$447.30 ,$372.75 , N/A ,$437.36 , N/A ,$372.75 ,$372.75 ,$422.45 ,$422.45 , N/A ,$422.45 , N/A ,$392.63 ,$392.63 ,$392.63 ,$447.30 , N/A ,$447.30 , N/A ,$497.00 ,$325.54 , N/A ,$215.70 , N/A , N/A ,$447.30 , N/A ,$313.61 ,$298.20 ,$447.30 , N/A ,$447.30 ,$447.30 , N/A ,$323.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),37000023,64416,HC INTRASCALENE BLOCK CONTINUOUS,370,1 ,"$3,634.00 ","$2,362.10 ",$836.09 ,"$3,634.00 ","$2,707.33 ","$2,380.27 ",$836.09 ,"$1,915.12 ",$836.09 ,"$2,293.05 ","$2,293.05 ","$2,293.05 ","$2,293.05 ","$3,270.60 ","$2,725.50 ",$836.09 ,"$3,197.92 ",$836.09 ,"$2,725.50 ","$2,725.50 ","$3,088.90 ","$3,088.90 ",$836.09 ,"$3,088.90 ",$836.09 ,"$2,870.86 ","$2,870.86 ","$2,870.86 ","$3,270.60 ","$2,007.08 ","$3,270.60 ",$836.09 ,"$3,634.00 ","$2,380.27 ",$836.09 ,"$1,577.16 ", N/A ,$875.12 ,"$3,270.60 ","$1,811.92 ","$2,293.05 ","$2,180.40 ","$3,270.60 ",$836.09 ,"$3,270.60 ","$3,270.60 ",$836.09 ,"$2,362.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),37000061,N/A,HC ANESTHESIA GENERAL INITIAL 15MIN,370,1 ,$553.00 ,$359.45 ,$240.00 ,$553.00 ,$411.99 ,$362.22 , N/A ,$291.43 , N/A ,$348.94 ,$348.94 ,$348.94 ,$348.94 ,$497.70 ,$414.75 , N/A ,$486.64 , N/A ,$414.75 ,$414.75 ,$470.05 ,$470.05 , N/A ,$470.05 , N/A ,$436.87 ,$436.87 ,$436.87 ,$497.70 , N/A ,$497.70 , N/A ,$553.00 ,$362.22 , N/A ,$240.00 , N/A , N/A ,$497.70 , N/A ,$348.94 ,$331.80 ,$497.70 , N/A ,$497.70 ,$497.70 , N/A ,$359.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),37000062,N/A,HC ANESTHESIA GENERAL ADDL 15MIN,370,1 ,$375.00 ,$243.75 ,$162.75 ,$375.00 ,$279.38 ,$245.63 , N/A ,$197.63 , N/A ,$236.63 ,$236.63 ,$236.63 ,$236.63 ,$337.50 ,$281.25 , N/A ,$330.00 , N/A ,$281.25 ,$281.25 ,$318.75 ,$318.75 , N/A ,$318.75 , N/A ,$296.25 ,$296.25 ,$296.25 ,$337.50 , N/A ,$337.50 , N/A ,$375.00 ,$245.63 , N/A ,$162.75 , N/A , N/A ,$337.50 , N/A ,$236.63 ,$225.00 ,$337.50 , N/A ,$337.50 ,$337.50 , N/A ,$243.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),37000063,N/A,HC ANESTHESIA REGIONAL BLOCK INITIAL 15MIN,370,1 ,$488.00 ,$317.20 ,$211.79 ,$488.00 ,$363.56 ,$319.64 , N/A ,$257.18 , N/A ,$307.93 ,$307.93 ,$307.93 ,$307.93 ,$439.20 ,$366.00 , N/A ,$429.44 , N/A ,$366.00 ,$366.00 ,$414.80 ,$414.80 , N/A ,$414.80 , N/A ,$385.52 ,$385.52 ,$385.52 ,$439.20 , N/A ,$439.20 , N/A ,$488.00 ,$319.64 , N/A ,$211.79 , N/A , N/A ,$439.20 , N/A ,$307.93 ,$292.80 ,$439.20 , N/A ,$439.20 ,$439.20 , N/A ,$317.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),37000064,N/A,HC ANESTHESIA REGIONAL BLOCK ADDL 15MIN,370,1 ,$268.00 ,$174.20 ,$116.31 ,$268.00 ,$199.66 ,$175.54 , N/A ,$141.24 , N/A ,$169.11 ,$169.11 ,$169.11 ,$169.11 ,$241.20 ,$201.00 , N/A ,$235.84 , N/A ,$201.00 ,$201.00 ,$227.80 ,$227.80 , N/A ,$227.80 , N/A ,$211.72 ,$211.72 ,$211.72 ,$241.20 , N/A ,$241.20 , N/A ,$268.00 ,$175.54 , N/A ,$116.31 , N/A , N/A ,$241.20 , N/A ,$169.11 ,$160.80 ,$241.20 , N/A ,$241.20 ,$241.20 , N/A ,$174.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),37000072,99151,HC MODERATE SEDATION SAME PHY <5YR 1ST 15MIN,370,1 ,$879.00 ,$571.35 ,$381.49 ,$879.00 ,$654.86 ,$575.75 , N/A ,$463.23 , N/A ,$554.65 ,$554.65 ,$554.65 ,$554.65 ,$791.10 ,$659.25 , N/A ,$773.52 , N/A ,$659.25 ,$659.25 ,$747.15 ,$747.15 , N/A ,$747.15 , N/A ,$694.41 ,$694.41 ,$694.41 ,$791.10 , N/A ,$791.10 , N/A ,$879.00 ,$575.75 , N/A ,$381.49 , N/A , N/A ,$791.10 , N/A ,$554.65 ,$527.40 ,$791.10 , N/A ,$791.10 ,$791.10 , N/A ,$571.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),37000073,99152,HC MODERATE SEDATION SAME PHY >5YR 1ST 15MIN,370,1 ,$993.00 ,$645.45 ,$430.96 ,$993.00 ,$739.79 ,$650.42 , N/A ,$523.31 , N/A ,$626.58 ,$626.58 ,$626.58 ,$626.58 ,$893.70 ,$744.75 , N/A ,$873.84 , N/A ,$744.75 ,$744.75 ,$844.05 ,$844.05 , N/A ,$844.05 , N/A ,$784.47 ,$784.47 ,$784.47 ,$893.70 , N/A ,$893.70 , N/A ,$993.00 ,$650.42 , N/A ,$430.96 , N/A , N/A ,$893.70 , N/A ,$626.58 ,$595.80 ,$893.70 , N/A ,$893.70 ,$893.70 , N/A ,$645.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),37000074,99155,HC MODERATE SEDATION DIFF PHY <5YR 1ST 15MIN,370,1 ,$907.00 ,$589.55 ,$393.64 ,$907.00 ,$675.72 ,$594.09 , N/A ,$477.99 , N/A ,$572.32 ,$572.32 ,$572.32 ,$572.32 ,$816.30 ,$680.25 , N/A ,$798.16 , N/A ,$680.25 ,$680.25 ,$770.95 ,$770.95 , N/A ,$770.95 , N/A ,$716.53 ,$716.53 ,$716.53 ,$816.30 , N/A ,$816.30 , N/A ,$907.00 ,$594.09 , N/A ,$393.64 , N/A , N/A ,$816.30 , N/A ,$572.32 ,$544.20 ,$816.30 , N/A ,$816.30 ,$816.30 , N/A ,$589.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),37000076,N/A,HC MONITORED ANESTHESIA INITIAL 15 MINS,370,1 ,$423.00 ,$274.95 ,$183.58 ,$423.00 ,$315.14 ,$277.07 , N/A ,$222.92 , N/A ,$266.91 ,$266.91 ,$266.91 ,$266.91 ,$380.70 ,$317.25 , N/A ,$372.24 , N/A ,$317.25 ,$317.25 ,$359.55 ,$359.55 , N/A ,$359.55 , N/A ,$334.17 ,$334.17 ,$334.17 ,$380.70 , N/A ,$380.70 , N/A ,$423.00 ,$277.07 , N/A ,$183.58 , N/A , N/A ,$380.70 , N/A ,$266.91 ,$253.80 ,$380.70 , N/A ,$380.70 ,$380.70 , N/A ,$274.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),37000077,N/A,HC MONITORED ANESTHESIA ADDL 15 MINS,370,1 ,$233.00 ,$151.45 ,$101.12 ,$233.00 ,$173.59 ,$152.62 , N/A ,$122.79 , N/A ,$147.02 ,$147.02 ,$147.02 ,$147.02 ,$209.70 ,$174.75 , N/A ,$205.04 , N/A ,$174.75 ,$174.75 ,$198.05 ,$198.05 , N/A ,$198.05 , N/A ,$184.07 ,$184.07 ,$184.07 ,$209.70 , N/A ,$209.70 , N/A ,$233.00 ,$152.62 , N/A ,$101.12 , N/A , N/A ,$209.70 , N/A ,$147.02 ,$139.80 ,$209.70 , N/A ,$209.70 ,$209.70 , N/A ,$151.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),37080000,64447,HC FEMORAL NERVE BLOCK SINGLE,360,1 ,"$1,818.00 ","$1,181.70 ",$645.11 ,"$1,818.00 ","$1,354.41 ","$1,190.79 ",$645.11 ,$958.09 ,$645.11 ,"$1,147.16 ","$1,147.16 ","$1,147.16 ","$1,147.16 ","$1,636.20 ","$1,363.50 ",$645.11 ,"$1,599.84 ",$645.11 ,"$1,363.50 ","$1,363.50 ","$1,545.30 ","$1,545.30 ",$645.11 ,"$1,545.30 ",$645.11 ,"$1,436.22 ","$1,436.22 ","$1,436.22 ","$1,636.20 ","$1,548.62 ","$1,636.20 ",$645.11 ,"$1,818.00 ","$1,190.79 ",$645.11 ,$789.01 , N/A ,$675.22 ,"$1,636.20 ","$1,398.03 ","$1,147.16 ","$1,090.80 ","$1,636.20 ",$645.11 ,"$1,636.20 ","$1,636.20 ",$645.11 ,"$1,181.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),37080001,64415,HC INTRASCALENE BLOCK SINGLE,360,1 ,"$3,634.00 ","$2,362.10 ",$836.09 ,"$3,634.00 ","$2,707.33 ","$2,380.27 ",$836.09 ,"$1,915.12 ",$836.09 ,"$2,293.05 ","$2,293.05 ","$2,293.05 ","$2,293.05 ","$3,270.60 ","$2,725.50 ",$836.09 ,"$3,197.92 ",$836.09 ,"$2,725.50 ","$2,725.50 ","$3,088.90 ","$3,088.90 ",$836.09 ,"$3,088.90 ",$836.09 ,"$2,870.86 ","$2,870.86 ","$2,870.86 ","$3,270.60 ","$2,007.08 ","$3,270.60 ",$836.09 ,"$3,634.00 ","$2,380.27 ",$836.09 ,"$1,577.16 ", N/A ,$875.12 ,"$3,270.60 ","$1,811.92 ","$2,293.05 ","$2,180.40 ","$3,270.60 ",$836.09 ,"$3,270.60 ","$3,270.60 ",$836.09 ,"$2,362.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),39000149,P9021,HC RED CELLS PACKED EA,390,1 ,$467.00 ,$303.55 ,$147.40 ,$467.00 ,$347.92 ,$305.89 ,$147.40 ,$246.11 ,$147.40 ,$294.68 ,$294.68 ,$294.68 ,$294.68 ,$420.30 ,$350.25 ,$147.40 ,$410.96 ,$147.40 ,$350.25 ,$350.25 ,$396.95 ,$396.95 ,$147.40 ,$396.95 ,$147.40 ,$368.93 ,$368.93 ,$368.93 ,$420.30 ,$353.85 ,$420.30 ,$147.40 ,$467.00 ,$305.89 ,$147.40 ,$202.68 , N/A ,$154.28 ,$420.30 ,$319.44 ,$294.68 ,$280.20 ,$420.30 ,$147.40 ,$420.30 ,$420.30 ,$147.40 ,$303.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),39000151,P9031,HC PLATELETS LEUKO RD EA UNIT,390,1 ,$379.05 ,$246.38 ,$160.56 ,$379.05 ,$282.39 ,$248.28 ,$160.56 ,$199.76 ,$160.56 ,$239.18 ,$239.18 ,$239.18 ,$239.18 ,$341.15 ,$284.29 ,$160.56 ,$333.56 ,$160.56 ,$284.29 ,$284.29 ,$322.19 ,$322.19 ,$160.56 ,$322.19 ,$160.56 ,$299.45 ,$299.45 ,$299.45 ,$341.15 ,$379.05 ,$341.15 ,$160.56 ,$379.05 ,$248.28 ,$160.56 ,$164.51 , N/A ,$168.06 ,$341.15 ,$347.96 ,$239.18 ,$227.43 ,$341.15 ,$160.56 ,$341.15 ,$341.15 ,$160.56 ,$246.38 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),39000152,P9033,HC PLATELETS L/R IRR EA,390,1 ,$651.36 ,$423.38 ,$228.33 ,$651.36 ,$485.26 ,$426.64 ,$228.33 ,$343.27 ,$228.33 ,$411.01 ,$411.01 ,$411.01 ,$411.01 ,$586.22 ,$488.52 ,$228.33 ,$573.20 ,$228.33 ,$488.52 ,$488.52 ,$553.66 ,$553.66 ,$228.33 ,$553.66 ,$228.33 ,$514.57 ,$514.57 ,$514.57 ,$586.22 ,$548.11 ,$586.22 ,$228.33 ,$651.36 ,$426.64 ,$228.33 ,$282.69 , N/A ,$238.99 ,$586.22 ,$494.81 ,$411.01 ,$390.82 ,$586.22 ,$228.33 ,$586.22 ,$586.22 ,$228.33 ,$423.38 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),39000157,P9052,HC PLT APHER/PHER L/R HLA EA,390,1 ,"$1,710.00 ","$1,111.50 ",$742.14 ,"$1,868.82 ","$1,273.95 ","$1,120.05 ",$862.35 ,$901.17 ,$862.35 ,"$1,079.01 ","$1,079.01 ","$1,079.01 ","$1,079.01 ","$1,539.00 ","$1,282.50 ",$862.35 ,"$1,504.80 ",$862.35 ,"$1,282.50 ","$1,282.50 ","$1,453.50 ","$1,453.50 ",$862.35 ,"$1,453.50 ",$862.35 ,"$1,350.90 ","$1,350.90 ","$1,350.90 ","$1,539.00 ","$1,710.00 ","$1,539.00 ",$862.35 ,"$1,710.00 ","$1,120.05 ",$862.35 ,$742.14 , N/A ,$902.61 ,"$1,539.00 ","$1,868.82 ","$1,079.01 ","$1,026.00 ","$1,539.00 ",$862.35 ,"$1,539.00 ","$1,539.00 ",$862.35 ,"$1,111.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),39000160,P9059,HC PLASMA FROZEN 8-24 HRS EA UNIT,390,1 ,$259.00 ,$168.35 ,$76.20 ,$259.00 ,$192.96 ,$169.65 ,$76.20 ,$136.49 ,$76.20 ,$163.43 ,$163.43 ,$163.43 ,$163.43 ,$233.10 ,$194.25 ,$76.20 ,$227.92 ,$76.20 ,$194.25 ,$194.25 ,$220.15 ,$220.15 ,$76.20 ,$220.15 ,$76.20 ,$204.61 ,$204.61 ,$204.61 ,$233.10 ,$182.93 ,$233.10 ,$76.20 ,$259.00 ,$169.65 ,$76.20 ,$112.41 , N/A ,$79.76 ,$233.10 ,$165.14 ,$163.43 ,$155.40 ,$233.10 ,$76.20 ,$233.10 ,$233.10 ,$76.20 ,$168.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),39000162,P9012,HC CRYOPRECIPITATE EA UNIT T1,390,1 ,$148.00 ,$96.20 ,$64.23 ,$185.33 ,$110.26 ,$96.94 ,$85.52 ,$78.00 ,$85.52 ,$93.39 ,$93.39 ,$93.39 ,$93.39 ,$133.20 ,$111.00 ,$85.52 ,$130.24 ,$85.52 ,$111.00 ,$111.00 ,$125.80 ,$125.80 ,$85.52 ,$125.80 ,$85.52 ,$116.92 ,$116.92 ,$116.92 ,$133.20 ,$148.00 ,$133.20 ,$85.52 ,$148.00 ,$96.94 ,$85.52 ,$64.23 , N/A ,$89.51 ,$133.20 ,$185.33 ,$93.39 ,$88.80 ,$133.20 ,$85.52 ,$133.20 ,$133.20 ,$85.52 ,$96.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),39000164,P9016,HC RED CELLS L/R EA T1,390,1 ,$439.00 ,$285.35 ,$190.53 ,$439.00 ,$327.06 ,$287.55 ,$201.89 ,$231.35 ,$201.89 ,$277.01 ,$277.01 ,$277.01 ,$277.01 ,$395.10 ,$329.25 ,$201.89 ,$386.32 ,$201.89 ,$329.25 ,$329.25 ,$373.15 ,$373.15 ,$201.89 ,$373.15 ,$201.89 ,$346.81 ,$346.81 ,$346.81 ,$395.10 ,$439.00 ,$395.10 ,$201.89 ,$439.00 ,$287.55 ,$201.89 ,$190.53 , N/A ,$211.32 ,$395.10 ,$437.53 ,$277.01 ,$263.40 ,$395.10 ,$201.89 ,$395.10 ,$395.10 ,$201.89 ,$285.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),39000173,P9035,HC PLATELETS PHER L/R EA T1,390,1 ,"$1,283.00 ",$833.95 ,$521.36 ,"$1,283.00 ",$955.84 ,$840.37 ,$521.36 ,$676.14 ,$521.36 ,$809.57 ,$809.57 ,$809.57 ,$809.57 ,"$1,154.70 ",$962.25 ,$521.36 ,"$1,129.04 ",$521.36 ,$962.25 ,$962.25 ,"$1,090.55 ","$1,090.55 ",$521.36 ,"$1,090.55 ",$521.36 ,"$1,013.57 ","$1,013.57 ","$1,013.57 ","$1,154.70 ","$1,251.56 ","$1,154.70 ",$521.36 ,"$1,283.00 ",$840.37 ,$521.36 ,$556.82 , N/A ,$545.70 ,"$1,154.70 ","$1,129.86 ",$809.57 ,$769.80 ,"$1,154.70 ",$521.36 ,"$1,154.70 ","$1,154.70 ",$521.36 ,$833.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),39000179,P9037,HC PLATELETS PHER L/R IRR EA T1,390,1 ,"$1,382.00 ",$898.30 ,$599.79 ,"$1,432.82 ","$1,029.59 ",$905.21 ,$661.16 ,$728.31 ,$661.16 ,$872.04 ,$872.04 ,$872.04 ,$872.04 ,"$1,243.80 ","$1,036.50 ",$661.16 ,"$1,216.16 ",$661.16 ,"$1,036.50 ","$1,036.50 ","$1,174.70 ","$1,174.70 ",$661.16 ,"$1,174.70 ",$661.16 ,"$1,091.78 ","$1,091.78 ","$1,091.78 ","$1,243.80 ","$1,382.00 ","$1,243.80 ",$661.16 ,"$1,382.00 ",$905.21 ,$661.16 ,$599.79 , N/A ,$692.03 ,"$1,243.80 ","$1,432.82 ",$872.04 ,$829.20 ,"$1,243.80 ",$661.16 ,"$1,243.80 ","$1,243.80 ",$661.16 ,$898.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),39000187,P9040,HC RED CELLS L/R IRR EA T1,390,1 ,$587.00 ,$381.55 ,$254.76 ,$604.74 ,$437.32 ,$384.49 ,$279.05 ,$309.35 ,$279.05 ,$370.40 ,$370.40 ,$370.40 ,$370.40 ,$528.30 ,$440.25 ,$279.05 ,$516.56 ,$279.05 ,$440.25 ,$440.25 ,$498.95 ,$498.95 ,$279.05 ,$498.95 ,$279.05 ,$463.73 ,$463.73 ,$463.73 ,$528.30 ,$587.00 ,$528.30 ,$279.05 ,$587.00 ,$384.49 ,$279.05 ,$254.76 , N/A ,$292.08 ,$528.30 ,$604.74 ,$370.40 ,$352.20 ,$528.30 ,$279.05 ,$528.30 ,$528.30 ,$279.05 ,$381.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),39100001,36430,HC BLOOD PROD ADMIN,391,1 ,$959.00 ,$623.35 ,$403.64 ,$959.00 ,$714.46 ,$628.15 ,$403.64 ,$505.39 ,$403.64 ,$605.13 ,$605.13 ,$605.13 ,$605.13 ,$863.10 ,$719.25 ,$403.64 ,$843.92 ,$403.64 ,$719.25 ,$719.25 ,$815.15 ,$815.15 ,$403.64 ,$815.15 ,$403.64 ,$757.61 ,$757.61 ,$757.61 ,$863.10 ,$959.00 ,$863.10 ,$403.64 ,$959.00 ,$628.15 ,$403.64 ,$416.21 , N/A ,$422.48 ,$863.10 ,$874.74 ,$605.13 ,$575.40 ,$863.10 ,$403.64 ,$863.10 ,$863.10 ,$403.64 ,$623.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40100003,77066,HC MAMMOGRAM DIAG BILAT W/CAD,401,1 ,$554.00 ,$360.10 ,$106.70 ,$554.00 ,$412.73 ,$362.87 ,$106.70 ,$291.96 ,$106.70 ,$349.57 ,$349.57 ,$349.57 ,$349.57 ,$498.60 ,$415.50 ,$106.70 ,$487.52 ,$106.70 ,$415.50 ,$415.50 ,$470.90 ,$470.90 ,$106.70 ,$470.90 ,$106.70 ,$437.66 ,$437.66 ,$437.66 ,$498.60 ,$266.75 ,$498.60 ,$106.70 ,$122.32 ,$362.87 ,$106.70 ,$240.44 , N/A ,$112.04 ,$498.60 ,$240.08 ,$349.57 ,$332.40 ,$498.60 ,$106.70 ,$498.60 ,$498.60 ,$106.70 ,$360.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40100004,77066,HC MAMMOGRAM DIAG BILAT W/CAD ADDNT VIEW,401,1 ,$554.00 ,$360.10 ,$106.70 ,$554.00 ,$412.73 ,$362.87 ,$106.70 ,$291.96 ,$106.70 ,$349.57 ,$349.57 ,$349.57 ,$349.57 ,$498.60 ,$415.50 ,$106.70 ,$487.52 ,$106.70 ,$415.50 ,$415.50 ,$470.90 ,$470.90 ,$106.70 ,$470.90 ,$106.70 ,$437.66 ,$437.66 ,$437.66 ,$498.60 ,$266.75 ,$498.60 ,$106.70 ,$122.32 ,$362.87 ,$106.70 ,$240.44 , N/A ,$112.04 ,$498.60 ,$240.08 ,$349.57 ,$332.40 ,$498.60 ,$106.70 ,$498.60 ,$498.60 ,$106.70 ,$360.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40100007,77065,HC MAMMOGRAM DIAG UNIL W/CAD,401,1 ,$459.00 ,$298.35 ,$83.47 ,$459.00 ,$341.96 ,$300.65 ,$83.47 ,$241.89 ,$83.47 ,$289.63 ,$289.63 ,$289.63 ,$289.63 ,$413.10 ,$344.25 ,$83.47 ,$403.92 ,$83.47 ,$344.25 ,$344.25 ,$390.15 ,$390.15 ,$83.47 ,$390.15 ,$83.47 ,$362.61 ,$362.61 ,$362.61 ,$413.10 ,$208.68 ,$413.10 ,$83.47 ,$95.73 ,$300.65 ,$83.47 ,$199.21 , N/A ,$87.64 ,$413.10 ,$187.81 ,$289.63 ,$275.40 ,$413.10 ,$83.47 ,$413.10 ,$413.10 ,$83.47 ,$298.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40100008,77065,HC MAMMOGRAM DIAG UNIL W/CAD ADDNT VIEW,401,1 ,$459.00 ,$298.35 ,$83.47 ,$459.00 ,$341.96 ,$300.65 ,$83.47 ,$241.89 ,$83.47 ,$289.63 ,$289.63 ,$289.63 ,$289.63 ,$413.10 ,$344.25 ,$83.47 ,$403.92 ,$83.47 ,$344.25 ,$344.25 ,$390.15 ,$390.15 ,$83.47 ,$390.15 ,$83.47 ,$362.61 ,$362.61 ,$362.61 ,$413.10 ,$208.68 ,$413.10 ,$83.47 ,$95.73 ,$300.65 ,$83.47 ,$199.21 , N/A ,$87.64 ,$413.10 ,$187.81 ,$289.63 ,$275.40 ,$413.10 ,$83.47 ,$413.10 ,$413.10 ,$83.47 ,$298.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40100009,77065,HC MAMMOGRAM DIAG UNIL W/CAD IMPLANT,401,1 ,$459.00 ,$298.35 ,$83.47 ,$459.00 ,$341.96 ,$300.65 ,$83.47 ,$241.89 ,$83.47 ,$289.63 ,$289.63 ,$289.63 ,$289.63 ,$413.10 ,$344.25 ,$83.47 ,$403.92 ,$83.47 ,$344.25 ,$344.25 ,$390.15 ,$390.15 ,$83.47 ,$390.15 ,$83.47 ,$362.61 ,$362.61 ,$362.61 ,$413.10 ,$208.68 ,$413.10 ,$83.47 ,$95.73 ,$300.65 ,$83.47 ,$199.21 , N/A ,$87.64 ,$413.10 ,$187.81 ,$289.63 ,$275.40 ,$413.10 ,$83.47 ,$413.10 ,$413.10 ,$83.47 ,$298.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40100014,G0279,HC DIAGNOSTIC DIGITAL BREAST TOMOSYTH UNI/BIL,401,1 ,$167.00 ,$108.55 ,$23.23 ,$167.00 ,$124.42 ,$109.39 ,$23.23 ,$88.01 ,$23.23 ,$105.38 ,$105.38 ,$105.38 ,$105.38 ,$150.30 ,$125.25 ,$23.23 ,$146.96 ,$23.23 ,$125.25 ,$125.25 ,$141.95 ,$141.95 ,$23.23 ,$141.95 ,$23.23 ,$131.93 ,$131.93 ,$131.93 ,$150.30 ,$58.08 ,$150.30 ,$23.23 ,$26.59 ,$109.39 ,$23.23 ,$72.48 , N/A ,$24.39 ,$150.30 ,$52.27 ,$105.38 ,$100.20 ,$150.30 ,$23.23 ,$150.30 ,$150.30 ,$23.23 ,$108.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200007,51798,HC US BLADDER SCAN,402,1 ,$170.00 ,$110.50 ,$56.58 ,$170.00 ,$126.65 ,$111.35 ,$56.58 ,$89.59 ,$56.58 ,$107.27 ,$107.27 ,$107.27 ,$107.27 ,$153.00 ,$127.50 ,$56.58 ,$149.60 ,$56.58 ,$127.50 ,$127.50 ,$144.50 ,$144.50 ,$56.58 ,$144.50 ,$56.58 ,$134.30 ,$134.30 ,$134.30 ,$153.00 ,$135.83 ,$153.00 ,$56.58 ,$170.00 ,$111.35 ,$56.58 ,$73.78 , N/A ,$59.22 ,$153.00 ,$122.62 ,$107.27 ,$102.00 ,$153.00 ,$56.58 ,$153.00 ,$153.00 ,$56.58 ,$110.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200010,59000,HC AMNIOCENTESIS DIAGNOSTIC,402,1 ,$526.00 ,$341.90 ,$228.28 ,"$1,395.43 ",$391.87 ,$344.53 ,$526.00 ,$277.20 ,$526.00 ,$331.91 ,$331.91 ,$331.91 ,$331.91 ,$473.40 ,$394.50 ,$526.00 ,$462.88 ,$526.00 ,$394.50 ,$394.50 ,$447.10 ,$447.10 ,$526.00 ,$447.10 ,$526.00 ,$415.54 ,$415.54 ,$415.54 ,$473.40 ,$526.00 ,$473.40 ,$526.00 ,$526.00 ,$344.53 ,$526.00 ,$228.28 , N/A ,$526.00 ,$473.40 ,"$1,395.43 ",$331.91 ,$315.60 ,$473.40 ,$526.00 ,$473.40 ,$473.40 ,$526.00 ,$341.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200011,60300,HC ASP/INJ CYST THYROID,402,1 ,"$1,170.00 ",$760.50 ,$507.78 ,"$1,370.23 ",$871.65 ,$766.35 ,$632.28 ,$616.59 ,$632.28 ,$738.27 ,$738.27 ,$738.27 ,$738.27 ,"$1,053.00 ",$877.50 ,$632.28 ,"$1,029.60 ",$632.28 ,$877.50 ,$877.50 ,$994.50 ,$994.50 ,$632.28 ,$994.50 ,$632.28 ,$924.30 ,$924.30 ,$924.30 ,"$1,053.00 ","$1,170.00 ","$1,053.00 ",$632.28 ,"$1,170.00 ",$766.35 ,$632.28 ,$507.78 , N/A ,$661.80 ,"$1,053.00 ","$1,370.23 ",$738.27 ,$702.00 ,"$1,053.00 ",$632.28 ,"$1,053.00 ","$1,053.00 ",$632.28 ,$760.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200012,76506,HC US ENCEPHALOGRAM,402,1 ,$642.00 ,$417.30 ,$110.78 ,$642.00 ,$478.29 ,$420.51 ,$110.78 ,$338.33 ,$110.78 ,$405.10 ,$405.10 ,$405.10 ,$405.10 ,$577.80 ,$481.50 ,$110.78 ,$564.96 ,$110.78 ,$481.50 ,$481.50 ,$545.70 ,$545.70 ,$110.78 ,$545.70 ,$110.78 ,$507.18 ,$507.18 ,$507.18 ,$577.80 ,$265.92 ,$577.80 ,$110.78 ,$642.00 ,$420.51 ,$110.78 ,$278.63 , N/A ,$115.95 ,$577.80 ,$240.07 ,$405.10 ,$385.20 ,$577.80 ,$110.78 ,$577.80 ,$577.80 ,$110.78 ,$417.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200013,76536,HC US SOFT TISSUE HEAD/NECK,402,1 ,"$1,211.00 ",$787.15 ,$110.78 ,"$1,211.00 ",$902.20 ,$793.21 ,$110.78 ,$638.20 ,$110.78 ,$764.14 ,$764.14 ,$764.14 ,$764.14 ,"$1,089.90 ",$908.25 ,$110.78 ,"$1,065.68 ",$110.78 ,$908.25 ,$908.25 ,"$1,029.35 ","$1,029.35 ",$110.78 ,"$1,029.35 ",$110.78 ,$956.69 ,$956.69 ,$956.69 ,"$1,089.90 ",$265.92 ,"$1,089.90 ",$110.78 ,"$1,211.00 ",$793.21 ,$110.78 ,$525.57 , N/A ,$115.95 ,"$1,089.90 ",$240.07 ,$764.14 ,$726.60 ,"$1,089.90 ",$110.78 ,"$1,089.90 ","$1,089.90 ",$110.78 ,$787.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200014,76604,HC US CHEST,402,1 ,$994.00 ,$646.10 ,$110.78 ,$994.00 ,$740.53 ,$651.07 ,$110.78 ,$523.84 ,$110.78 ,$627.21 ,$627.21 ,$627.21 ,$627.21 ,$894.60 ,$745.50 ,$110.78 ,$874.72 ,$110.78 ,$745.50 ,$745.50 ,$844.90 ,$844.90 ,$110.78 ,$844.90 ,$110.78 ,$785.26 ,$785.26 ,$785.26 ,$894.60 ,$265.92 ,$894.60 ,$110.78 ,$994.00 ,$651.07 ,$110.78 ,$431.40 , N/A ,$115.95 ,$894.60 ,$240.07 ,$627.21 ,$596.40 ,$894.60 ,$110.78 ,$894.60 ,$894.60 ,$110.78 ,$646.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200015,76641,HC US BREAST COMPLETE,402,1 ,$866.00 ,$562.90 ,$76.42 ,$866.00 ,$645.17 ,$567.23 ,$110.78 ,$456.38 ,$110.78 ,$546.45 ,$546.45 ,$546.45 ,$546.45 ,$779.40 ,$649.50 ,$110.78 ,$762.08 ,$110.78 ,$649.50 ,$649.50 ,$736.10 ,$736.10 ,$110.78 ,$736.10 ,$110.78 ,$684.14 ,$684.14 ,$684.14 ,$779.40 ,$265.92 ,$779.40 ,$110.78 ,$76.42 ,$567.23 ,$110.78 ,$375.84 , N/A ,$115.95 ,$779.40 ,$240.07 ,$546.45 ,$519.60 ,$779.40 ,$110.78 ,$779.40 ,$779.40 ,$110.78 ,$562.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200015,76641,HC US BREAST COMPLETE,402,1 ,"$1,299.00 ",$844.35 ,$76.42 ,"$1,299.00 ",$967.76 ,$850.85 ,$110.78 ,$684.57 ,$110.78 ,$819.67 ,$819.67 ,$819.67 ,$819.67 ,"$1,169.10 ",$974.25 ,$110.78 ,"$1,143.12 ",$110.78 ,$974.25 ,$974.25 ,"$1,104.15 ","$1,104.15 ",$110.78 ,"$1,104.15 ",$110.78 ,"$1,026.21 ","$1,026.21 ","$1,026.21 ","$1,169.10 ",$265.92 ,"$1,169.10 ",$110.78 ,$76.42 ,$850.85 ,$110.78 ,$563.77 , N/A ,$115.95 ,"$1,169.10 ",$240.07 ,$819.67 ,$779.40 ,"$1,169.10 ",$110.78 ,"$1,169.10 ","$1,169.10 ",$110.78 ,$844.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200016,76642,HC US BREAST LIMITED,402,1 ,$650.00 ,$422.50 ,$58.57 ,$650.00 ,$484.25 ,$425.75 ,$82.24 ,$342.55 ,$82.24 ,$410.15 ,$410.15 ,$410.15 ,$410.15 ,$585.00 ,$487.50 ,$82.24 ,$572.00 ,$82.24 ,$487.50 ,$487.50 ,$552.50 ,$552.50 ,$82.24 ,$552.50 ,$82.24 ,$513.50 ,$513.50 ,$513.50 ,$585.00 ,$197.42 ,$585.00 ,$82.24 ,$58.57 ,$425.75 ,$82.24 ,$282.10 , N/A ,$86.08 ,$585.00 ,$178.23 ,$410.15 ,$390.00 ,$585.00 ,$82.24 ,$585.00 ,$585.00 ,$82.24 ,$422.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200016,76642,HC US BREAST LIMITED,402,1 ,$974.00 ,$633.10 ,$58.57 ,$974.00 ,$725.63 ,$637.97 ,$82.24 ,$513.30 ,$82.24 ,$614.59 ,$614.59 ,$614.59 ,$614.59 ,$876.60 ,$730.50 ,$82.24 ,$857.12 ,$82.24 ,$730.50 ,$730.50 ,$827.90 ,$827.90 ,$82.24 ,$827.90 ,$82.24 ,$769.46 ,$769.46 ,$769.46 ,$876.60 ,$197.42 ,$876.60 ,$82.24 ,$58.57 ,$637.97 ,$82.24 ,$422.72 , N/A ,$86.08 ,$876.60 ,$178.23 ,$614.59 ,$584.40 ,$876.60 ,$82.24 ,$876.60 ,$876.60 ,$82.24 ,$633.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200017,76700,HC US ABDOMEN CMPL,402,1 ,"$1,504.00 ",$977.60 ,$110.78 ,"$1,504.00 ","$1,120.48 ",$985.12 ,$110.78 ,$792.61 ,$110.78 ,$949.02 ,$949.02 ,$949.02 ,$949.02 ,"$1,353.60 ","$1,128.00 ",$110.78 ,"$1,323.52 ",$110.78 ,"$1,128.00 ","$1,128.00 ","$1,278.40 ","$1,278.40 ",$110.78 ,"$1,278.40 ",$110.78 ,"$1,188.16 ","$1,188.16 ","$1,188.16 ","$1,353.60 ",$265.92 ,"$1,353.60 ",$110.78 ,"$1,504.00 ",$985.12 ,$110.78 ,$652.74 , N/A ,$115.95 ,"$1,353.60 ",$240.07 ,$949.02 ,$902.40 ,"$1,353.60 ",$110.78 ,"$1,353.60 ","$1,353.60 ",$110.78 ,$977.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200018,76705,HC US ABDOMEN LTD,402,1 ,"$1,432.00 ",$930.80 ,$110.78 ,"$1,432.00 ","$1,066.84 ",$937.96 ,$110.78 ,$754.66 ,$110.78 ,$903.59 ,$903.59 ,$903.59 ,$903.59 ,"$1,288.80 ","$1,074.00 ",$110.78 ,"$1,260.16 ",$110.78 ,"$1,074.00 ","$1,074.00 ","$1,217.20 ","$1,217.20 ",$110.78 ,"$1,217.20 ",$110.78 ,"$1,131.28 ","$1,131.28 ","$1,131.28 ","$1,288.80 ",$265.92 ,"$1,288.80 ",$110.78 ,"$1,432.00 ",$937.96 ,$110.78 ,$621.49 , N/A ,$115.95 ,"$1,288.80 ",$240.07 ,$903.59 ,$859.20 ,"$1,288.80 ",$110.78 ,"$1,288.80 ","$1,288.80 ",$110.78 ,$930.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200019,76770,HC US RETROPERITIONEAL,402,1 ,"$1,030.00 ",$669.50 ,$110.78 ,"$1,030.00 ",$767.35 ,$674.65 ,$110.78 ,$542.81 ,$110.78 ,$649.93 ,$649.93 ,$649.93 ,$649.93 ,$927.00 ,$772.50 ,$110.78 ,$906.40 ,$110.78 ,$772.50 ,$772.50 ,$875.50 ,$875.50 ,$110.78 ,$875.50 ,$110.78 ,$813.70 ,$813.70 ,$813.70 ,$927.00 ,$265.92 ,$927.00 ,$110.78 ,"$1,030.00 ",$674.65 ,$110.78 ,$447.02 , N/A ,$115.95 ,$927.00 ,$240.07 ,$649.93 ,$618.00 ,$927.00 ,$110.78 ,$927.00 ,$927.00 ,$110.78 ,$669.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200020,76775,HC US RETROPERITONEAL LTD,402,1 ,$961.00 ,$624.65 ,$110.78 ,$961.00 ,$715.95 ,$629.46 ,$110.78 ,$506.45 ,$110.78 ,$606.39 ,$606.39 ,$606.39 ,$606.39 ,$864.90 ,$720.75 ,$110.78 ,$845.68 ,$110.78 ,$720.75 ,$720.75 ,$816.85 ,$816.85 ,$110.78 ,$816.85 ,$110.78 ,$759.19 ,$759.19 ,$759.19 ,$864.90 ,$265.92 ,$864.90 ,$110.78 ,$961.00 ,$629.46 ,$110.78 ,$417.07 , N/A ,$115.95 ,$864.90 ,$240.07 ,$606.39 ,$576.60 ,$864.90 ,$110.78 ,$864.90 ,$864.90 ,$110.78 ,$624.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200022,76800,HC US SPINAL CANAL AND CONTENTS,402,1 ,$559.00 ,$363.35 ,$110.78 ,$559.00 ,$416.46 ,$366.15 ,$110.78 ,$294.59 ,$110.78 ,$352.73 ,$352.73 ,$352.73 ,$352.73 ,$503.10 ,$419.25 ,$110.78 ,$491.92 ,$110.78 ,$419.25 ,$419.25 ,$475.15 ,$475.15 ,$110.78 ,$475.15 ,$110.78 ,$441.61 ,$441.61 ,$441.61 ,$503.10 ,$265.92 ,$503.10 ,$110.78 ,$559.00 ,$366.15 ,$110.78 ,$242.61 , N/A ,$115.95 ,$503.10 ,$240.07 ,$352.73 ,$335.40 ,$503.10 ,$110.78 ,$503.10 ,$503.10 ,$110.78 ,$363.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200023,76801,HC US PREGNANCY <14 WEEKS SGL,402,1 ,$906.00 ,$588.90 ,$110.78 ,$906.00 ,$674.97 ,$593.43 ,$110.78 ,$477.46 ,$110.78 ,$571.69 ,$571.69 ,$571.69 ,$571.69 ,$815.40 ,$679.50 ,$110.78 ,$797.28 ,$110.78 ,$679.50 ,$679.50 ,$770.10 ,$770.10 ,$110.78 ,$770.10 ,$110.78 ,$715.74 ,$715.74 ,$715.74 ,$815.40 ,$265.92 ,$815.40 ,$110.78 ,$906.00 ,$593.43 ,$110.78 ,$393.20 , N/A ,$115.95 ,$815.40 ,$240.07 ,$571.69 ,$543.60 ,$815.40 ,$110.78 ,$815.40 ,$815.40 ,$110.78 ,$588.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200024,76802,HC US PREGNANCY <14 WEEKS ADDL,402,1 ,$195.00 ,$126.75 ,$84.63 ,$195.00 ,$145.28 ,$127.73 , N/A ,$102.77 , N/A ,$123.05 ,$123.05 ,$123.05 ,$123.05 ,$175.50 ,$146.25 , N/A ,$171.60 , N/A ,$146.25 ,$146.25 ,$165.75 ,$165.75 , N/A ,$165.75 , N/A ,$154.05 ,$154.05 ,$154.05 ,$175.50 , N/A ,$175.50 , N/A ,$195.00 ,$127.73 , N/A ,$84.63 , N/A , N/A ,$175.50 , N/A ,$123.05 ,$117.00 ,$175.50 , N/A ,$175.50 ,$175.50 , N/A ,$126.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200025,76805,HC US PREGNANCY >14 WEEKS SGL,402,1 ,"$1,200.00 ",$780.00 ,$110.78 ,"$1,200.00 ",$894.00 ,$786.00 ,$110.78 ,$632.40 ,$110.78 ,$757.20 ,$757.20 ,$757.20 ,$757.20 ,"$1,080.00 ",$900.00 ,$110.78 ,"$1,056.00 ",$110.78 ,$900.00 ,$900.00 ,"$1,020.00 ","$1,020.00 ",$110.78 ,"$1,020.00 ",$110.78 ,$948.00 ,$948.00 ,$948.00 ,"$1,080.00 ",$265.92 ,"$1,080.00 ",$110.78 ,"$1,200.00 ",$786.00 ,$110.78 ,$520.80 , N/A ,$115.95 ,"$1,080.00 ",$240.07 ,$757.20 ,$720.00 ,"$1,080.00 ",$110.78 ,"$1,080.00 ","$1,080.00 ",$110.78 ,$780.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200027,76810,HC US PREGNANCY >14 WEEKS ADDL,402,1 ,"$1,200.00 ",$780.00 ,$520.80 ,"$1,200.00 ",$894.00 ,$786.00 , N/A ,$632.40 , N/A ,$757.20 ,$757.20 ,$757.20 ,$757.20 ,"$1,080.00 ",$900.00 , N/A ,"$1,056.00 ", N/A ,$900.00 ,$900.00 ,"$1,020.00 ","$1,020.00 ", N/A ,"$1,020.00 ", N/A ,$948.00 ,$948.00 ,$948.00 ,"$1,080.00 ", N/A ,"$1,080.00 ", N/A ,"$1,200.00 ",$786.00 , N/A ,$520.80 , N/A , N/A ,"$1,080.00 ", N/A ,$757.20 ,$720.00 ,"$1,080.00 ", N/A ,"$1,080.00 ","$1,080.00 ", N/A ,$780.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200028,76811,HC US PREGNANCY DETAILED SGL,402,1 ,$655.00 ,$425.75 ,$233.94 ,$655.00 ,$487.98 ,$429.03 ,$233.94 ,$345.19 ,$233.94 ,$413.31 ,$413.31 ,$413.31 ,$413.31 ,$589.50 ,$491.25 ,$233.94 ,$576.40 ,$233.94 ,$491.25 ,$491.25 ,$556.75 ,$556.75 ,$233.94 ,$556.75 ,$233.94 ,$517.45 ,$517.45 ,$517.45 ,$589.50 ,$561.60 ,$589.50 ,$233.94 ,$655.00 ,$429.03 ,$233.94 ,$284.27 , N/A ,$244.87 ,$589.50 ,$506.99 ,$413.31 ,$393.00 ,$589.50 ,$233.94 ,$589.50 ,$589.50 ,$233.94 ,$425.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200030,76816,HC US OB GROWTH FOLLOWUP,402,1 ,$347.00 ,$225.55 ,$110.78 ,$347.00 ,$258.52 ,$227.29 ,$110.78 ,$182.87 ,$110.78 ,$218.96 ,$218.96 ,$218.96 ,$218.96 ,$312.30 ,$260.25 ,$110.78 ,$305.36 ,$110.78 ,$260.25 ,$260.25 ,$294.95 ,$294.95 ,$110.78 ,$294.95 ,$110.78 ,$274.13 ,$274.13 ,$274.13 ,$312.30 ,$265.92 ,$312.30 ,$110.78 ,$347.00 ,$227.29 ,$110.78 ,$150.60 , N/A ,$115.95 ,$312.30 ,$240.07 ,$218.96 ,$208.20 ,$312.30 ,$110.78 ,$312.30 ,$312.30 ,$110.78 ,$225.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200031,76815,HC US FETAL HEART BEAT,402,1 ,$415.00 ,$269.75 ,$110.78 ,$415.00 ,$309.18 ,$271.83 ,$110.78 ,$218.71 ,$110.78 ,$261.87 ,$261.87 ,$261.87 ,$261.87 ,$373.50 ,$311.25 ,$110.78 ,$365.20 ,$110.78 ,$311.25 ,$311.25 ,$352.75 ,$352.75 ,$110.78 ,$352.75 ,$110.78 ,$327.85 ,$327.85 ,$327.85 ,$373.50 ,$265.92 ,$373.50 ,$110.78 ,$415.00 ,$271.83 ,$110.78 ,$180.11 , N/A ,$115.95 ,$373.50 ,$240.07 ,$261.87 ,$249.00 ,$373.50 ,$110.78 ,$373.50 ,$373.50 ,$110.78 ,$269.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200032,76817,HC US PREGNANCY TRANSVAGINAL,402,1 ,"$1,019.00 ",$662.35 ,$110.78 ,"$1,019.00 ",$759.16 ,$667.45 ,$110.78 ,$537.01 ,$110.78 ,$642.99 ,$642.99 ,$642.99 ,$642.99 ,$917.10 ,$764.25 ,$110.78 ,$896.72 ,$110.78 ,$764.25 ,$764.25 ,$866.15 ,$866.15 ,$110.78 ,$866.15 ,$110.78 ,$805.01 ,$805.01 ,$805.01 ,$917.10 ,$265.92 ,$917.10 ,$110.78 ,"$1,019.00 ",$667.45 ,$110.78 ,$442.25 , N/A ,$115.95 ,$917.10 ,$240.07 ,$642.99 ,$611.40 ,$917.10 ,$110.78 ,$917.10 ,$917.10 ,$110.78 ,$662.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200034,76819,HC US FETAL BIO PROFILE W/O NST,402,1 ,$608.00 ,$395.20 ,$110.78 ,$608.00 ,$452.96 ,$398.24 ,$110.78 ,$320.42 ,$110.78 ,$383.65 ,$383.65 ,$383.65 ,$383.65 ,$547.20 ,$456.00 ,$110.78 ,$535.04 ,$110.78 ,$456.00 ,$456.00 ,$516.80 ,$516.80 ,$110.78 ,$516.80 ,$110.78 ,$480.32 ,$480.32 ,$480.32 ,$547.20 ,$265.92 ,$547.20 ,$110.78 ,$608.00 ,$398.24 ,$110.78 ,$263.87 , N/A ,$115.95 ,$547.20 ,$240.07 ,$383.65 ,$364.80 ,$547.20 ,$110.78 ,$547.20 ,$547.20 ,$110.78 ,$395.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200036,76820,HC US FETAL DOPLR VELO UMB,402,1 ,$299.00 ,$194.35 ,$110.78 ,$299.00 ,$222.76 ,$195.85 ,$110.78 ,$157.57 ,$110.78 ,$188.67 ,$188.67 ,$188.67 ,$188.67 ,$269.10 ,$224.25 ,$110.78 ,$263.12 ,$110.78 ,$224.25 ,$224.25 ,$254.15 ,$254.15 ,$110.78 ,$254.15 ,$110.78 ,$236.21 ,$236.21 ,$236.21 ,$269.10 ,$265.92 ,$269.10 ,$110.78 ,$299.00 ,$195.85 ,$110.78 ,$129.77 , N/A ,$115.95 ,$269.10 ,$240.07 ,$188.67 ,$179.40 ,$269.10 ,$110.78 ,$269.10 ,$269.10 ,$110.78 ,$194.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200038,76830,HC US TRANSVAGINAL,402,1 ,"$1,058.00 ",$687.70 ,$110.78 ,"$1,058.00 ",$788.21 ,$692.99 ,$110.78 ,$557.57 ,$110.78 ,$667.60 ,$667.60 ,$667.60 ,$667.60 ,$952.20 ,$793.50 ,$110.78 ,$931.04 ,$110.78 ,$793.50 ,$793.50 ,$899.30 ,$899.30 ,$110.78 ,$899.30 ,$110.78 ,$835.82 ,$835.82 ,$835.82 ,$952.20 ,$265.92 ,$952.20 ,$110.78 ,"$1,058.00 ",$692.99 ,$110.78 ,$459.17 , N/A ,$115.95 ,$952.20 ,$240.07 ,$667.60 ,$634.80 ,$952.20 ,$110.78 ,$952.20 ,$952.20 ,$110.78 ,$687.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200040,76856,HC US PELVIS NON OB,402,1 ,"$1,771.00 ","$1,151.15 ",$81.89 ,"$1,771.00 ","$1,319.40 ","$1,160.01 ",$110.78 ,$933.32 ,$110.78 ,"$1,117.50 ","$1,117.50 ","$1,117.50 ","$1,117.50 ","$1,593.90 ","$1,328.25 ",$110.78 ,"$1,558.48 ",$110.78 ,"$1,328.25 ","$1,328.25 ","$1,505.35 ","$1,505.35 ",$110.78 ,"$1,505.35 ",$110.78 ,"$1,399.09 ","$1,399.09 ","$1,399.09 ","$1,593.90 ",$265.92 ,"$1,593.90 ",$110.78 ,$81.89 ,"$1,160.01 ",$110.78 ,$768.61 , N/A ,$115.95 ,"$1,593.90 ",$240.07 ,"$1,117.50 ","$1,062.60 ","$1,593.90 ",$110.78 ,"$1,593.90 ","$1,593.90 ",$110.78 ,"$1,151.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200041,76857,HC US PELVIS NON-OB LTD,402,1 ,$922.00 ,$599.30 ,$110.78 ,$922.00 ,$686.89 ,$603.91 ,$110.78 ,$485.89 ,$110.78 ,$581.78 ,$581.78 ,$581.78 ,$581.78 ,$829.80 ,$691.50 ,$110.78 ,$811.36 ,$110.78 ,$691.50 ,$691.50 ,$783.70 ,$783.70 ,$110.78 ,$783.70 ,$110.78 ,$728.38 ,$728.38 ,$728.38 ,$829.80 ,$265.92 ,$829.80 ,$110.78 ,$922.00 ,$603.91 ,$110.78 ,$400.15 , N/A ,$115.95 ,$829.80 ,$240.07 ,$581.78 ,$553.20 ,$829.80 ,$110.78 ,$829.80 ,$829.80 ,$110.78 ,$599.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200042,76870,HC US SCROTUM,402,1 ,"$1,259.00 ",$818.35 ,$110.78 ,"$1,259.00 ",$937.96 ,$824.65 ,$110.78 ,$663.49 ,$110.78 ,$794.43 ,$794.43 ,$794.43 ,$794.43 ,"$1,133.10 ",$944.25 ,$110.78 ,"$1,107.92 ",$110.78 ,$944.25 ,$944.25 ,"$1,070.15 ","$1,070.15 ",$110.78 ,"$1,070.15 ",$110.78 ,$994.61 ,$994.61 ,$994.61 ,"$1,133.10 ",$265.92 ,"$1,133.10 ",$110.78 ,"$1,259.00 ",$824.65 ,$110.78 ,$546.41 , N/A ,$115.95 ,"$1,133.10 ",$240.07 ,$794.43 ,$755.40 ,"$1,133.10 ",$110.78 ,"$1,133.10 ","$1,133.10 ",$110.78 ,$818.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200043,76872,HC ULTRA BX PROS,402,1 ,$784.00 ,$509.60 ,$110.78 ,$784.00 ,$584.08 ,$513.52 ,$110.78 ,$413.17 ,$110.78 ,$494.70 ,$494.70 ,$494.70 ,$494.70 ,$705.60 ,$588.00 ,$110.78 ,$689.92 ,$110.78 ,$588.00 ,$588.00 ,$666.40 ,$666.40 ,$110.78 ,$666.40 ,$110.78 ,$619.36 ,$619.36 ,$619.36 ,$705.60 ,$265.92 ,$705.60 ,$110.78 ,$784.00 ,$513.52 ,$110.78 ,$340.26 , N/A ,$115.95 ,$705.60 ,$240.07 ,$494.70 ,$470.40 ,$705.60 ,$110.78 ,$705.60 ,$705.60 ,$110.78 ,$509.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200045,76881,HC US EXTREMITY NON VASCULAR COMP,402,1 ,$932.00 ,$605.80 ,$110.78 ,$932.00 ,$694.34 ,$610.46 ,$110.78 ,$491.16 ,$110.78 ,$588.09 ,$588.09 ,$588.09 ,$588.09 ,$838.80 ,$699.00 ,$110.78 ,$820.16 ,$110.78 ,$699.00 ,$699.00 ,$792.20 ,$792.20 ,$110.78 ,$792.20 ,$110.78 ,$736.28 ,$736.28 ,$736.28 ,$838.80 ,$265.92 ,$838.80 ,$110.78 ,$932.00 ,$610.46 ,$110.78 ,$404.49 , N/A ,$115.95 ,$838.80 ,$240.07 ,$588.09 ,$559.20 ,$838.80 ,$110.78 ,$838.80 ,$838.80 ,$110.78 ,$605.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200046,76882,HC US EXTREMITY NON VASCULAR LMTD,402,1 ,$795.00 ,$516.75 ,$110.78 ,$795.00 ,$592.28 ,$520.73 ,$110.78 ,$418.97 ,$110.78 ,$501.65 ,$501.65 ,$501.65 ,$501.65 ,$715.50 ,$596.25 ,$110.78 ,$699.60 ,$110.78 ,$596.25 ,$596.25 ,$675.75 ,$675.75 ,$110.78 ,$675.75 ,$110.78 ,$628.05 ,$628.05 ,$628.05 ,$715.50 ,$265.92 ,$715.50 ,$110.78 ,$795.00 ,$520.73 ,$110.78 ,$345.03 , N/A ,$115.95 ,$715.50 ,$240.07 ,$501.65 ,$477.00 ,$715.50 ,$110.78 ,$715.50 ,$715.50 ,$110.78 ,$516.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200048,76885,HC US HIPS INFANT DYNAMIC,402,1 ,$860.00 ,$559.00 ,$82.24 ,$860.00 ,$640.70 ,$563.30 ,$82.24 ,$453.22 ,$82.24 ,$542.66 ,$542.66 ,$542.66 ,$542.66 ,$774.00 ,$645.00 ,$82.24 ,$756.80 ,$82.24 ,$645.00 ,$645.00 ,$731.00 ,$731.00 ,$82.24 ,$731.00 ,$82.24 ,$679.40 ,$679.40 ,$679.40 ,$774.00 ,$197.42 ,$774.00 ,$82.24 ,$860.00 ,$563.30 ,$82.24 ,$373.24 , N/A ,$86.08 ,$774.00 ,$178.23 ,$542.66 ,$516.00 ,$774.00 ,$82.24 ,$774.00 ,$774.00 ,$82.24 ,$559.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200049,76930,HC US GUIDED PERICARDIOCENTESIS,402,1 ,$952.00 ,$618.80 ,$413.17 ,$952.00 ,$709.24 ,$623.56 , N/A ,$501.70 , N/A ,$600.71 ,$600.71 ,$600.71 ,$600.71 ,$856.80 ,$714.00 , N/A ,$837.76 , N/A ,$714.00 ,$714.00 ,$809.20 ,$809.20 , N/A ,$809.20 , N/A ,$752.08 ,$752.08 ,$752.08 ,$856.80 , N/A ,$856.80 , N/A ,$952.00 ,$623.56 , N/A ,$413.17 , N/A , N/A ,$856.80 , N/A ,$600.71 ,$571.20 ,$856.80 , N/A ,$856.80 ,$856.80 , N/A ,$618.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200050,76936,HC US GUIDED COMPRESSION RPR,402,1 ,$771.00 ,$501.15 ,$268.83 ,$771.00 ,$574.40 ,$505.01 ,$268.83 ,$406.32 ,$268.83 ,$486.50 ,$486.50 ,$486.50 ,$486.50 ,$693.90 ,$578.25 ,$268.83 ,$678.48 ,$268.83 ,$578.25 ,$578.25 ,$655.35 ,$655.35 ,$268.83 ,$655.35 ,$268.83 ,$609.09 ,$609.09 ,$609.09 ,$693.90 ,$645.35 ,$693.90 ,$268.83 ,$771.00 ,$505.01 ,$268.83 ,$334.61 , N/A ,$281.38 ,$693.90 ,$582.60 ,$486.50 ,$462.60 ,$693.90 ,$268.83 ,$693.90 ,$693.90 ,$268.83 ,$501.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200051,76937,HC US GUIDED VASCULAR ACCESS 76937,402,1 ,$195.00 ,$126.75 ,$84.63 ,$195.00 ,$145.28 ,$127.73 , N/A ,$102.77 , N/A ,$123.05 ,$123.05 ,$123.05 ,$123.05 ,$175.50 ,$146.25 , N/A ,$171.60 , N/A ,$146.25 ,$146.25 ,$165.75 ,$165.75 , N/A ,$165.75 , N/A ,$154.05 ,$154.05 ,$154.05 ,$175.50 , N/A ,$175.50 , N/A ,$195.00 ,$127.73 , N/A ,$84.63 , N/A , N/A ,$175.50 , N/A ,$123.05 ,$117.00 ,$175.50 , N/A ,$175.50 ,$175.50 , N/A ,$126.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200053,76942,HC US GUIDED NEEDLE PLCMT,402,1 ,"$1,075.00 ",$698.75 ,$29.07 ,"$1,075.00 ",$800.88 ,$704.13 , N/A ,$566.53 , N/A ,$678.33 ,$678.33 ,$678.33 ,$678.33 ,$967.50 ,$806.25 , N/A ,$946.00 , N/A ,$806.25 ,$806.25 ,$913.75 ,$913.75 , N/A ,$913.75 , N/A ,$849.25 ,$849.25 ,$849.25 ,$967.50 , N/A ,$967.50 , N/A ,$29.07 ,$704.13 , N/A ,$466.55 , N/A , N/A ,$967.50 , N/A ,$678.33 ,$645.00 ,$967.50 , N/A ,$967.50 ,$967.50 , N/A ,$698.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200059,76946,HC US GUIDED AMNIOCENTESIS,402,1 ,$559.00 ,$363.35 ,$242.61 ,$559.00 ,$416.46 ,$366.15 , N/A ,$294.59 , N/A ,$352.73 ,$352.73 ,$352.73 ,$352.73 ,$503.10 ,$419.25 , N/A ,$491.92 , N/A ,$419.25 ,$419.25 ,$475.15 ,$475.15 , N/A ,$475.15 , N/A ,$441.61 ,$441.61 ,$441.61 ,$503.10 , N/A ,$503.10 , N/A ,$559.00 ,$366.15 , N/A ,$242.61 , N/A , N/A ,$503.10 , N/A ,$352.73 ,$335.40 ,$503.10 , N/A ,$503.10 ,$503.10 , N/A ,$363.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200062,76998,HC US INTRAOPERATIVE,402,1 ,$527.00 ,$342.55 ,$228.72 ,$527.00 ,$392.62 ,$345.19 , N/A ,$277.73 , N/A ,$332.54 ,$332.54 ,$332.54 ,$332.54 ,$474.30 ,$395.25 , N/A ,$463.76 , N/A ,$395.25 ,$395.25 ,$447.95 ,$447.95 , N/A ,$447.95 , N/A ,$416.33 ,$416.33 ,$416.33 ,$474.30 , N/A ,$474.30 , N/A ,$527.00 ,$345.19 , N/A ,$228.72 , N/A , N/A ,$474.30 , N/A ,$332.54 ,$316.20 ,$474.30 , N/A ,$474.30 ,$474.30 , N/A ,$342.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200064,93975,HC DUPLEX ABD/PEL/RETRO CMPL,402,1 ,"$2,089.00 ","$1,357.85 ",$233.94 ,"$2,089.00 ","$1,556.31 ","$1,368.30 ",$233.94 ,"$1,100.90 ",$233.94 ,"$1,318.16 ","$1,318.16 ","$1,318.16 ","$1,318.16 ","$1,880.10 ","$1,566.75 ",$233.94 ,"$1,838.32 ",$233.94 ,"$1,566.75 ","$1,566.75 ","$1,775.65 ","$1,775.65 ",$233.94 ,"$1,775.65 ",$233.94 ,"$1,650.31 ","$1,650.31 ","$1,650.31 ","$1,880.10 ",$561.60 ,"$1,880.10 ",$233.94 ,"$2,089.00 ","$1,368.30 ",$233.94 ,$906.63 , N/A ,$244.87 ,"$1,880.10 ",$506.99 ,"$1,318.16 ","$1,253.40 ","$1,880.10 ",$233.94 ,"$1,880.10 ","$1,880.10 ",$233.94 ,"$1,357.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200071,93976,HC DUPLEX ABD/PEL/RETRO SCAN LTD AORTA,402,1 ,"$1,330.00 ",$864.50 ,$110.78 ,"$1,330.00 ",$990.85 ,$871.15 ,$110.78 ,$700.91 ,$110.78 ,$839.23 ,$839.23 ,$839.23 ,$839.23 ,"$1,197.00 ",$997.50 ,$110.78 ,"$1,170.40 ",$110.78 ,$997.50 ,$997.50 ,"$1,130.50 ","$1,130.50 ",$110.78 ,"$1,130.50 ",$110.78 ,"$1,050.70 ","$1,050.70 ","$1,050.70 ","$1,197.00 ",$265.92 ,"$1,197.00 ",$110.78 ,"$1,330.00 ",$871.15 ,$110.78 ,$577.22 , N/A ,$115.95 ,"$1,197.00 ",$240.07 ,$839.23 ,$798.00 ,"$1,197.00 ",$110.78 ,"$1,197.00 ","$1,197.00 ",$110.78 ,$864.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200073,93978,HC DUPLEX AORTA/IVC/GRAFT CMPL,402,1 ,"$1,464.00 ",$951.60 ,$233.94 ,"$1,464.00 ","$1,090.68 ",$958.92 ,$233.94 ,$771.53 ,$233.94 ,$923.78 ,$923.78 ,$923.78 ,$923.78 ,"$1,317.60 ","$1,098.00 ",$233.94 ,"$1,288.32 ",$233.94 ,"$1,098.00 ","$1,098.00 ","$1,244.40 ","$1,244.40 ",$233.94 ,"$1,244.40 ",$233.94 ,"$1,156.56 ","$1,156.56 ","$1,156.56 ","$1,317.60 ",$561.60 ,"$1,317.60 ",$233.94 ,"$1,464.00 ",$958.92 ,$233.94 ,$635.38 , N/A ,$244.87 ,"$1,317.60 ",$506.99 ,$923.78 ,$878.40 ,"$1,317.60 ",$233.94 ,"$1,317.60 ","$1,317.60 ",$233.94 ,$951.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200074,93979,HC DUPLEX AORTA/IVC/GRAFT LTD,402,1 ,"$1,037.00 ",$674.05 ,$110.78 ,"$1,037.00 ",$772.57 ,$679.24 ,$110.78 ,$546.50 ,$110.78 ,$654.35 ,$654.35 ,$654.35 ,$654.35 ,$933.30 ,$777.75 ,$110.78 ,$912.56 ,$110.78 ,$777.75 ,$777.75 ,$881.45 ,$881.45 ,$110.78 ,$881.45 ,$110.78 ,$819.23 ,$819.23 ,$819.23 ,$933.30 ,$265.92 ,$933.30 ,$110.78 ,"$1,037.00 ",$679.24 ,$110.78 ,$450.06 , N/A ,$115.95 ,$933.30 ,$240.07 ,$654.35 ,$622.20 ,$933.30 ,$110.78 ,$933.30 ,$933.30 ,$110.78 ,$674.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200075,76706,HC US AORTA (SCREENING),402,1 ,$771.00 ,$501.15 ,$110.78 ,$771.00 ,$574.40 ,$505.01 ,$110.78 ,$406.32 ,$110.78 ,$486.50 ,$486.50 ,$486.50 ,$486.50 ,$693.90 ,$578.25 ,$110.78 ,$678.48 ,$110.78 ,$578.25 ,$578.25 ,$655.35 ,$655.35 ,$110.78 ,$655.35 ,$110.78 ,$609.09 ,$609.09 ,$609.09 ,$693.90 ,$265.92 ,$693.90 ,$110.78 ,$771.00 ,$505.01 ,$110.78 ,$334.61 , N/A ,$115.95 ,$693.90 ,$240.07 ,$486.50 ,$462.60 ,$693.90 ,$110.78 ,$693.90 ,$693.90 ,$110.78 ,$501.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40200091,76886,HC US HIPS INFANT STATIC,402,1 ,$393.00 ,$255.45 ,$82.24 ,$393.00 ,$292.79 ,$257.42 ,$82.24 ,$207.11 ,$82.24 ,$247.98 ,$247.98 ,$247.98 ,$247.98 ,$353.70 ,$294.75 ,$82.24 ,$345.84 ,$82.24 ,$294.75 ,$294.75 ,$334.05 ,$334.05 ,$82.24 ,$334.05 ,$82.24 ,$310.47 ,$310.47 ,$310.47 ,$353.70 ,$197.42 ,$353.70 ,$82.24 ,$393.00 ,$257.42 ,$82.24 ,$170.56 , N/A ,$86.08 ,$353.70 ,$178.23 ,$247.98 ,$235.80 ,$353.70 ,$82.24 ,$353.70 ,$353.70 ,$82.24 ,$255.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40300003,77067,HC MAMMOGRAM SCREEN DIGI W/CAD,403,1 ,$582.00 ,$378.30 ,$88.24 ,$582.00 ,$433.59 ,$381.21 ,$88.24 ,$306.71 ,$88.24 ,$367.24 ,$367.24 ,$367.24 ,$367.24 ,$523.80 ,$436.50 ,$88.24 ,$512.16 ,$88.24 ,$436.50 ,$436.50 ,$494.70 ,$494.70 ,$88.24 ,$494.70 ,$88.24 ,$459.78 ,$459.78 ,$459.78 ,$523.80 ,$220.60 ,$523.80 ,$88.24 ,$101.20 ,$381.21 ,$88.24 ,$252.59 , N/A ,$92.65 ,$523.80 ,$198.54 ,$367.24 ,$349.20 ,$523.80 ,$88.24 ,$523.80 ,$523.80 ,$88.24 ,$378.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40300005,77067,HC MAMMOGRAM SCREEN W/CAD IMPLANT,403,1 ,$582.00 ,$378.30 ,$88.24 ,$582.00 ,$433.59 ,$381.21 ,$88.24 ,$306.71 ,$88.24 ,$367.24 ,$367.24 ,$367.24 ,$367.24 ,$523.80 ,$436.50 ,$88.24 ,$512.16 ,$88.24 ,$436.50 ,$436.50 ,$494.70 ,$494.70 ,$88.24 ,$494.70 ,$88.24 ,$459.78 ,$459.78 ,$459.78 ,$523.80 ,$220.60 ,$523.80 ,$88.24 ,$101.20 ,$381.21 ,$88.24 ,$252.59 , N/A ,$92.65 ,$523.80 ,$198.54 ,$367.24 ,$349.20 ,$523.80 ,$88.24 ,$523.80 ,$523.80 ,$88.24 ,$378.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40300005,77067,HC MAMMOGRAM SCREEN W/CAD IMPLANT,403,1 ,$355.00 ,$230.75 ,$88.24 ,$355.00 ,$264.48 ,$232.53 ,$88.24 ,$187.09 ,$88.24 ,$224.01 ,$224.01 ,$224.01 ,$224.01 ,$319.50 ,$266.25 ,$88.24 ,$312.40 ,$88.24 ,$266.25 ,$266.25 ,$301.75 ,$301.75 ,$88.24 ,$301.75 ,$88.24 ,$280.45 ,$280.45 ,$280.45 ,$319.50 ,$220.60 ,$319.50 ,$88.24 ,$101.20 ,$232.53 ,$88.24 ,$154.07 , N/A ,$92.65 ,$319.50 ,$198.54 ,$224.01 ,$213.00 ,$319.50 ,$88.24 ,$319.50 ,$319.50 ,$88.24 ,$230.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40300006,77063,HC SCREEN DIGITAL BREAST TOMOSYTH BIL,403,1 ,$167.00 ,$108.55 ,$23.23 ,$167.00 ,$124.42 ,$109.39 ,$23.23 ,$88.01 ,$23.23 ,$105.38 ,$105.38 ,$105.38 ,$105.38 ,$150.30 ,$125.25 ,$23.23 ,$146.96 ,$23.23 ,$125.25 ,$125.25 ,$141.95 ,$141.95 ,$23.23 ,$141.95 ,$23.23 ,$131.93 ,$131.93 ,$131.93 ,$150.30 ,$58.08 ,$150.30 ,$23.23 ,$26.59 ,$109.39 ,$23.23 ,$72.48 , N/A ,$24.39 ,$150.30 ,$52.27 ,$105.38 ,$100.20 ,$150.30 ,$23.23 ,$150.30 ,$150.30 ,$23.23 ,$108.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40400004,78815,HC PET W/CT TUMR SKULL MID-THIGH,404,1 ,"$6,466.00 ","$4,202.90 ","$1,504.87 ","$6,466.00 ","$4,817.17 ","$4,235.23 ","$1,504.87 ","$3,407.58 ","$1,504.87 ","$4,080.05 ","$4,080.05 ","$4,080.05 ","$4,080.05 ","$5,819.40 ","$4,849.50 ","$1,504.87 ","$5,690.08 ","$1,504.87 ","$4,849.50 ","$4,849.50 ","$5,496.10 ","$5,496.10 ","$1,504.87 ","$5,496.10 ","$1,504.87 ","$5,108.14 ","$5,108.14 ","$5,108.14 ","$5,819.40 ","$3,612.54 ","$5,819.40 ","$1,504.87 ","$6,466.00 ","$4,235.23 ","$1,504.87 ","$2,806.24 ", N/A ,"$1,575.13 ","$5,819.40 ","$3,261.26 ","$4,080.05 ","$3,879.60 ","$5,819.40 ","$1,504.87 ","$5,819.40 ","$5,819.40 ","$1,504.87 ","$4,202.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),40400005,78816,HC PET W/CT MELAN IMAG WHOLE BODY,404,1 ,"$6,624.00 ","$4,305.60 ","$1,504.87 ","$6,624.00 ","$4,934.88 ","$4,338.72 ","$1,504.87 ","$3,490.85 ","$1,504.87 ","$4,179.74 ","$4,179.74 ","$4,179.74 ","$4,179.74 ","$5,961.60 ","$4,968.00 ","$1,504.87 ","$5,829.12 ","$1,504.87 ","$4,968.00 ","$4,968.00 ","$5,630.40 ","$5,630.40 ","$1,504.87 ","$5,630.40 ","$1,504.87 ","$5,232.96 ","$5,232.96 ","$5,232.96 ","$5,961.60 ","$3,612.54 ","$5,961.60 ","$1,504.87 ","$6,624.00 ","$4,338.72 ","$1,504.87 ","$2,874.82 ", N/A ,"$1,575.13 ","$5,961.60 ","$3,261.26 ","$4,179.74 ","$3,974.40 ","$5,961.60 ","$1,504.87 ","$5,961.60 ","$5,961.60 ","$1,504.87 ","$4,305.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000002,31502,HC CHG TUBE TRACHEOTOMY,410,1 ,$631.00 ,$410.15 ,$215.11 ,$631.00 ,$470.10 ,$413.31 ,$215.11 ,$332.54 ,$215.11 ,$398.16 ,$398.16 ,$398.16 ,$398.16 ,$567.90 ,$473.25 ,$215.11 ,$555.28 ,$215.11 ,$473.25 ,$473.25 ,$536.35 ,$536.35 ,$215.11 ,$536.35 ,$215.11 ,$498.49 ,$498.49 ,$498.49 ,$567.90 ,$516.38 ,$567.90 ,$215.11 ,$631.00 ,$413.31 ,$215.11 ,$273.85 , N/A ,$225.15 ,$567.90 ,$466.16 ,$398.16 ,$378.60 ,$567.90 ,$215.11 ,$567.90 ,$567.90 ,$215.11 ,$410.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000005,92950,HC CPR,480,1 ,$607.00 ,$394.55 ,$263.44 ,$607.00 ,$452.22 ,$397.59 ,$268.83 ,$319.89 ,$268.83 ,$383.02 ,$383.02 ,$383.02 ,$383.02 ,$546.30 ,$455.25 ,$268.83 ,$534.16 ,$268.83 ,$455.25 ,$455.25 ,$515.95 ,$515.95 ,$268.83 ,$515.95 ,$268.83 ,$479.53 ,$479.53 ,$479.53 ,$546.30 ,$607.00 ,$546.30 ,$268.83 ,$607.00 ,$397.59 ,$268.83 ,$263.44 , N/A ,$281.38 ,$546.30 ,$582.60 ,$383.02 ,$364.20 ,$546.30 ,$268.83 ,$546.30 ,$546.30 ,$268.83 ,$394.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000009,94002,HC VENT MANGMNT INPT/OBS INIT DAY,410,1 ,$833.00 ,$541.45 ,$361.52 ,"$1,069.05 ",$620.59 ,$545.62 ,$493.30 ,$438.99 ,$493.30 ,$525.62 ,$525.62 ,$525.62 ,$525.62 ,$749.70 ,$624.75 ,$493.30 ,$733.04 ,$493.30 ,$624.75 ,$624.75 ,$708.05 ,$708.05 ,$493.30 ,$708.05 ,$493.30 ,$658.07 ,$658.07 ,$658.07 ,$749.70 ,$833.00 ,$749.70 ,$493.30 ,$833.00 ,$545.62 ,$493.30 ,$361.52 , N/A ,$516.33 ,$749.70 ,"$1,069.05 ",$525.62 ,$499.80 ,$749.70 ,$493.30 ,$749.70 ,$749.70 ,$493.30 ,$541.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000013,94660,HC VENT NONINVAS ADULT INTL DAY,410,1 ,$212.00 ,$137.80 ,$92.01 ,$413.91 ,$157.94 ,$138.86 ,$190.99 ,$111.72 ,$190.99 ,$133.77 ,$133.77 ,$133.77 ,$133.77 ,$190.80 ,$159.00 ,$190.99 ,$186.56 ,$190.99 ,$159.00 ,$159.00 ,$180.20 ,$180.20 ,$190.99 ,$180.20 ,$190.99 ,$167.48 ,$167.48 ,$167.48 ,$190.80 ,$212.00 ,$190.80 ,$190.99 ,$212.00 ,$138.86 ,$190.99 ,$92.01 , N/A ,$199.91 ,$190.80 ,$413.91 ,$133.77 ,$127.20 ,$190.80 ,$190.99 ,$190.80 ,$190.80 ,$190.99 ,$137.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000014,94002,HC VENT WEANING FIRST DAY,410,1 ,$833.00 ,$541.45 ,$361.52 ,"$1,069.05 ",$620.59 ,$545.62 ,$493.30 ,$438.99 ,$493.30 ,$525.62 ,$525.62 ,$525.62 ,$525.62 ,$749.70 ,$624.75 ,$493.30 ,$733.04 ,$493.30 ,$624.75 ,$624.75 ,$708.05 ,$708.05 ,$493.30 ,$708.05 ,$493.30 ,$658.07 ,$658.07 ,$658.07 ,$749.70 ,$833.00 ,$749.70 ,$493.30 ,$833.00 ,$545.62 ,$493.30 ,$361.52 , N/A ,$516.33 ,$749.70 ,"$1,069.05 ",$525.62 ,$499.80 ,$749.70 ,$493.30 ,$749.70 ,$749.70 ,$493.30 ,$541.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000015,94002,HC VENT NEONATAL INTL DAY,410,1 ,$833.00 ,$541.45 ,$361.52 ,"$1,069.05 ",$620.59 ,$545.62 ,$493.30 ,$438.99 ,$493.30 ,$525.62 ,$525.62 ,$525.62 ,$525.62 ,$749.70 ,$624.75 ,$493.30 ,$733.04 ,$493.30 ,$624.75 ,$624.75 ,$708.05 ,$708.05 ,$493.30 ,$708.05 ,$493.30 ,$658.07 ,$658.07 ,$658.07 ,$749.70 ,$833.00 ,$749.70 ,$493.30 ,$833.00 ,$545.62 ,$493.30 ,$361.52 , N/A ,$516.33 ,$749.70 ,"$1,069.05 ",$525.62 ,$499.80 ,$749.70 ,$493.30 ,$749.70 ,$749.70 ,$493.30 ,$541.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000018,94660,HC VENT NONINVAS PEDS INTL DAY,410,1 ,$212.00 ,$137.80 ,$92.01 ,$413.91 ,$157.94 ,$138.86 ,$190.99 ,$111.72 ,$190.99 ,$133.77 ,$133.77 ,$133.77 ,$133.77 ,$190.80 ,$159.00 ,$190.99 ,$186.56 ,$190.99 ,$159.00 ,$159.00 ,$180.20 ,$180.20 ,$190.99 ,$180.20 ,$190.99 ,$167.48 ,$167.48 ,$167.48 ,$190.80 ,$212.00 ,$190.80 ,$190.99 ,$212.00 ,$138.86 ,$190.99 ,$92.01 , N/A ,$199.91 ,$190.80 ,$413.91 ,$133.77 ,$127.20 ,$190.80 ,$190.99 ,$190.80 ,$190.80 ,$190.99 ,$137.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000027,94003,HC VENT MANGMNT INPT/OBS SUBS DAY,410,1 ,$554.00 ,$360.10 ,$240.44 ,"$1,069.05 ",$412.73 ,$362.87 ,$493.30 ,$291.96 ,$493.30 ,$349.57 ,$349.57 ,$349.57 ,$349.57 ,$498.60 ,$415.50 ,$493.30 ,$487.52 ,$493.30 ,$415.50 ,$415.50 ,$470.90 ,$470.90 ,$493.30 ,$470.90 ,$493.30 ,$437.66 ,$437.66 ,$437.66 ,$498.60 ,$554.00 ,$498.60 ,$493.30 ,$554.00 ,$362.87 ,$493.30 ,$240.44 , N/A ,$516.33 ,$498.60 ,"$1,069.05 ",$349.57 ,$332.40 ,$498.60 ,$493.30 ,$498.60 ,$498.60 ,$493.30 ,$360.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000029,94660,HC VENT NONINVAS ADLT SUBQ DAY,410,1 ,$212.00 ,$137.80 ,$92.01 ,$413.91 ,$157.94 ,$138.86 ,$190.99 ,$111.72 ,$190.99 ,$133.77 ,$133.77 ,$133.77 ,$133.77 ,$190.80 ,$159.00 ,$190.99 ,$186.56 ,$190.99 ,$159.00 ,$159.00 ,$180.20 ,$180.20 ,$190.99 ,$180.20 ,$190.99 ,$167.48 ,$167.48 ,$167.48 ,$190.80 ,$212.00 ,$190.80 ,$190.99 ,$212.00 ,$138.86 ,$190.99 ,$92.01 , N/A ,$199.91 ,$190.80 ,$413.91 ,$133.77 ,$127.20 ,$190.80 ,$190.99 ,$190.80 ,$190.80 ,$190.99 ,$137.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000033,94660,HC VENT NONINVAS PEDS SUBQ DAY,410,1 ,$212.00 ,$137.80 ,$92.01 ,$413.91 ,$157.94 ,$138.86 ,$190.99 ,$111.72 ,$190.99 ,$133.77 ,$133.77 ,$133.77 ,$133.77 ,$190.80 ,$159.00 ,$190.99 ,$186.56 ,$190.99 ,$159.00 ,$159.00 ,$180.20 ,$180.20 ,$190.99 ,$180.20 ,$190.99 ,$167.48 ,$167.48 ,$167.48 ,$190.80 ,$212.00 ,$190.80 ,$190.99 ,$212.00 ,$138.86 ,$190.99 ,$92.01 , N/A ,$199.91 ,$190.80 ,$413.91 ,$133.77 ,$127.20 ,$190.80 ,$190.99 ,$190.80 ,$190.80 ,$190.99 ,$137.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000035,94640,HC NEBULIZER TREATMENT EACH,410,1 ,$81.00 ,$52.65 ,$35.15 ,$413.91 ,$60.35 ,$53.06 ,$81.00 ,$42.69 ,$81.00 ,$51.11 ,$51.11 ,$51.11 ,$51.11 ,$72.90 ,$60.75 ,$81.00 ,$71.28 ,$81.00 ,$60.75 ,$60.75 ,$68.85 ,$68.85 ,$81.00 ,$68.85 ,$81.00 ,$63.99 ,$63.99 ,$63.99 ,$72.90 ,$81.00 ,$72.90 ,$81.00 ,$81.00 ,$53.06 ,$81.00 ,$35.15 , N/A ,$81.00 ,$72.90 ,$413.91 ,$51.11 ,$48.60 ,$72.90 ,$81.00 ,$72.90 ,$72.90 ,$81.00 ,$52.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000037,94640,HC INCENTIVE SPIROMETER TRT,410,1 ,$81.00 ,$52.65 ,$35.15 ,$413.91 ,$60.35 ,$53.06 ,$81.00 ,$42.69 ,$81.00 ,$51.11 ,$51.11 ,$51.11 ,$51.11 ,$72.90 ,$60.75 ,$81.00 ,$71.28 ,$81.00 ,$60.75 ,$60.75 ,$68.85 ,$68.85 ,$81.00 ,$68.85 ,$81.00 ,$63.99 ,$63.99 ,$63.99 ,$72.90 ,$81.00 ,$72.90 ,$81.00 ,$81.00 ,$53.06 ,$81.00 ,$35.15 , N/A ,$81.00 ,$72.90 ,$413.91 ,$51.11 ,$48.60 ,$72.90 ,$81.00 ,$72.90 ,$72.90 ,$81.00 ,$52.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000038,94640,HC AEROSOL GENTR SHORT-TERM,410,1 ,$81.00 ,$52.65 ,$35.15 ,$413.91 ,$60.35 ,$53.06 ,$81.00 ,$42.69 ,$81.00 ,$51.11 ,$51.11 ,$51.11 ,$51.11 ,$72.90 ,$60.75 ,$81.00 ,$71.28 ,$81.00 ,$60.75 ,$60.75 ,$68.85 ,$68.85 ,$81.00 ,$68.85 ,$81.00 ,$63.99 ,$63.99 ,$63.99 ,$72.90 ,$81.00 ,$72.90 ,$81.00 ,$81.00 ,$53.06 ,$81.00 ,$35.15 , N/A ,$81.00 ,$72.90 ,$413.91 ,$51.11 ,$48.60 ,$72.90 ,$81.00 ,$72.90 ,$72.90 ,$81.00 ,$52.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000040,94640,HC EZ PAP TREATMENT,410,1 ,$81.00 ,$52.65 ,$35.15 ,$413.91 ,$60.35 ,$53.06 ,$81.00 ,$42.69 ,$81.00 ,$51.11 ,$51.11 ,$51.11 ,$51.11 ,$72.90 ,$60.75 ,$81.00 ,$71.28 ,$81.00 ,$60.75 ,$60.75 ,$68.85 ,$68.85 ,$81.00 ,$68.85 ,$81.00 ,$63.99 ,$63.99 ,$63.99 ,$72.90 ,$81.00 ,$72.90 ,$81.00 ,$81.00 ,$53.06 ,$81.00 ,$35.15 , N/A ,$81.00 ,$72.90 ,$413.91 ,$51.11 ,$48.60 ,$72.90 ,$81.00 ,$72.90 ,$72.90 ,$81.00 ,$52.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000041,94640,HC MDI/DPI TX INITIAL,410,1 ,$81.00 ,$52.65 ,$35.15 ,$413.91 ,$60.35 ,$53.06 ,$81.00 ,$42.69 ,$81.00 ,$51.11 ,$51.11 ,$51.11 ,$51.11 ,$72.90 ,$60.75 ,$81.00 ,$71.28 ,$81.00 ,$60.75 ,$60.75 ,$68.85 ,$68.85 ,$81.00 ,$68.85 ,$81.00 ,$63.99 ,$63.99 ,$63.99 ,$72.90 ,$81.00 ,$72.90 ,$81.00 ,$81.00 ,$53.06 ,$81.00 ,$35.15 , N/A ,$81.00 ,$72.90 ,$413.91 ,$51.11 ,$48.60 ,$72.90 ,$81.00 ,$72.90 ,$72.90 ,$81.00 ,$52.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000050,94644,HC AEROSOL CONTINUOUS 1ST HR,410,1 ,$302.00 ,$196.30 ,$113.81 ,$302.00 ,$224.99 ,$197.81 ,$113.81 ,$159.15 ,$113.81 ,$190.56 ,$190.56 ,$190.56 ,$190.56 ,$271.80 ,$226.50 ,$113.81 ,$265.76 ,$113.81 ,$226.50 ,$226.50 ,$256.70 ,$256.70 ,$113.81 ,$256.70 ,$113.81 ,$238.58 ,$238.58 ,$238.58 ,$271.80 ,$273.20 ,$271.80 ,$113.81 ,$302.00 ,$197.81 ,$113.81 ,$131.07 , N/A ,$119.12 ,$271.80 ,$246.63 ,$190.56 ,$181.20 ,$271.80 ,$113.81 ,$271.80 ,$271.80 ,$113.81 ,$196.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000051,94645,HC AEROSOL CONTINUOUS ADDL HR,410,1 ,$318.00 ,$206.70 ,$138.01 ,$318.00 ,$236.91 ,$208.29 , N/A ,$167.59 , N/A ,$200.66 ,$200.66 ,$200.66 ,$200.66 ,$286.20 ,$238.50 , N/A ,$279.84 , N/A ,$238.50 ,$238.50 ,$270.30 ,$270.30 , N/A ,$270.30 , N/A ,$251.22 ,$251.22 ,$251.22 ,$286.20 , N/A ,$286.20 , N/A ,$318.00 ,$208.29 , N/A ,$138.01 , N/A , N/A ,$286.20 , N/A ,$200.66 ,$190.80 ,$286.20 , N/A ,$286.20 ,$286.20 , N/A ,$206.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000052,94660,HC CPAP,410,1 ,$212.00 ,$137.80 ,$92.01 ,$413.91 ,$157.94 ,$138.86 ,$190.99 ,$111.72 ,$190.99 ,$133.77 ,$133.77 ,$133.77 ,$133.77 ,$190.80 ,$159.00 ,$190.99 ,$186.56 ,$190.99 ,$159.00 ,$159.00 ,$180.20 ,$180.20 ,$190.99 ,$180.20 ,$190.99 ,$167.48 ,$167.48 ,$167.48 ,$190.80 ,$212.00 ,$190.80 ,$190.99 ,$212.00 ,$138.86 ,$190.99 ,$92.01 , N/A ,$199.91 ,$190.80 ,$413.91 ,$133.77 ,$127.20 ,$190.80 ,$190.99 ,$190.80 ,$190.80 ,$190.99 ,$137.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000054,94660,HC CPAP NEONATAL/DAY,410,1 ,$212.00 ,$137.80 ,$92.01 ,$413.91 ,$157.94 ,$138.86 ,$190.99 ,$111.72 ,$190.99 ,$133.77 ,$133.77 ,$133.77 ,$133.77 ,$190.80 ,$159.00 ,$190.99 ,$186.56 ,$190.99 ,$159.00 ,$159.00 ,$180.20 ,$180.20 ,$190.99 ,$180.20 ,$190.99 ,$167.48 ,$167.48 ,$167.48 ,$190.80 ,$212.00 ,$190.80 ,$190.99 ,$212.00 ,$138.86 ,$190.99 ,$92.01 , N/A ,$199.91 ,$190.80 ,$413.91 ,$133.77 ,$127.20 ,$190.80 ,$190.99 ,$190.80 ,$190.80 ,$190.99 ,$137.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000057,94664,HC DEMO/EVAL/MDI/NEB DAILY,410,1 ,$41.00 ,$26.65 ,$17.79 ,$413.91 ,$30.55 ,$26.86 ,$41.00 ,$21.61 ,$41.00 ,$25.87 ,$25.87 ,$25.87 ,$25.87 ,$36.90 ,$30.75 ,$41.00 ,$36.08 ,$41.00 ,$30.75 ,$30.75 ,$34.85 ,$34.85 ,$41.00 ,$34.85 ,$41.00 ,$32.39 ,$32.39 ,$32.39 ,$36.90 ,$41.00 ,$36.90 ,$41.00 ,$41.00 ,$26.86 ,$41.00 ,$17.79 , N/A ,$41.00 ,$36.90 ,$413.91 ,$25.87 ,$24.60 ,$36.90 ,$41.00 ,$36.90 ,$36.90 ,$41.00 ,$26.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000058,94667,HC CHEST PHYSIOTHRPY INIT,410,1 ,$74.00 ,$48.10 ,$32.12 ,$246.63 ,$55.13 ,$48.47 ,$74.00 ,$39.00 ,$74.00 ,$46.69 ,$46.69 ,$46.69 ,$46.69 ,$66.60 ,$55.50 ,$74.00 ,$65.12 ,$74.00 ,$55.50 ,$55.50 ,$62.90 ,$62.90 ,$74.00 ,$62.90 ,$74.00 ,$58.46 ,$58.46 ,$58.46 ,$66.60 ,$74.00 ,$66.60 ,$74.00 ,$74.00 ,$48.47 ,$74.00 ,$32.12 , N/A ,$74.00 ,$66.60 ,$246.63 ,$46.69 ,$44.40 ,$66.60 ,$74.00 ,$66.60 ,$66.60 ,$74.00 ,$48.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000059,94667,HC CHEST PHYSIOTHRPY INIT ACAPELLA,410,1 ,$74.00 ,$48.10 ,$32.12 ,$246.63 ,$55.13 ,$48.47 ,$74.00 ,$39.00 ,$74.00 ,$46.69 ,$46.69 ,$46.69 ,$46.69 ,$66.60 ,$55.50 ,$74.00 ,$65.12 ,$74.00 ,$55.50 ,$55.50 ,$62.90 ,$62.90 ,$74.00 ,$62.90 ,$74.00 ,$58.46 ,$58.46 ,$58.46 ,$66.60 ,$74.00 ,$66.60 ,$74.00 ,$74.00 ,$48.47 ,$74.00 ,$32.12 , N/A ,$74.00 ,$66.60 ,$246.63 ,$46.69 ,$44.40 ,$66.60 ,$74.00 ,$66.60 ,$66.60 ,$74.00 ,$48.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000060,94668,HC CHEST PHYSIOTHRPY SUBSQ,410,1 ,$65.00 ,$42.25 ,$28.21 ,$246.63 ,$48.43 ,$42.58 ,$65.00 ,$34.26 ,$65.00 ,$41.02 ,$41.02 ,$41.02 ,$41.02 ,$58.50 ,$48.75 ,$65.00 ,$57.20 ,$65.00 ,$48.75 ,$48.75 ,$55.25 ,$55.25 ,$65.00 ,$55.25 ,$65.00 ,$51.35 ,$51.35 ,$51.35 ,$58.50 ,$65.00 ,$58.50 ,$65.00 ,$65.00 ,$42.58 ,$65.00 ,$28.21 , N/A ,$65.00 ,$58.50 ,$246.63 ,$41.02 ,$39.00 ,$58.50 ,$65.00 ,$58.50 ,$58.50 ,$65.00 ,$42.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000061,94668,HC CHEST PHYSIOTHRPY SUBSQ ACAPELLA,410,1 ,$65.00 ,$42.25 ,$28.21 ,$246.63 ,$48.43 ,$42.58 ,$65.00 ,$34.26 ,$65.00 ,$41.02 ,$41.02 ,$41.02 ,$41.02 ,$58.50 ,$48.75 ,$65.00 ,$57.20 ,$65.00 ,$48.75 ,$48.75 ,$55.25 ,$55.25 ,$65.00 ,$55.25 ,$65.00 ,$51.35 ,$51.35 ,$51.35 ,$58.50 ,$65.00 ,$58.50 ,$65.00 ,$65.00 ,$42.58 ,$65.00 ,$28.21 , N/A ,$65.00 ,$58.50 ,$246.63 ,$41.02 ,$39.00 ,$58.50 ,$65.00 ,$58.50 ,$58.50 ,$65.00 ,$42.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000068,G0237,HC RESP STRENGTH/ENDURANCE 15 MIN,410,1 ,$63.00 ,$40.95 ,$25.08 ,$63.00 ,$46.94 ,$41.27 ,$25.08 ,$33.20 ,$25.08 ,$39.75 ,$39.75 ,$39.75 ,$39.75 ,$56.70 ,$47.25 ,$25.08 ,$55.44 ,$25.08 ,$47.25 ,$47.25 ,$53.55 ,$53.55 ,$25.08 ,$53.55 ,$25.08 ,$49.77 ,$49.77 ,$49.77 ,$56.70 ,$60.20 ,$56.70 ,$25.08 ,$63.00 ,$41.27 ,$25.08 ,$27.34 , N/A ,$26.25 ,$56.70 ,$54.35 ,$39.75 ,$37.80 ,$56.70 ,$25.08 ,$56.70 ,$56.70 ,$25.08 ,$40.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000069,G0238,HC RESP THRP FUNCTION 15 MIN,410,1 ,$82.00 ,$53.30 ,$25.08 ,$82.00 ,$61.09 ,$53.71 ,$25.08 ,$43.21 ,$25.08 ,$51.74 ,$51.74 ,$51.74 ,$51.74 ,$73.80 ,$61.50 ,$25.08 ,$72.16 ,$25.08 ,$61.50 ,$61.50 ,$69.70 ,$69.70 ,$25.08 ,$69.70 ,$25.08 ,$64.78 ,$64.78 ,$64.78 ,$73.80 ,$60.20 ,$73.80 ,$25.08 ,$82.00 ,$53.71 ,$25.08 ,$35.59 , N/A ,$26.25 ,$73.80 ,$54.35 ,$51.74 ,$49.20 ,$73.80 ,$25.08 ,$73.80 ,$73.80 ,$25.08 ,$53.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000070,G0239,HC THERAPEUTIC RT EXERCISE GROUP,410,1 ,$97.00 ,$63.05 ,$34.40 ,$97.00 ,$72.27 ,$63.54 ,$34.40 ,$51.12 ,$34.40 ,$61.21 ,$61.21 ,$61.21 ,$61.21 ,$87.30 ,$72.75 ,$34.40 ,$85.36 ,$34.40 ,$72.75 ,$72.75 ,$82.45 ,$82.45 ,$34.40 ,$82.45 ,$34.40 ,$76.63 ,$76.63 ,$76.63 ,$87.30 ,$82.58 ,$87.30 ,$34.40 ,$97.00 ,$63.54 ,$34.40 ,$42.10 , N/A ,$36.01 ,$87.30 ,$74.55 ,$61.21 ,$58.20 ,$87.30 ,$34.40 ,$87.30 ,$87.30 ,$34.40 ,$63.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000076,94640,HC NEBULIZER SUBSQ,410,1 ,$81.00 ,$52.65 ,$35.15 ,$413.91 ,$60.35 ,$53.06 ,$81.00 ,$42.69 ,$81.00 ,$51.11 ,$51.11 ,$51.11 ,$51.11 ,$72.90 ,$60.75 ,$81.00 ,$71.28 ,$81.00 ,$60.75 ,$60.75 ,$68.85 ,$68.85 ,$81.00 ,$68.85 ,$81.00 ,$63.99 ,$63.99 ,$63.99 ,$72.90 ,$81.00 ,$72.90 ,$81.00 ,$81.00 ,$53.06 ,$81.00 ,$35.15 , N/A ,$81.00 ,$72.90 ,$413.91 ,$51.11 ,$48.60 ,$72.90 ,$81.00 ,$72.90 ,$72.90 ,$81.00 ,$52.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000077,94762,HC PULSE OX PER DAY,410,1 ,$240.00 ,$156.00 ,$104.16 ,$307.44 ,$178.80 ,$157.20 ,$141.86 ,$126.48 ,$141.86 ,$151.44 ,$151.44 ,$151.44 ,$151.44 ,$216.00 ,$180.00 ,$141.86 ,$211.20 ,$141.86 ,$180.00 ,$180.00 ,$204.00 ,$204.00 ,$141.86 ,$204.00 ,$141.86 ,$189.60 ,$189.60 ,$189.60 ,$216.00 ,$240.00 ,$216.00 ,$141.86 ,$240.00 ,$157.20 ,$141.86 ,$104.16 , N/A ,$148.49 ,$216.00 ,$307.44 ,$151.44 ,$144.00 ,$216.00 ,$141.86 ,$216.00 ,$216.00 ,$141.86 ,$156.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000082,94640,HC EZPAP TREATMENT SUBSQ,410,1 ,$81.00 ,$52.65 ,$35.15 ,$413.91 ,$60.35 ,$53.06 ,$81.00 ,$42.69 ,$81.00 ,$51.11 ,$51.11 ,$51.11 ,$51.11 ,$72.90 ,$60.75 ,$81.00 ,$71.28 ,$81.00 ,$60.75 ,$60.75 ,$68.85 ,$68.85 ,$81.00 ,$68.85 ,$81.00 ,$63.99 ,$63.99 ,$63.99 ,$72.90 ,$81.00 ,$72.90 ,$81.00 ,$81.00 ,$53.06 ,$81.00 ,$35.15 , N/A ,$81.00 ,$72.90 ,$413.91 ,$51.11 ,$48.60 ,$72.90 ,$81.00 ,$72.90 ,$72.90 ,$81.00 ,$52.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000083,94660,HC CPAP/BIPAP SUBSQ,410,1 ,$212.00 ,$137.80 ,$92.01 ,$413.91 ,$157.94 ,$138.86 ,$190.99 ,$111.72 ,$190.99 ,$133.77 ,$133.77 ,$133.77 ,$133.77 ,$190.80 ,$159.00 ,$190.99 ,$186.56 ,$190.99 ,$159.00 ,$159.00 ,$180.20 ,$180.20 ,$190.99 ,$180.20 ,$190.99 ,$167.48 ,$167.48 ,$167.48 ,$190.80 ,$212.00 ,$190.80 ,$190.99 ,$212.00 ,$138.86 ,$190.99 ,$92.01 , N/A ,$199.91 ,$190.80 ,$413.91 ,$133.77 ,$127.20 ,$190.80 ,$190.99 ,$190.80 ,$190.80 ,$190.99 ,$137.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000089,94660,HC CPAP NEONATAL/DAY SUBSQ,410,1 ,$212.00 ,$137.80 ,$92.01 ,$413.91 ,$157.94 ,$138.86 ,$190.99 ,$111.72 ,$190.99 ,$133.77 ,$133.77 ,$133.77 ,$133.77 ,$190.80 ,$159.00 ,$190.99 ,$186.56 ,$190.99 ,$159.00 ,$159.00 ,$180.20 ,$180.20 ,$190.99 ,$180.20 ,$190.99 ,$167.48 ,$167.48 ,$167.48 ,$190.80 ,$212.00 ,$190.80 ,$190.99 ,$212.00 ,$138.86 ,$190.99 ,$92.01 , N/A ,$199.91 ,$190.80 ,$413.91 ,$133.77 ,$127.20 ,$190.80 ,$190.99 ,$190.80 ,$190.80 ,$190.99 ,$137.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000090,94640,HC MDI/DPI INHAL TX SUBSQ,410,1 ,$81.00 ,$52.65 ,$35.15 ,$413.91 ,$60.35 ,$53.06 ,$81.00 ,$42.69 ,$81.00 ,$51.11 ,$51.11 ,$51.11 ,$51.11 ,$72.90 ,$60.75 ,$81.00 ,$71.28 ,$81.00 ,$60.75 ,$60.75 ,$68.85 ,$68.85 ,$81.00 ,$68.85 ,$81.00 ,$63.99 ,$63.99 ,$63.99 ,$72.90 ,$81.00 ,$72.90 ,$81.00 ,$81.00 ,$53.06 ,$81.00 ,$35.15 , N/A ,$81.00 ,$72.90 ,$413.91 ,$51.11 ,$48.60 ,$72.90 ,$81.00 ,$72.90 ,$72.90 ,$81.00 ,$52.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41000092,94640,HC AEROSOL INHALATION SUBSQ,410,1 ,$81.00 ,$52.65 ,$35.15 ,$413.91 ,$60.35 ,$53.06 ,$81.00 ,$42.69 ,$81.00 ,$51.11 ,$51.11 ,$51.11 ,$51.11 ,$72.90 ,$60.75 ,$81.00 ,$71.28 ,$81.00 ,$60.75 ,$60.75 ,$68.85 ,$68.85 ,$81.00 ,$68.85 ,$81.00 ,$63.99 ,$63.99 ,$63.99 ,$72.90 ,$81.00 ,$72.90 ,$81.00 ,$81.00 ,$53.06 ,$81.00 ,$35.15 , N/A ,$81.00 ,$72.90 ,$413.91 ,$51.11 ,$48.60 ,$72.90 ,$81.00 ,$72.90 ,$72.90 ,$81.00 ,$52.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41300000,99183,HC HYPERBARIC O2 PER SESSION,413,1 ,"$2,334.00 ","$1,517.10 ","$1,012.96 ","$2,334.00 ","$1,738.83 ","$1,528.77 ", N/A ,"$1,230.02 ", N/A ,"$1,472.75 ","$1,472.75 ","$1,472.75 ","$1,472.75 ","$2,100.60 ","$1,750.50 ", N/A ,"$2,053.92 ", N/A ,"$1,750.50 ","$1,750.50 ","$1,983.90 ","$1,983.90 ", N/A ,"$1,983.90 ", N/A ,"$1,843.86 ","$1,843.86 ","$1,843.86 ","$2,100.60 ", N/A ,"$2,100.60 ", N/A ,"$2,334.00 ","$1,528.77 ", N/A ,"$1,012.96 ", N/A , N/A ,"$2,100.60 ", N/A ,"$1,472.75 ","$1,400.40 ","$2,100.60 ", N/A ,"$2,100.60 ","$2,100.60 ", N/A ,"$1,517.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),41300002,G0277,HC HYPERBARIC O2 PER 30 MIN,413,1 ,$570.00 ,$370.50 ,$121.26 ,$570.00 ,$424.65 ,$373.35 ,$121.26 ,$300.39 ,$121.26 ,$359.67 ,$359.67 ,$359.67 ,$359.67 ,$513.00 ,$427.50 ,$121.26 ,$501.60 ,$121.26 ,$427.50 ,$427.50 ,$484.50 ,$484.50 ,$121.26 ,$484.50 ,$121.26 ,$450.30 ,$450.30 ,$450.30 ,$513.00 ,$291.08 ,$513.00 ,$121.26 ,$570.00 ,$373.35 ,$121.26 ,$247.38 , N/A ,$126.92 ,$513.00 ,$262.78 ,$359.67 ,$342.00 ,$513.00 ,$121.26 ,$513.00 ,$513.00 ,$121.26 ,$370.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000008,95992,HC CANNALITH REPOSITIONING,420,1 ,$103.00 ,$66.95 ,$43.41 ,$103.00 ,$76.74 ,$67.47 ,$43.41 ,$54.28 ,$43.41 ,$64.99 ,$64.99 ,$64.99 ,$64.99 ,$92.70 ,$77.25 ,$43.41 ,$90.64 ,$43.41 ,$77.25 ,$77.25 ,$87.55 ,$87.55 ,$43.41 ,$87.55 ,$43.41 ,$81.37 ,$81.37 ,$81.37 ,$92.70 ,$103.00 ,$92.70 ,$43.41 ,$103.00 ,$67.47 ,$43.41 ,$44.70 , N/A ,$45.58 ,$92.70 ,$97.67 ,$64.99 ,$61.80 ,$92.70 ,$43.41 ,$92.70 ,$92.70 ,$43.41 ,$66.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000016,97022,HC WHIRLPOOL 15 MINUTES,420,1 ,$136.00 ,$88.40 ,$17.16 ,$136.00 ,$101.32 ,$89.08 ,$17.16 ,$71.67 ,$17.16 ,$85.82 ,$85.82 ,$85.82 ,$85.82 ,$122.40 ,$102.00 ,$17.16 ,$119.68 ,$17.16 ,$102.00 ,$102.00 ,$115.60 ,$115.60 ,$17.16 ,$115.60 ,$17.16 ,$107.44 ,$107.44 ,$107.44 ,$122.40 ,$42.90 ,$122.40 ,$17.16 ,$136.00 ,$89.08 ,$17.16 ,$59.02 , N/A ,$18.02 ,$122.40 ,$38.61 ,$85.82 ,$81.60 ,$122.40 ,$17.16 ,$122.40 ,$122.40 ,$17.16 ,$88.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000017,97022,HC WHIRLPOOL 30 MINUTES,420,1 ,$136.00 ,$88.40 ,$17.16 ,$136.00 ,$101.32 ,$89.08 ,$17.16 ,$71.67 ,$17.16 ,$85.82 ,$85.82 ,$85.82 ,$85.82 ,$122.40 ,$102.00 ,$17.16 ,$119.68 ,$17.16 ,$102.00 ,$102.00 ,$115.60 ,$115.60 ,$17.16 ,$115.60 ,$17.16 ,$107.44 ,$107.44 ,$107.44 ,$122.40 ,$42.90 ,$122.40 ,$17.16 ,$136.00 ,$89.08 ,$17.16 ,$59.02 , N/A ,$18.02 ,$122.40 ,$38.61 ,$85.82 ,$81.60 ,$122.40 ,$17.16 ,$122.40 ,$122.40 ,$17.16 ,$88.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000018,97022,HC WHIRLPOOL 45 MINUTES,420,1 ,$136.00 ,$88.40 ,$17.16 ,$136.00 ,$101.32 ,$89.08 ,$17.16 ,$71.67 ,$17.16 ,$85.82 ,$85.82 ,$85.82 ,$85.82 ,$122.40 ,$102.00 ,$17.16 ,$119.68 ,$17.16 ,$102.00 ,$102.00 ,$115.60 ,$115.60 ,$17.16 ,$115.60 ,$17.16 ,$107.44 ,$107.44 ,$107.44 ,$122.40 ,$42.90 ,$122.40 ,$17.16 ,$136.00 ,$89.08 ,$17.16 ,$59.02 , N/A ,$18.02 ,$122.40 ,$38.61 ,$85.82 ,$81.60 ,$122.40 ,$17.16 ,$122.40 ,$122.40 ,$17.16 ,$88.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000019,97022,HC WHIRLPOOL 60 MINUTES,420,1 ,$136.00 ,$88.40 ,$17.16 ,$136.00 ,$101.32 ,$89.08 ,$17.16 ,$71.67 ,$17.16 ,$85.82 ,$85.82 ,$85.82 ,$85.82 ,$122.40 ,$102.00 ,$17.16 ,$119.68 ,$17.16 ,$102.00 ,$102.00 ,$115.60 ,$115.60 ,$17.16 ,$115.60 ,$17.16 ,$107.44 ,$107.44 ,$107.44 ,$122.40 ,$42.90 ,$122.40 ,$17.16 ,$136.00 ,$89.08 ,$17.16 ,$59.02 , N/A ,$18.02 ,$122.40 ,$38.61 ,$85.82 ,$81.60 ,$122.40 ,$17.16 ,$122.40 ,$122.40 ,$17.16 ,$88.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000025,97032,HC ELECTRIC STIM EACH 15 MIN,420,1 ,$98.00 ,$63.70 ,$14.55 ,$98.00 ,$73.01 ,$64.19 ,$14.55 ,$51.65 ,$14.55 ,$61.84 ,$61.84 ,$61.84 ,$61.84 ,$88.20 ,$73.50 ,$14.55 ,$86.24 ,$14.55 ,$73.50 ,$73.50 ,$83.30 ,$83.30 ,$14.55 ,$83.30 ,$14.55 ,$77.42 ,$77.42 ,$77.42 ,$88.20 ,$36.38 ,$88.20 ,$14.55 ,$98.00 ,$64.19 ,$14.55 ,$42.53 , N/A ,$15.28 ,$88.20 ,$32.74 ,$61.84 ,$58.80 ,$88.20 ,$14.55 ,$88.20 ,$88.20 ,$14.55 ,$63.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000031,97033,HC IONTOPHORESIS; EA 15 MIN,420,1 ,$158.00 ,$102.70 ,$19.67 ,$158.00 ,$117.71 ,$103.49 ,$19.67 ,$83.27 ,$19.67 ,$99.70 ,$99.70 ,$99.70 ,$99.70 ,$142.20 ,$118.50 ,$19.67 ,$139.04 ,$19.67 ,$118.50 ,$118.50 ,$134.30 ,$134.30 ,$19.67 ,$134.30 ,$19.67 ,$124.82 ,$124.82 ,$124.82 ,$142.20 ,$49.18 ,$142.20 ,$19.67 ,$158.00 ,$103.49 ,$19.67 ,$68.57 , N/A ,$20.65 ,$142.20 ,$44.26 ,$99.70 ,$94.80 ,$142.20 ,$19.67 ,$142.20 ,$142.20 ,$19.67 ,$102.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000033,97035,HC ULTRASOUND EA 15MIN,420,1 ,$136.00 ,$88.40 ,$14.10 ,$136.00 ,$101.32 ,$89.08 ,$14.10 ,$71.67 ,$14.10 ,$85.82 ,$85.82 ,$85.82 ,$85.82 ,$122.40 ,$102.00 ,$14.10 ,$119.68 ,$14.10 ,$102.00 ,$102.00 ,$115.60 ,$115.60 ,$14.10 ,$115.60 ,$14.10 ,$107.44 ,$107.44 ,$107.44 ,$122.40 ,$35.25 ,$122.40 ,$14.10 ,$136.00 ,$89.08 ,$14.10 ,$59.02 , N/A ,$14.81 ,$122.40 ,$31.73 ,$85.82 ,$81.60 ,$122.40 ,$14.10 ,$122.40 ,$122.40 ,$14.10 ,$88.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000037,97110,HC THERA EXER; EA 15 MIN,420,1 ,$63.00 ,$40.95 ,$27.34 ,$65.84 ,$46.94 ,$41.27 ,$29.26 ,$33.20 ,$29.26 ,$39.75 ,$39.75 ,$39.75 ,$39.75 ,$56.70 ,$47.25 ,$29.26 ,$55.44 ,$29.26 ,$47.25 ,$47.25 ,$53.55 ,$53.55 ,$29.26 ,$53.55 ,$29.26 ,$49.77 ,$49.77 ,$49.77 ,$56.70 ,$63.00 ,$56.70 ,$29.26 ,$63.00 ,$41.27 ,$29.26 ,$27.34 , N/A ,$30.72 ,$56.70 ,$65.84 ,$39.75 ,$37.80 ,$56.70 ,$29.26 ,$56.70 ,$56.70 ,$29.26 ,$40.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000045,97112,HC NEUROMUSCULAR RE ED EA 15 MIN,420,1 ,$130.00 ,$84.50 ,$33.86 ,$130.00 ,$96.85 ,$85.15 ,$33.86 ,$68.51 ,$33.86 ,$82.03 ,$82.03 ,$82.03 ,$82.03 ,$117.00 ,$97.50 ,$33.86 ,$114.40 ,$33.86 ,$97.50 ,$97.50 ,$110.50 ,$110.50 ,$33.86 ,$110.50 ,$33.86 ,$102.70 ,$102.70 ,$102.70 ,$117.00 ,$84.65 ,$117.00 ,$33.86 ,$130.00 ,$85.15 ,$33.86 ,$56.42 , N/A ,$35.55 ,$117.00 ,$76.19 ,$82.03 ,$78.00 ,$117.00 ,$33.86 ,$117.00 ,$117.00 ,$33.86 ,$84.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000049,97116,HC AMBULATION GAIT TRAIN EA 15 MIN,420,1 ,$77.00 ,$50.05 ,$29.26 ,$77.00 ,$57.37 ,$50.44 ,$29.26 ,$40.58 ,$29.26 ,$48.59 ,$48.59 ,$48.59 ,$48.59 ,$69.30 ,$57.75 ,$29.26 ,$67.76 ,$29.26 ,$57.75 ,$57.75 ,$65.45 ,$65.45 ,$29.26 ,$65.45 ,$29.26 ,$60.83 ,$60.83 ,$60.83 ,$69.30 ,$73.15 ,$69.30 ,$29.26 ,$77.00 ,$50.44 ,$29.26 ,$33.42 , N/A ,$30.72 ,$69.30 ,$65.84 ,$48.59 ,$46.20 ,$69.30 ,$29.26 ,$69.30 ,$69.30 ,$29.26 ,$50.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000053,97124,HC THERAPEUTIC MASSAGE EA 15 MIN,420,1 ,$99.00 ,$64.35 ,$28.22 ,$99.00 ,$73.76 ,$64.85 ,$28.22 ,$52.17 ,$28.22 ,$62.47 ,$62.47 ,$62.47 ,$62.47 ,$89.10 ,$74.25 ,$28.22 ,$87.12 ,$28.22 ,$74.25 ,$74.25 ,$84.15 ,$84.15 ,$28.22 ,$84.15 ,$28.22 ,$78.21 ,$78.21 ,$78.21 ,$89.10 ,$70.55 ,$89.10 ,$28.22 ,$99.00 ,$64.85 ,$28.22 ,$42.97 , N/A ,$29.63 ,$89.10 ,$63.50 ,$62.47 ,$59.40 ,$89.10 ,$28.22 ,$89.10 ,$89.10 ,$28.22 ,$64.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000056,97140,HC MANUAL THERAPY EA 15 MIN,420,1 ,$132.00 ,$85.80 ,$26.97 ,$132.00 ,$98.34 ,$86.46 ,$26.97 ,$69.56 ,$26.97 ,$83.29 ,$83.29 ,$83.29 ,$83.29 ,$118.80 ,$99.00 ,$26.97 ,$116.16 ,$26.97 ,$99.00 ,$99.00 ,$112.20 ,$112.20 ,$26.97 ,$112.20 ,$26.97 ,$104.28 ,$104.28 ,$104.28 ,$118.80 ,$67.43 ,$118.80 ,$26.97 ,$132.00 ,$86.46 ,$26.97 ,$57.29 , N/A ,$28.32 ,$118.80 ,$60.68 ,$83.29 ,$79.20 ,$118.80 ,$26.97 ,$118.80 ,$118.80 ,$26.97 ,$85.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000065,97530,HC THERAPEUTIC ACTIVITIES EA 15 MIN,420,1 ,$223.00 ,$144.95 ,$37.50 ,$223.00 ,$166.14 ,$146.07 ,$37.50 ,$117.52 ,$37.50 ,$140.71 ,$140.71 ,$140.71 ,$140.71 ,$200.70 ,$167.25 ,$37.50 ,$196.24 ,$37.50 ,$167.25 ,$167.25 ,$189.55 ,$189.55 ,$37.50 ,$189.55 ,$37.50 ,$176.17 ,$176.17 ,$176.17 ,$200.70 ,$93.75 ,$200.70 ,$37.50 ,$223.00 ,$146.07 ,$37.50 ,$96.78 , N/A ,$39.38 ,$200.70 ,$84.38 ,$140.71 ,$133.80 ,$200.70 ,$37.50 ,$200.70 ,$200.70 ,$37.50 ,$144.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000083,97598,HC DEBR SKIN PART THICKNESS EA ADDN>20CM FACIL,420,1 ,$523.00 ,$339.95 ,$226.98 ,$523.00 ,$389.64 ,$342.57 , N/A ,$275.62 , N/A ,$330.01 ,$330.01 ,$330.01 ,$330.01 ,$470.70 ,$392.25 , N/A ,$460.24 , N/A ,$392.25 ,$392.25 ,$444.55 ,$444.55 , N/A ,$444.55 , N/A ,$413.17 ,$413.17 ,$413.17 ,$470.70 , N/A ,$470.70 , N/A ,$523.00 ,$342.57 , N/A ,$226.98 , N/A , N/A ,$470.70 , N/A ,$330.01 ,$313.80 ,$470.70 , N/A ,$470.70 ,$470.70 , N/A ,$339.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000084,97602,HC DEBRIDEMENT NONSELECTIVE,420,1 ,$517.00 ,$336.05 ,$224.38 ,$517.00 ,$385.17 ,$338.64 , N/A ,$272.46 , N/A ,$326.23 ,$326.23 ,$326.23 ,$326.23 ,$465.30 ,$387.75 , N/A ,$454.96 , N/A ,$387.75 ,$387.75 ,$439.45 ,$439.45 , N/A ,$439.45 , N/A ,$408.43 ,$408.43 ,$408.43 ,$465.30 , N/A ,$465.30 , N/A ,$517.00 ,$338.64 , N/A ,$224.38 , N/A , N/A ,$465.30 , N/A ,$326.23 ,$310.20 ,$465.30 , N/A ,$465.30 ,$465.30 , N/A ,$336.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000085,97605,HC NWPT <50 SQ CM FAC,420,1 ,$346.00 ,$224.90 ,$41.34 ,$346.00 ,$257.77 ,$226.63 ,$41.34 ,$182.34 ,$41.34 ,$218.33 ,$218.33 ,$218.33 ,$218.33 ,$311.40 ,$259.50 ,$41.34 ,$304.48 ,$41.34 ,$259.50 ,$259.50 ,$294.10 ,$294.10 ,$41.34 ,$294.10 ,$41.34 ,$273.34 ,$273.34 ,$273.34 ,$311.40 ,$103.35 ,$311.40 ,$41.34 ,$346.00 ,$226.63 ,$41.34 ,$150.16 , N/A ,$43.41 ,$311.40 ,$93.02 ,$218.33 ,$207.60 ,$311.40 ,$41.34 ,$311.40 ,$311.40 ,$41.34 ,$224.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000089,97606,HC NWPT >50 SQ CM FAC,420,1 ,$552.00 ,$358.80 ,$48.81 ,$552.00 ,$411.24 ,$361.56 ,$48.81 ,$290.90 ,$48.81 ,$348.31 ,$348.31 ,$348.31 ,$348.31 ,$496.80 ,$414.00 ,$48.81 ,$485.76 ,$48.81 ,$414.00 ,$414.00 ,$469.20 ,$469.20 ,$48.81 ,$469.20 ,$48.81 ,$436.08 ,$436.08 ,$436.08 ,$496.80 ,$122.03 ,$496.80 ,$48.81 ,$552.00 ,$361.56 ,$48.81 ,$239.57 , N/A ,$51.25 ,$496.80 ,$109.82 ,$348.31 ,$331.20 ,$496.80 ,$48.81 ,$496.80 ,$496.80 ,$48.81 ,$358.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000093,97750,HC PHYSICAL PERFORMANCE TST EA 15 MIN,420,1 ,$111.00 ,$72.15 ,$33.07 ,$111.00 ,$82.70 ,$72.71 ,$33.07 ,$58.50 ,$33.07 ,$70.04 ,$70.04 ,$70.04 ,$70.04 ,$99.90 ,$83.25 ,$33.07 ,$97.68 ,$33.07 ,$83.25 ,$83.25 ,$94.35 ,$94.35 ,$33.07 ,$94.35 ,$33.07 ,$87.69 ,$87.69 ,$87.69 ,$99.90 ,$82.68 ,$99.90 ,$33.07 ,$111.00 ,$72.71 ,$33.07 ,$48.17 , N/A ,$34.72 ,$99.90 ,$74.41 ,$70.04 ,$66.60 ,$99.90 ,$33.07 ,$99.90 ,$99.90 ,$33.07 ,$72.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000095,97763,HC ORTHTC/PRSTHTC CHECK EA 15MIN,420,1 ,$86.00 ,$55.90 ,$37.32 ,$116.87 ,$64.07 ,$56.33 ,$51.94 ,$45.32 ,$51.94 ,$54.27 ,$54.27 ,$54.27 ,$54.27 ,$77.40 ,$64.50 ,$51.94 ,$75.68 ,$51.94 ,$64.50 ,$64.50 ,$73.10 ,$73.10 ,$51.94 ,$73.10 ,$51.94 ,$67.94 ,$67.94 ,$67.94 ,$77.40 ,$86.00 ,$77.40 ,$51.94 ,$86.00 ,$56.33 ,$51.94 ,$37.32 , N/A ,$54.54 ,$77.40 ,$116.87 ,$54.27 ,$51.60 ,$77.40 ,$51.94 ,$77.40 ,$77.40 ,$51.94 ,$55.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000110,G0283,HC ELECT STIM(UNATTEND) OTHER,420,1 ,$64.00 ,$41.60 ,$12.74 ,$64.00 ,$47.68 ,$41.92 ,$12.74 ,$33.73 ,$12.74 ,$40.38 ,$40.38 ,$40.38 ,$40.38 ,$57.60 ,$48.00 ,$12.74 ,$56.32 ,$12.74 ,$48.00 ,$48.00 ,$54.40 ,$54.40 ,$12.74 ,$54.40 ,$12.74 ,$50.56 ,$50.56 ,$50.56 ,$57.60 ,$31.85 ,$57.60 ,$12.74 ,$64.00 ,$41.92 ,$12.74 ,$27.78 , N/A ,$13.38 ,$57.60 ,$28.67 ,$40.38 ,$38.40 ,$57.60 ,$12.74 ,$57.60 ,$57.60 ,$12.74 ,$41.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000160,97113,HC THERAPEUTIC ACT W/AQUA,420,1 ,$192.00 ,$124.80 ,$36.67 ,$192.00 ,$143.04 ,$125.76 ,$36.67 ,$101.18 ,$36.67 ,$121.15 ,$121.15 ,$121.15 ,$121.15 ,$172.80 ,$144.00 ,$36.67 ,$168.96 ,$36.67 ,$144.00 ,$144.00 ,$163.20 ,$163.20 ,$36.67 ,$163.20 ,$36.67 ,$151.68 ,$151.68 ,$151.68 ,$172.80 ,$91.68 ,$172.80 ,$36.67 ,$192.00 ,$125.76 ,$36.67 ,$83.33 , N/A ,$38.50 ,$172.80 ,$82.51 ,$121.15 ,$115.20 ,$172.80 ,$36.67 ,$172.80 ,$172.80 ,$36.67 ,$124.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000206,G0283,HC ELECT STIM (UNATTEND) OTHER 15MIN,420,1 ,$64.00 ,$41.60 ,$12.74 ,$64.00 ,$47.68 ,$41.92 ,$12.74 ,$33.73 ,$12.74 ,$40.38 ,$40.38 ,$40.38 ,$40.38 ,$57.60 ,$48.00 ,$12.74 ,$56.32 ,$12.74 ,$48.00 ,$48.00 ,$54.40 ,$54.40 ,$12.74 ,$54.40 ,$12.74 ,$50.56 ,$50.56 ,$50.56 ,$57.60 ,$31.85 ,$57.60 ,$12.74 ,$64.00 ,$41.92 ,$12.74 ,$27.78 , N/A ,$13.38 ,$57.60 ,$28.67 ,$40.38 ,$38.40 ,$57.60 ,$12.74 ,$57.60 ,$57.60 ,$12.74 ,$41.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000207,G0283,HC ELECT STIM (UNATTEND) OTHER 30MIN,420,1 ,$64.00 ,$41.60 ,$12.74 ,$64.00 ,$47.68 ,$41.92 ,$12.74 ,$33.73 ,$12.74 ,$40.38 ,$40.38 ,$40.38 ,$40.38 ,$57.60 ,$48.00 ,$12.74 ,$56.32 ,$12.74 ,$48.00 ,$48.00 ,$54.40 ,$54.40 ,$12.74 ,$54.40 ,$12.74 ,$50.56 ,$50.56 ,$50.56 ,$57.60 ,$31.85 ,$57.60 ,$12.74 ,$64.00 ,$41.92 ,$12.74 ,$27.78 , N/A ,$13.38 ,$57.60 ,$28.67 ,$40.38 ,$38.40 ,$57.60 ,$12.74 ,$57.60 ,$57.60 ,$12.74 ,$41.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000208,G0283,HC ELECT STIM (UNATTEND) OTHER 45MIN,420,1 ,$64.00 ,$41.60 ,$12.74 ,$64.00 ,$47.68 ,$41.92 ,$12.74 ,$33.73 ,$12.74 ,$40.38 ,$40.38 ,$40.38 ,$40.38 ,$57.60 ,$48.00 ,$12.74 ,$56.32 ,$12.74 ,$48.00 ,$48.00 ,$54.40 ,$54.40 ,$12.74 ,$54.40 ,$12.74 ,$50.56 ,$50.56 ,$50.56 ,$57.60 ,$31.85 ,$57.60 ,$12.74 ,$64.00 ,$41.92 ,$12.74 ,$27.78 , N/A ,$13.38 ,$57.60 ,$28.67 ,$40.38 ,$38.40 ,$57.60 ,$12.74 ,$57.60 ,$57.60 ,$12.74 ,$41.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000209,G0283,HC ELECT STIM (UNATTEND) OTHER 60MIN,420,1 ,$64.00 ,$41.60 ,$12.74 ,$64.00 ,$47.68 ,$41.92 ,$12.74 ,$33.73 ,$12.74 ,$40.38 ,$40.38 ,$40.38 ,$40.38 ,$57.60 ,$48.00 ,$12.74 ,$56.32 ,$12.74 ,$48.00 ,$48.00 ,$54.40 ,$54.40 ,$12.74 ,$54.40 ,$12.74 ,$50.56 ,$50.56 ,$50.56 ,$57.60 ,$31.85 ,$57.60 ,$12.74 ,$64.00 ,$41.92 ,$12.74 ,$27.78 , N/A ,$13.38 ,$57.60 ,$28.67 ,$40.38 ,$38.40 ,$57.60 ,$12.74 ,$57.60 ,$57.60 ,$12.74 ,$41.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000210,97016,HC APPLY VASOPNEUMATIC DEVICE 15MIN,420,1 ,$291.00 ,$189.15 ,$11.78 ,$291.00 ,$216.80 ,$190.61 ,$11.78 ,$153.36 ,$11.78 ,$183.62 ,$183.62 ,$183.62 ,$183.62 ,$261.90 ,$218.25 ,$11.78 ,$256.08 ,$11.78 ,$218.25 ,$218.25 ,$247.35 ,$247.35 ,$11.78 ,$247.35 ,$11.78 ,$229.89 ,$229.89 ,$229.89 ,$261.90 ,$29.45 ,$261.90 ,$11.78 ,$291.00 ,$190.61 ,$11.78 ,$126.29 , N/A ,$12.37 ,$261.90 ,$26.51 ,$183.62 ,$174.60 ,$261.90 ,$11.78 ,$261.90 ,$261.90 ,$11.78 ,$189.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000211,97016,HC APPLY VASOPNEUMATIC DEVICE 30MIN,420,1 ,$291.00 ,$189.15 ,$11.78 ,$291.00 ,$216.80 ,$190.61 ,$11.78 ,$153.36 ,$11.78 ,$183.62 ,$183.62 ,$183.62 ,$183.62 ,$261.90 ,$218.25 ,$11.78 ,$256.08 ,$11.78 ,$218.25 ,$218.25 ,$247.35 ,$247.35 ,$11.78 ,$247.35 ,$11.78 ,$229.89 ,$229.89 ,$229.89 ,$261.90 ,$29.45 ,$261.90 ,$11.78 ,$291.00 ,$190.61 ,$11.78 ,$126.29 , N/A ,$12.37 ,$261.90 ,$26.51 ,$183.62 ,$174.60 ,$261.90 ,$11.78 ,$261.90 ,$261.90 ,$11.78 ,$189.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000214,97012,HC TRACTION MECHANICAL APPL 15 MIN,420,1 ,$130.00 ,$84.50 ,$14.55 ,$130.00 ,$96.85 ,$85.15 ,$14.55 ,$68.51 ,$14.55 ,$82.03 ,$82.03 ,$82.03 ,$82.03 ,$117.00 ,$97.50 ,$14.55 ,$114.40 ,$14.55 ,$97.50 ,$97.50 ,$110.50 ,$110.50 ,$14.55 ,$110.50 ,$14.55 ,$102.70 ,$102.70 ,$102.70 ,$117.00 ,$36.38 ,$117.00 ,$14.55 ,$130.00 ,$85.15 ,$14.55 ,$56.42 , N/A ,$15.28 ,$117.00 ,$32.74 ,$82.03 ,$78.00 ,$117.00 ,$14.55 ,$117.00 ,$117.00 ,$14.55 ,$84.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000215,97012,HC TRACTION MECHANICAL APPL 30 MIN,420,1 ,$130.00 ,$84.50 ,$14.55 ,$130.00 ,$96.85 ,$85.15 ,$14.55 ,$68.51 ,$14.55 ,$82.03 ,$82.03 ,$82.03 ,$82.03 ,$117.00 ,$97.50 ,$14.55 ,$114.40 ,$14.55 ,$97.50 ,$97.50 ,$110.50 ,$110.50 ,$14.55 ,$110.50 ,$14.55 ,$102.70 ,$102.70 ,$102.70 ,$117.00 ,$36.38 ,$117.00 ,$14.55 ,$130.00 ,$85.15 ,$14.55 ,$56.42 , N/A ,$15.28 ,$117.00 ,$32.74 ,$82.03 ,$78.00 ,$117.00 ,$14.55 ,$117.00 ,$117.00 ,$14.55 ,$84.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000241,97110,HC EARLY INTER THERA PROC TX OFFSITE- 15MIN,420,1 ,$63.00 ,$40.95 ,$27.34 ,$65.84 ,$46.94 ,$41.27 ,$29.26 ,$33.20 ,$29.26 ,$39.75 ,$39.75 ,$39.75 ,$39.75 ,$56.70 ,$47.25 ,$29.26 ,$55.44 ,$29.26 ,$47.25 ,$47.25 ,$53.55 ,$53.55 ,$29.26 ,$53.55 ,$29.26 ,$49.77 ,$49.77 ,$49.77 ,$56.70 ,$63.00 ,$56.70 ,$29.26 ,$63.00 ,$41.27 ,$29.26 ,$27.34 , N/A ,$30.72 ,$56.70 ,$65.84 ,$39.75 ,$37.80 ,$56.70 ,$29.26 ,$56.70 ,$56.70 ,$29.26 ,$40.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000250,97124,HC MASSAGE THERAPY ASTYM EXTREMITY UNILAT 30 MIN,420,1 ,$44.00 ,$28.60 ,$19.10 ,$63.50 ,$32.78 ,$28.82 ,$28.22 ,$23.19 ,$28.22 ,$27.76 ,$27.76 ,$27.76 ,$27.76 ,$39.60 ,$33.00 ,$28.22 ,$38.72 ,$28.22 ,$33.00 ,$33.00 ,$37.40 ,$37.40 ,$28.22 ,$37.40 ,$28.22 ,$34.76 ,$34.76 ,$34.76 ,$39.60 ,$44.00 ,$39.60 ,$28.22 ,$44.00 ,$28.82 ,$28.22 ,$19.10 , N/A ,$29.63 ,$39.60 ,$63.50 ,$27.76 ,$26.40 ,$39.60 ,$28.22 ,$39.60 ,$39.60 ,$28.22 ,$28.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000251,97124,HC MASSAGE THERAPY ASTYM EXTREMITY BILAT 45 MIN,420,1 ,$77.00 ,$50.05 ,$28.22 ,$77.00 ,$57.37 ,$50.44 ,$28.22 ,$40.58 ,$28.22 ,$48.59 ,$48.59 ,$48.59 ,$48.59 ,$69.30 ,$57.75 ,$28.22 ,$67.76 ,$28.22 ,$57.75 ,$57.75 ,$65.45 ,$65.45 ,$28.22 ,$65.45 ,$28.22 ,$60.83 ,$60.83 ,$60.83 ,$69.30 ,$70.55 ,$69.30 ,$28.22 ,$77.00 ,$50.44 ,$28.22 ,$33.42 , N/A ,$29.63 ,$69.30 ,$63.50 ,$48.59 ,$46.20 ,$69.30 ,$28.22 ,$69.30 ,$69.30 ,$28.22 ,$50.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000252,97124,HC MASSAGE THERAPY ASTYM LOWER EXTR BILAT W/BACK,420,1 ,$77.00 ,$50.05 ,$28.22 ,$77.00 ,$57.37 ,$50.44 ,$28.22 ,$40.58 ,$28.22 ,$48.59 ,$48.59 ,$48.59 ,$48.59 ,$69.30 ,$57.75 ,$28.22 ,$67.76 ,$28.22 ,$57.75 ,$57.75 ,$65.45 ,$65.45 ,$28.22 ,$65.45 ,$28.22 ,$60.83 ,$60.83 ,$60.83 ,$69.30 ,$70.55 ,$69.30 ,$28.22 ,$77.00 ,$50.44 ,$28.22 ,$33.42 , N/A ,$29.63 ,$69.30 ,$63.50 ,$48.59 ,$46.20 ,$69.30 ,$28.22 ,$69.30 ,$69.30 ,$28.22 ,$50.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000253,97124,HC MASSAGE THERAPY ASTYM LOWER EXTR BILAT W/BACK/ABDOMEN,420,1 ,$88.00 ,$57.20 ,$28.22 ,$88.00 ,$65.56 ,$57.64 ,$28.22 ,$46.38 ,$28.22 ,$55.53 ,$55.53 ,$55.53 ,$55.53 ,$79.20 ,$66.00 ,$28.22 ,$77.44 ,$28.22 ,$66.00 ,$66.00 ,$74.80 ,$74.80 ,$28.22 ,$74.80 ,$28.22 ,$69.52 ,$69.52 ,$69.52 ,$79.20 ,$70.55 ,$79.20 ,$28.22 ,$88.00 ,$57.64 ,$28.22 ,$38.19 , N/A ,$29.63 ,$79.20 ,$63.50 ,$55.53 ,$52.80 ,$79.20 ,$28.22 ,$79.20 ,$79.20 ,$28.22 ,$57.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000254,97124,HC MASSAGE THERAPY ASTYM BACK/ABDOMEN,420,1 ,$110.00 ,$71.50 ,$28.22 ,$110.00 ,$81.95 ,$72.05 ,$28.22 ,$57.97 ,$28.22 ,$69.41 ,$69.41 ,$69.41 ,$69.41 ,$99.00 ,$82.50 ,$28.22 ,$96.80 ,$28.22 ,$82.50 ,$82.50 ,$93.50 ,$93.50 ,$28.22 ,$93.50 ,$28.22 ,$86.90 ,$86.90 ,$86.90 ,$99.00 ,$70.55 ,$99.00 ,$28.22 ,$110.00 ,$72.05 ,$28.22 ,$47.74 , N/A ,$29.63 ,$99.00 ,$63.50 ,$69.41 ,$66.00 ,$99.00 ,$28.22 ,$99.00 ,$99.00 ,$28.22 ,$71.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000255,97124,HC MASSAGE THERAPY ASTYM PER HOUR,420,1 ,$88.00 ,$57.20 ,$28.22 ,$88.00 ,$65.56 ,$57.64 ,$28.22 ,$46.38 ,$28.22 ,$55.53 ,$55.53 ,$55.53 ,$55.53 ,$79.20 ,$66.00 ,$28.22 ,$77.44 ,$28.22 ,$66.00 ,$66.00 ,$74.80 ,$74.80 ,$28.22 ,$74.80 ,$28.22 ,$69.52 ,$69.52 ,$69.52 ,$79.20 ,$70.55 ,$79.20 ,$28.22 ,$88.00 ,$57.64 ,$28.22 ,$38.19 , N/A ,$29.63 ,$79.20 ,$63.50 ,$55.53 ,$52.80 ,$79.20 ,$28.22 ,$79.20 ,$79.20 ,$28.22 ,$57.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42000256,N/A,HC EVAL BODY MOTION ANALYSIS DARTFISH,420,1 ,$132.00 ,$85.80 ,$57.29 ,$132.00 ,$98.34 ,$86.46 , N/A ,$69.56 , N/A ,$83.29 ,$83.29 ,$83.29 ,$83.29 ,$118.80 ,$99.00 , N/A ,$116.16 , N/A ,$99.00 ,$99.00 ,$112.20 ,$112.20 , N/A ,$112.20 , N/A ,$104.28 ,$104.28 ,$104.28 ,$118.80 , N/A ,$118.80 , N/A ,$132.00 ,$86.46 , N/A ,$57.29 , N/A , N/A ,$118.80 , N/A ,$83.29 ,$79.20 ,$118.80 , N/A ,$118.80 ,$118.80 , N/A ,$85.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42010001,G8978,HC MOBILITY CURRENT STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42010002,G8979,HC MOBILITY GOAL STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42010003,G8980,HC MOBILITY DISCHARGE STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42010004,G8981,HC BODY POSITION CURRENT STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42010005,G8982,HC BODY POSITION GOAL STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42010006,G8983,HC BODY POSITION DISCHARGE STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42010007,G8984,HC CARRY CURRENT STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42010008,G8985,HC CARRY GOAL STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42010009,G8986,HC CARRY DISCHARGE STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42010010,G8987,HC SELF CARE CURRENT STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42010011,G8988,HC SELF CARE GOAL STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42010012,G8989,HC SELF CARE DISCHARGE STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42010013,G8990,HC OTHER PT/OT CURRENT STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42010014,G8991,HC OTHER PT/OT GOAL STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42010015,G8992,HC OTHER PT/OT DISCHARGE STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42010016,G8993,HC SUBSEQUENT LIMITATION CURRENT STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42010017,G8994,HC SUBSEQUENT LIMITATION GOAL STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42010018,G8995,HC SUBSEQUENT LIMITIATION DISCHARGE STATUS,420,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400043,97161,HC PT EVAL LOW COMPLEXITY 15MIN,424,1 ,$381.00 ,$247.65 ,$98.12 ,$381.00 ,$283.85 ,$249.56 ,$98.12 ,$200.79 ,$98.12 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$98.12 ,$335.28 ,$98.12 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$98.12 ,$323.85 ,$98.12 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$245.30 ,$342.90 ,$98.12 ,$381.00 ,$249.56 ,$98.12 ,$165.35 , N/A ,$103.03 ,$342.90 ,$220.77 ,$240.41 ,$228.60 ,$342.90 ,$98.12 ,$342.90 ,$342.90 ,$98.12 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400044,97161,HC PT EVAL LOW COMPLEXITY 30MIN,424,1 ,$381.00 ,$247.65 ,$98.12 ,$381.00 ,$283.85 ,$249.56 ,$98.12 ,$200.79 ,$98.12 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$98.12 ,$335.28 ,$98.12 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$98.12 ,$323.85 ,$98.12 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$245.30 ,$342.90 ,$98.12 ,$381.00 ,$249.56 ,$98.12 ,$165.35 , N/A ,$103.03 ,$342.90 ,$220.77 ,$240.41 ,$228.60 ,$342.90 ,$98.12 ,$342.90 ,$342.90 ,$98.12 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400045,97161,HC PT EVAL LOW COMPLEXITY 45MIN,424,1 ,$381.00 ,$247.65 ,$98.12 ,$381.00 ,$283.85 ,$249.56 ,$98.12 ,$200.79 ,$98.12 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$98.12 ,$335.28 ,$98.12 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$98.12 ,$323.85 ,$98.12 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$245.30 ,$342.90 ,$98.12 ,$381.00 ,$249.56 ,$98.12 ,$165.35 , N/A ,$103.03 ,$342.90 ,$220.77 ,$240.41 ,$228.60 ,$342.90 ,$98.12 ,$342.90 ,$342.90 ,$98.12 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400046,97161,HC PT EVAL LOW COMPLEXITY 60MIN,424,1 ,$381.00 ,$247.65 ,$98.12 ,$381.00 ,$283.85 ,$249.56 ,$98.12 ,$200.79 ,$98.12 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$98.12 ,$335.28 ,$98.12 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$98.12 ,$323.85 ,$98.12 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$245.30 ,$342.90 ,$98.12 ,$381.00 ,$249.56 ,$98.12 ,$165.35 , N/A ,$103.03 ,$342.90 ,$220.77 ,$240.41 ,$228.60 ,$342.90 ,$98.12 ,$342.90 ,$342.90 ,$98.12 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400047,97161,HC PT EVAL LOW COMPLEXITY 75MIN,424,1 ,$381.00 ,$247.65 ,$98.12 ,$381.00 ,$283.85 ,$249.56 ,$98.12 ,$200.79 ,$98.12 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$98.12 ,$335.28 ,$98.12 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$98.12 ,$323.85 ,$98.12 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$245.30 ,$342.90 ,$98.12 ,$381.00 ,$249.56 ,$98.12 ,$165.35 , N/A ,$103.03 ,$342.90 ,$220.77 ,$240.41 ,$228.60 ,$342.90 ,$98.12 ,$342.90 ,$342.90 ,$98.12 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400048,97161,HC PT EVAL LOW COMPLEXITY 90MIN,424,1 ,$381.00 ,$247.65 ,$98.12 ,$381.00 ,$283.85 ,$249.56 ,$98.12 ,$200.79 ,$98.12 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$98.12 ,$335.28 ,$98.12 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$98.12 ,$323.85 ,$98.12 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$245.30 ,$342.90 ,$98.12 ,$381.00 ,$249.56 ,$98.12 ,$165.35 , N/A ,$103.03 ,$342.90 ,$220.77 ,$240.41 ,$228.60 ,$342.90 ,$98.12 ,$342.90 ,$342.90 ,$98.12 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400049,97161,HC PT EVAL LOW COMPLEXITY 105MIN,424,1 ,$381.00 ,$247.65 ,$98.12 ,$381.00 ,$283.85 ,$249.56 ,$98.12 ,$200.79 ,$98.12 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$98.12 ,$335.28 ,$98.12 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$98.12 ,$323.85 ,$98.12 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$245.30 ,$342.90 ,$98.12 ,$381.00 ,$249.56 ,$98.12 ,$165.35 , N/A ,$103.03 ,$342.90 ,$220.77 ,$240.41 ,$228.60 ,$342.90 ,$98.12 ,$342.90 ,$342.90 ,$98.12 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400055,97162,HC PT EVAL MOD COMPLEXITY 15MIN,424,1 ,$443.00 ,$287.95 ,$98.12 ,$443.00 ,$330.04 ,$290.17 ,$98.12 ,$233.46 ,$98.12 ,$279.53 ,$279.53 ,$279.53 ,$279.53 ,$398.70 ,$332.25 ,$98.12 ,$389.84 ,$98.12 ,$332.25 ,$332.25 ,$376.55 ,$376.55 ,$98.12 ,$376.55 ,$98.12 ,$349.97 ,$349.97 ,$349.97 ,$398.70 ,$245.30 ,$398.70 ,$98.12 ,$443.00 ,$290.17 ,$98.12 ,$192.26 , N/A ,$103.03 ,$398.70 ,$220.77 ,$279.53 ,$265.80 ,$398.70 ,$98.12 ,$398.70 ,$398.70 ,$98.12 ,$287.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400056,97162,HC PT EVAL MOD COMPLEXITY 30MIN,424,1 ,$443.00 ,$287.95 ,$98.12 ,$443.00 ,$330.04 ,$290.17 ,$98.12 ,$233.46 ,$98.12 ,$279.53 ,$279.53 ,$279.53 ,$279.53 ,$398.70 ,$332.25 ,$98.12 ,$389.84 ,$98.12 ,$332.25 ,$332.25 ,$376.55 ,$376.55 ,$98.12 ,$376.55 ,$98.12 ,$349.97 ,$349.97 ,$349.97 ,$398.70 ,$245.30 ,$398.70 ,$98.12 ,$443.00 ,$290.17 ,$98.12 ,$192.26 , N/A ,$103.03 ,$398.70 ,$220.77 ,$279.53 ,$265.80 ,$398.70 ,$98.12 ,$398.70 ,$398.70 ,$98.12 ,$287.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400057,97162,HC PT EVAL MOD COMPLEXITY 45MIN,424,1 ,$443.00 ,$287.95 ,$98.12 ,$443.00 ,$330.04 ,$290.17 ,$98.12 ,$233.46 ,$98.12 ,$279.53 ,$279.53 ,$279.53 ,$279.53 ,$398.70 ,$332.25 ,$98.12 ,$389.84 ,$98.12 ,$332.25 ,$332.25 ,$376.55 ,$376.55 ,$98.12 ,$376.55 ,$98.12 ,$349.97 ,$349.97 ,$349.97 ,$398.70 ,$245.30 ,$398.70 ,$98.12 ,$443.00 ,$290.17 ,$98.12 ,$192.26 , N/A ,$103.03 ,$398.70 ,$220.77 ,$279.53 ,$265.80 ,$398.70 ,$98.12 ,$398.70 ,$398.70 ,$98.12 ,$287.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400058,97162,HC PT EVAL MOD COMPLEXITY 60MIN,424,1 ,$443.00 ,$287.95 ,$98.12 ,$443.00 ,$330.04 ,$290.17 ,$98.12 ,$233.46 ,$98.12 ,$279.53 ,$279.53 ,$279.53 ,$279.53 ,$398.70 ,$332.25 ,$98.12 ,$389.84 ,$98.12 ,$332.25 ,$332.25 ,$376.55 ,$376.55 ,$98.12 ,$376.55 ,$98.12 ,$349.97 ,$349.97 ,$349.97 ,$398.70 ,$245.30 ,$398.70 ,$98.12 ,$443.00 ,$290.17 ,$98.12 ,$192.26 , N/A ,$103.03 ,$398.70 ,$220.77 ,$279.53 ,$265.80 ,$398.70 ,$98.12 ,$398.70 ,$398.70 ,$98.12 ,$287.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400059,97162,HC PT EVAL MOD COMPLEXITY 75MIN,424,1 ,$443.00 ,$287.95 ,$98.12 ,$443.00 ,$330.04 ,$290.17 ,$98.12 ,$233.46 ,$98.12 ,$279.53 ,$279.53 ,$279.53 ,$279.53 ,$398.70 ,$332.25 ,$98.12 ,$389.84 ,$98.12 ,$332.25 ,$332.25 ,$376.55 ,$376.55 ,$98.12 ,$376.55 ,$98.12 ,$349.97 ,$349.97 ,$349.97 ,$398.70 ,$245.30 ,$398.70 ,$98.12 ,$443.00 ,$290.17 ,$98.12 ,$192.26 , N/A ,$103.03 ,$398.70 ,$220.77 ,$279.53 ,$265.80 ,$398.70 ,$98.12 ,$398.70 ,$398.70 ,$98.12 ,$287.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400060,97162,HC PT EVAL MOD COMPLEXITY 90MIN,424,1 ,$443.00 ,$287.95 ,$98.12 ,$443.00 ,$330.04 ,$290.17 ,$98.12 ,$233.46 ,$98.12 ,$279.53 ,$279.53 ,$279.53 ,$279.53 ,$398.70 ,$332.25 ,$98.12 ,$389.84 ,$98.12 ,$332.25 ,$332.25 ,$376.55 ,$376.55 ,$98.12 ,$376.55 ,$98.12 ,$349.97 ,$349.97 ,$349.97 ,$398.70 ,$245.30 ,$398.70 ,$98.12 ,$443.00 ,$290.17 ,$98.12 ,$192.26 , N/A ,$103.03 ,$398.70 ,$220.77 ,$279.53 ,$265.80 ,$398.70 ,$98.12 ,$398.70 ,$398.70 ,$98.12 ,$287.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400061,97162,HC PT EVAL MOD COMPLEXITY 105MIN,424,1 ,$443.00 ,$287.95 ,$98.12 ,$443.00 ,$330.04 ,$290.17 ,$98.12 ,$233.46 ,$98.12 ,$279.53 ,$279.53 ,$279.53 ,$279.53 ,$398.70 ,$332.25 ,$98.12 ,$389.84 ,$98.12 ,$332.25 ,$332.25 ,$376.55 ,$376.55 ,$98.12 ,$376.55 ,$98.12 ,$349.97 ,$349.97 ,$349.97 ,$398.70 ,$245.30 ,$398.70 ,$98.12 ,$443.00 ,$290.17 ,$98.12 ,$192.26 , N/A ,$103.03 ,$398.70 ,$220.77 ,$279.53 ,$265.80 ,$398.70 ,$98.12 ,$398.70 ,$398.70 ,$98.12 ,$287.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400067,97163,HC PT EVAL HIGH COMPLEXITY 15MIN,424,1 ,$618.00 ,$401.70 ,$98.12 ,$618.00 ,$460.41 ,$404.79 ,$98.12 ,$325.69 ,$98.12 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$98.12 ,$543.84 ,$98.12 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$98.12 ,$525.30 ,$98.12 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$245.30 ,$556.20 ,$98.12 ,$618.00 ,$404.79 ,$98.12 ,$268.21 , N/A ,$103.03 ,$556.20 ,$220.77 ,$389.96 ,$370.80 ,$556.20 ,$98.12 ,$556.20 ,$556.20 ,$98.12 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400068,97163,HC PT EVAL HIGH COMPLEXITY 30MIN,424,1 ,$618.00 ,$401.70 ,$98.12 ,$618.00 ,$460.41 ,$404.79 ,$98.12 ,$325.69 ,$98.12 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$98.12 ,$543.84 ,$98.12 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$98.12 ,$525.30 ,$98.12 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$245.30 ,$556.20 ,$98.12 ,$618.00 ,$404.79 ,$98.12 ,$268.21 , N/A ,$103.03 ,$556.20 ,$220.77 ,$389.96 ,$370.80 ,$556.20 ,$98.12 ,$556.20 ,$556.20 ,$98.12 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400069,97163,HC PT EVAL HIGH COMPLEXITY 45MIN,424,1 ,$618.00 ,$401.70 ,$98.12 ,$618.00 ,$460.41 ,$404.79 ,$98.12 ,$325.69 ,$98.12 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$98.12 ,$543.84 ,$98.12 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$98.12 ,$525.30 ,$98.12 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$245.30 ,$556.20 ,$98.12 ,$618.00 ,$404.79 ,$98.12 ,$268.21 , N/A ,$103.03 ,$556.20 ,$220.77 ,$389.96 ,$370.80 ,$556.20 ,$98.12 ,$556.20 ,$556.20 ,$98.12 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400070,97163,HC PT EVAL HIGH COMPLEXITY 60MIN,424,1 ,$618.00 ,$401.70 ,$98.12 ,$618.00 ,$460.41 ,$404.79 ,$98.12 ,$325.69 ,$98.12 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$98.12 ,$543.84 ,$98.12 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$98.12 ,$525.30 ,$98.12 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$245.30 ,$556.20 ,$98.12 ,$618.00 ,$404.79 ,$98.12 ,$268.21 , N/A ,$103.03 ,$556.20 ,$220.77 ,$389.96 ,$370.80 ,$556.20 ,$98.12 ,$556.20 ,$556.20 ,$98.12 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400071,97163,HC PT EVAL HIGH COMPLEXITY 75MIN,424,1 ,$618.00 ,$401.70 ,$98.12 ,$618.00 ,$460.41 ,$404.79 ,$98.12 ,$325.69 ,$98.12 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$98.12 ,$543.84 ,$98.12 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$98.12 ,$525.30 ,$98.12 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$245.30 ,$556.20 ,$98.12 ,$618.00 ,$404.79 ,$98.12 ,$268.21 , N/A ,$103.03 ,$556.20 ,$220.77 ,$389.96 ,$370.80 ,$556.20 ,$98.12 ,$556.20 ,$556.20 ,$98.12 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400072,97163,HC PT EVAL HIGH COMPLEXITY 90MIN,424,1 ,$618.00 ,$401.70 ,$98.12 ,$618.00 ,$460.41 ,$404.79 ,$98.12 ,$325.69 ,$98.12 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$98.12 ,$543.84 ,$98.12 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$98.12 ,$525.30 ,$98.12 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$245.30 ,$556.20 ,$98.12 ,$618.00 ,$404.79 ,$98.12 ,$268.21 , N/A ,$103.03 ,$556.20 ,$220.77 ,$389.96 ,$370.80 ,$556.20 ,$98.12 ,$556.20 ,$556.20 ,$98.12 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400073,97163,HC PT EVAL HIGH COMPLEXITY 105MIN,424,1 ,$618.00 ,$401.70 ,$98.12 ,$618.00 ,$460.41 ,$404.79 ,$98.12 ,$325.69 ,$98.12 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$98.12 ,$543.84 ,$98.12 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$98.12 ,$525.30 ,$98.12 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$245.30 ,$556.20 ,$98.12 ,$618.00 ,$404.79 ,$98.12 ,$268.21 , N/A ,$103.03 ,$556.20 ,$220.77 ,$389.96 ,$370.80 ,$556.20 ,$98.12 ,$556.20 ,$556.20 ,$98.12 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400079,97164,HC PT RE-EVAL 15MIN,424,1 ,$214.00 ,$139.10 ,$66.97 ,$214.00 ,$159.43 ,$140.17 ,$66.97 ,$112.78 ,$66.97 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$66.97 ,$188.32 ,$66.97 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$66.97 ,$181.90 ,$66.97 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$167.43 ,$192.60 ,$66.97 ,$214.00 ,$140.17 ,$66.97 ,$92.88 , N/A ,$70.32 ,$192.60 ,$150.68 ,$135.03 ,$128.40 ,$192.60 ,$66.97 ,$192.60 ,$192.60 ,$66.97 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400080,97164,HC PT RE-EVAL 30MIN,424,1 ,$214.00 ,$139.10 ,$66.97 ,$214.00 ,$159.43 ,$140.17 ,$66.97 ,$112.78 ,$66.97 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$66.97 ,$188.32 ,$66.97 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$66.97 ,$181.90 ,$66.97 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$167.43 ,$192.60 ,$66.97 ,$214.00 ,$140.17 ,$66.97 ,$92.88 , N/A ,$70.32 ,$192.60 ,$150.68 ,$135.03 ,$128.40 ,$192.60 ,$66.97 ,$192.60 ,$192.60 ,$66.97 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400081,97164,HC PT RE-EVAL 45MIN,424,1 ,$214.00 ,$139.10 ,$66.97 ,$214.00 ,$159.43 ,$140.17 ,$66.97 ,$112.78 ,$66.97 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$66.97 ,$188.32 ,$66.97 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$66.97 ,$181.90 ,$66.97 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$167.43 ,$192.60 ,$66.97 ,$214.00 ,$140.17 ,$66.97 ,$92.88 , N/A ,$70.32 ,$192.60 ,$150.68 ,$135.03 ,$128.40 ,$192.60 ,$66.97 ,$192.60 ,$192.60 ,$66.97 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400082,97164,HC PT RE-EVAL 60MIN,424,1 ,$214.00 ,$139.10 ,$66.97 ,$214.00 ,$159.43 ,$140.17 ,$66.97 ,$112.78 ,$66.97 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$66.97 ,$188.32 ,$66.97 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$66.97 ,$181.90 ,$66.97 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$167.43 ,$192.60 ,$66.97 ,$214.00 ,$140.17 ,$66.97 ,$92.88 , N/A ,$70.32 ,$192.60 ,$150.68 ,$135.03 ,$128.40 ,$192.60 ,$66.97 ,$192.60 ,$192.60 ,$66.97 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400083,97164,HC PT RE-EVAL 75MIN,424,1 ,$214.00 ,$139.10 ,$66.97 ,$214.00 ,$159.43 ,$140.17 ,$66.97 ,$112.78 ,$66.97 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$66.97 ,$188.32 ,$66.97 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$66.97 ,$181.90 ,$66.97 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$167.43 ,$192.60 ,$66.97 ,$214.00 ,$140.17 ,$66.97 ,$92.88 , N/A ,$70.32 ,$192.60 ,$150.68 ,$135.03 ,$128.40 ,$192.60 ,$66.97 ,$192.60 ,$192.60 ,$66.97 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400084,97164,HC PT RE-EVAL 90MIN,424,1 ,$214.00 ,$139.10 ,$66.97 ,$214.00 ,$159.43 ,$140.17 ,$66.97 ,$112.78 ,$66.97 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$66.97 ,$188.32 ,$66.97 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$66.97 ,$181.90 ,$66.97 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$167.43 ,$192.60 ,$66.97 ,$214.00 ,$140.17 ,$66.97 ,$92.88 , N/A ,$70.32 ,$192.60 ,$150.68 ,$135.03 ,$128.40 ,$192.60 ,$66.97 ,$192.60 ,$192.60 ,$66.97 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),42400085,97164,HC PT RE-EVAL 105MIN,424,1 ,$214.00 ,$139.10 ,$66.97 ,$214.00 ,$159.43 ,$140.17 ,$66.97 ,$112.78 ,$66.97 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$66.97 ,$188.32 ,$66.97 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$66.97 ,$181.90 ,$66.97 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$167.43 ,$192.60 ,$66.97 ,$214.00 ,$140.17 ,$66.97 ,$92.88 , N/A ,$70.32 ,$192.60 ,$150.68 ,$135.03 ,$128.40 ,$192.60 ,$66.97 ,$192.60 ,$192.60 ,$66.97 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43000013,97034,HC CONTRAST BATH EA 15 MIN,430,1 ,$77.00 ,$50.05 ,$14.42 ,$77.00 ,$57.37 ,$50.44 ,$14.42 ,$40.58 ,$14.42 ,$48.59 ,$48.59 ,$48.59 ,$48.59 ,$69.30 ,$57.75 ,$14.42 ,$67.76 ,$14.42 ,$57.75 ,$57.75 ,$65.45 ,$65.45 ,$14.42 ,$65.45 ,$14.42 ,$60.83 ,$60.83 ,$60.83 ,$69.30 ,$36.05 ,$69.30 ,$14.42 ,$77.00 ,$50.44 ,$14.42 ,$33.42 , N/A ,$15.14 ,$69.30 ,$32.45 ,$48.59 ,$46.20 ,$69.30 ,$14.42 ,$69.30 ,$69.30 ,$14.42 ,$50.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43000015,97533,HC PERCEPTUAL ACTIVITY EA 15 MIN,430,1 ,$94.00 ,$61.10 ,$40.80 ,$128.32 ,$70.03 ,$61.57 ,$57.03 ,$49.54 ,$57.03 ,$59.31 ,$59.31 ,$59.31 ,$59.31 ,$84.60 ,$70.50 ,$57.03 ,$82.72 ,$57.03 ,$70.50 ,$70.50 ,$79.90 ,$79.90 ,$57.03 ,$79.90 ,$57.03 ,$74.26 ,$74.26 ,$74.26 ,$84.60 ,$94.00 ,$84.60 ,$57.03 ,$94.00 ,$61.57 ,$57.03 ,$40.80 , N/A ,$59.88 ,$84.60 ,$128.32 ,$59.31 ,$56.40 ,$84.60 ,$57.03 ,$84.60 ,$84.60 ,$57.03 ,$61.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43000016,97535,HC SELF CARE ADL TRAINING EA 15MIN,430,1 ,$84.00 ,$54.60 ,$32.44 ,$84.00 ,$62.58 ,$55.02 ,$32.44 ,$44.27 ,$32.44 ,$53.00 ,$53.00 ,$53.00 ,$53.00 ,$75.60 ,$63.00 ,$32.44 ,$73.92 ,$32.44 ,$63.00 ,$63.00 ,$71.40 ,$71.40 ,$32.44 ,$71.40 ,$32.44 ,$66.36 ,$66.36 ,$66.36 ,$75.60 ,$81.10 ,$75.60 ,$32.44 ,$84.00 ,$55.02 ,$32.44 ,$36.46 , N/A ,$34.06 ,$75.60 ,$72.99 ,$53.00 ,$50.40 ,$75.60 ,$32.44 ,$75.60 ,$75.60 ,$32.44 ,$54.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43000027,97760,HC ORTHOTICS FABRICATION EA 15 MIN,430,1 ,$103.00 ,$66.95 ,$44.70 ,$106.99 ,$76.74 ,$67.47 ,$47.55 ,$54.28 ,$47.55 ,$64.99 ,$64.99 ,$64.99 ,$64.99 ,$92.70 ,$77.25 ,$47.55 ,$90.64 ,$47.55 ,$77.25 ,$77.25 ,$87.55 ,$87.55 ,$47.55 ,$87.55 ,$47.55 ,$81.37 ,$81.37 ,$81.37 ,$92.70 ,$103.00 ,$92.70 ,$47.55 ,$103.00 ,$67.47 ,$47.55 ,$44.70 , N/A ,$49.93 ,$92.70 ,$106.99 ,$64.99 ,$61.80 ,$92.70 ,$47.55 ,$92.70 ,$92.70 ,$47.55 ,$66.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43000035,97545,HC WORK HARDENING/CONDITIONING FIRST 2 HRS,430,1 ,$710.00 ,$461.50 ,$308.14 ,$710.00 ,$528.95 ,$465.05 , N/A ,$374.17 , N/A ,$448.01 ,$448.01 ,$448.01 ,$448.01 ,$639.00 ,$532.50 , N/A ,$624.80 , N/A ,$532.50 ,$532.50 ,$603.50 ,$603.50 , N/A ,$603.50 , N/A ,$560.90 ,$560.90 ,$560.90 ,$639.00 , N/A ,$639.00 , N/A ,$710.00 ,$465.05 , N/A ,$308.14 , N/A , N/A ,$639.00 , N/A ,$448.01 ,$426.00 ,$639.00 , N/A ,$639.00 ,$639.00 , N/A ,$461.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43000038,97018,HC PARAFFIN BATH THERAPY 15MIN,430,1 ,$86.00 ,$55.90 ,$5.69 ,$86.00 ,$64.07 ,$56.33 ,$5.69 ,$45.32 ,$5.69 ,$54.27 ,$54.27 ,$54.27 ,$54.27 ,$77.40 ,$64.50 ,$5.69 ,$75.68 ,$5.69 ,$64.50 ,$64.50 ,$73.10 ,$73.10 ,$5.69 ,$73.10 ,$5.69 ,$67.94 ,$67.94 ,$67.94 ,$77.40 ,$14.23 ,$77.40 ,$5.69 ,$86.00 ,$56.33 ,$5.69 ,$37.32 , N/A ,$5.97 ,$77.40 ,$12.80 ,$54.27 ,$51.60 ,$77.40 ,$5.69 ,$77.40 ,$77.40 ,$5.69 ,$55.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43000039,97018,HC PARAFFIN BATH THERAPY 30MIN,430,1 ,$86.00 ,$55.90 ,$5.69 ,$86.00 ,$64.07 ,$56.33 ,$5.69 ,$45.32 ,$5.69 ,$54.27 ,$54.27 ,$54.27 ,$54.27 ,$77.40 ,$64.50 ,$5.69 ,$75.68 ,$5.69 ,$64.50 ,$64.50 ,$73.10 ,$73.10 ,$5.69 ,$73.10 ,$5.69 ,$67.94 ,$67.94 ,$67.94 ,$77.40 ,$14.23 ,$77.40 ,$5.69 ,$86.00 ,$56.33 ,$5.69 ,$37.32 , N/A ,$5.97 ,$77.40 ,$12.80 ,$54.27 ,$51.60 ,$77.40 ,$5.69 ,$77.40 ,$77.40 ,$5.69 ,$55.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43000050,97530,HC EARLY INTER THERA ACTIV TX 15MIN,430,1 ,$223.00 ,$144.95 ,$37.50 ,$223.00 ,$166.14 ,$146.07 ,$37.50 ,$117.52 ,$37.50 ,$140.71 ,$140.71 ,$140.71 ,$140.71 ,$200.70 ,$167.25 ,$37.50 ,$196.24 ,$37.50 ,$167.25 ,$167.25 ,$189.55 ,$189.55 ,$37.50 ,$189.55 ,$37.50 ,$176.17 ,$176.17 ,$176.17 ,$200.70 ,$93.75 ,$200.70 ,$37.50 ,$223.00 ,$146.07 ,$37.50 ,$96.78 , N/A ,$39.38 ,$200.70 ,$84.38 ,$140.71 ,$133.80 ,$200.70 ,$37.50 ,$200.70 ,$200.70 ,$37.50 ,$144.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43000051,97530,HC EARLY INTER THERA ACTIV TX OFFSITE - 15MIN,430,1 ,$223.00 ,$144.95 ,$37.50 ,$223.00 ,$166.14 ,$146.07 ,$37.50 ,$117.52 ,$37.50 ,$140.71 ,$140.71 ,$140.71 ,$140.71 ,$200.70 ,$167.25 ,$37.50 ,$196.24 ,$37.50 ,$167.25 ,$167.25 ,$189.55 ,$189.55 ,$37.50 ,$189.55 ,$37.50 ,$176.17 ,$176.17 ,$176.17 ,$200.70 ,$93.75 ,$200.70 ,$37.50 ,$223.00 ,$146.07 ,$37.50 ,$96.78 , N/A ,$39.38 ,$200.70 ,$84.38 ,$140.71 ,$133.80 ,$200.70 ,$37.50 ,$200.70 ,$200.70 ,$37.50 ,$144.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43000061,97129,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION INITIAL 15 MIN,430,1 ,$199.00 ,$129.35 ,$23.04 ,$199.00 ,$148.26 ,$130.35 ,$23.04 ,$104.87 ,$23.04 ,$125.57 ,$125.57 ,$125.57 ,$125.57 ,$179.10 ,$149.25 ,$23.04 ,$175.12 ,$23.04 ,$149.25 ,$149.25 ,$169.15 ,$169.15 ,$23.04 ,$169.15 ,$23.04 ,$157.21 ,$157.21 ,$157.21 ,$179.10 ,$57.60 ,$179.10 ,$23.04 ,$199.00 ,$130.35 ,$23.04 ,$86.37 , N/A ,$24.19 ,$179.10 ,$51.84 ,$125.57 ,$119.40 ,$179.10 ,$23.04 ,$179.10 ,$179.10 ,$23.04 ,$129.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43000062,97130,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION ADDL 15 MIN,430,1 ,$163.00 ,$105.95 ,$22.35 ,$163.00 ,$121.44 ,$106.77 ,$22.35 ,$85.90 ,$22.35 ,$102.85 ,$102.85 ,$102.85 ,$102.85 ,$146.70 ,$122.25 ,$22.35 ,$143.44 ,$22.35 ,$122.25 ,$122.25 ,$138.55 ,$138.55 ,$22.35 ,$138.55 ,$22.35 ,$128.77 ,$128.77 ,$128.77 ,$146.70 ,$55.88 ,$146.70 ,$22.35 ,$163.00 ,$106.77 ,$22.35 ,$70.74 , N/A ,$23.47 ,$146.70 ,$50.29 ,$102.85 ,$97.80 ,$146.70 ,$22.35 ,$146.70 ,$146.70 ,$22.35 ,$105.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400034,97165,HC OT EVAL LOW COMPLEXITY 15MIN,434,1 ,$381.00 ,$247.65 ,$95.26 ,$381.00 ,$283.85 ,$249.56 ,$95.26 ,$200.79 ,$95.26 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$95.26 ,$335.28 ,$95.26 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$95.26 ,$323.85 ,$95.26 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$238.15 ,$342.90 ,$95.26 ,$381.00 ,$249.56 ,$95.26 ,$165.35 , N/A ,$100.02 ,$342.90 ,$214.34 ,$240.41 ,$228.60 ,$342.90 ,$95.26 ,$342.90 ,$342.90 ,$95.26 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400035,97165,HC OT EVAL LOW COMPLEXITY 30MIN,434,1 ,$381.00 ,$247.65 ,$95.26 ,$381.00 ,$283.85 ,$249.56 ,$95.26 ,$200.79 ,$95.26 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$95.26 ,$335.28 ,$95.26 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$95.26 ,$323.85 ,$95.26 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$238.15 ,$342.90 ,$95.26 ,$381.00 ,$249.56 ,$95.26 ,$165.35 , N/A ,$100.02 ,$342.90 ,$214.34 ,$240.41 ,$228.60 ,$342.90 ,$95.26 ,$342.90 ,$342.90 ,$95.26 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400036,97165,HC OT EVAL LOW COMPLEXITY 45MIN,434,1 ,$381.00 ,$247.65 ,$95.26 ,$381.00 ,$283.85 ,$249.56 ,$95.26 ,$200.79 ,$95.26 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$95.26 ,$335.28 ,$95.26 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$95.26 ,$323.85 ,$95.26 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$238.15 ,$342.90 ,$95.26 ,$381.00 ,$249.56 ,$95.26 ,$165.35 , N/A ,$100.02 ,$342.90 ,$214.34 ,$240.41 ,$228.60 ,$342.90 ,$95.26 ,$342.90 ,$342.90 ,$95.26 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400037,97165,HC OT EVAL LOW COMPLEXITY 60MIN,434,1 ,$381.00 ,$247.65 ,$95.26 ,$381.00 ,$283.85 ,$249.56 ,$95.26 ,$200.79 ,$95.26 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$95.26 ,$335.28 ,$95.26 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$95.26 ,$323.85 ,$95.26 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$238.15 ,$342.90 ,$95.26 ,$381.00 ,$249.56 ,$95.26 ,$165.35 , N/A ,$100.02 ,$342.90 ,$214.34 ,$240.41 ,$228.60 ,$342.90 ,$95.26 ,$342.90 ,$342.90 ,$95.26 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400038,97165,HC OT EVAL LOW COMPLEXITY 75MIN,434,1 ,$381.00 ,$247.65 ,$95.26 ,$381.00 ,$283.85 ,$249.56 ,$95.26 ,$200.79 ,$95.26 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$95.26 ,$335.28 ,$95.26 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$95.26 ,$323.85 ,$95.26 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$238.15 ,$342.90 ,$95.26 ,$381.00 ,$249.56 ,$95.26 ,$165.35 , N/A ,$100.02 ,$342.90 ,$214.34 ,$240.41 ,$228.60 ,$342.90 ,$95.26 ,$342.90 ,$342.90 ,$95.26 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400039,97165,HC OT EVAL LOW COMPLEXITY 90MIN,434,1 ,$381.00 ,$247.65 ,$95.26 ,$381.00 ,$283.85 ,$249.56 ,$95.26 ,$200.79 ,$95.26 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$95.26 ,$335.28 ,$95.26 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$95.26 ,$323.85 ,$95.26 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$238.15 ,$342.90 ,$95.26 ,$381.00 ,$249.56 ,$95.26 ,$165.35 , N/A ,$100.02 ,$342.90 ,$214.34 ,$240.41 ,$228.60 ,$342.90 ,$95.26 ,$342.90 ,$342.90 ,$95.26 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400040,97165,HC OT EVAL LOW COMPLEXITY 105MIN,434,1 ,$381.00 ,$247.65 ,$95.26 ,$381.00 ,$283.85 ,$249.56 ,$95.26 ,$200.79 ,$95.26 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$95.26 ,$335.28 ,$95.26 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$95.26 ,$323.85 ,$95.26 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$238.15 ,$342.90 ,$95.26 ,$381.00 ,$249.56 ,$95.26 ,$165.35 , N/A ,$100.02 ,$342.90 ,$214.34 ,$240.41 ,$228.60 ,$342.90 ,$95.26 ,$342.90 ,$342.90 ,$95.26 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400046,97166,HC OT EVAL MOD COMPLEXITY 15MIN,434,1 ,$509.00 ,$330.85 ,$95.26 ,$509.00 ,$379.21 ,$333.40 ,$95.26 ,$268.24 ,$95.26 ,$321.18 ,$321.18 ,$321.18 ,$321.18 ,$458.10 ,$381.75 ,$95.26 ,$447.92 ,$95.26 ,$381.75 ,$381.75 ,$432.65 ,$432.65 ,$95.26 ,$432.65 ,$95.26 ,$402.11 ,$402.11 ,$402.11 ,$458.10 ,$238.15 ,$458.10 ,$95.26 ,$509.00 ,$333.40 ,$95.26 ,$220.91 , N/A ,$100.02 ,$458.10 ,$214.34 ,$321.18 ,$305.40 ,$458.10 ,$95.26 ,$458.10 ,$458.10 ,$95.26 ,$330.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400047,97166,HC OT EVAL MOD COMPLEXITY 30MIN,434,1 ,$509.00 ,$330.85 ,$95.26 ,$509.00 ,$379.21 ,$333.40 ,$95.26 ,$268.24 ,$95.26 ,$321.18 ,$321.18 ,$321.18 ,$321.18 ,$458.10 ,$381.75 ,$95.26 ,$447.92 ,$95.26 ,$381.75 ,$381.75 ,$432.65 ,$432.65 ,$95.26 ,$432.65 ,$95.26 ,$402.11 ,$402.11 ,$402.11 ,$458.10 ,$238.15 ,$458.10 ,$95.26 ,$509.00 ,$333.40 ,$95.26 ,$220.91 , N/A ,$100.02 ,$458.10 ,$214.34 ,$321.18 ,$305.40 ,$458.10 ,$95.26 ,$458.10 ,$458.10 ,$95.26 ,$330.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400048,97166,HC OT EVAL MOD COMPLEXITY 45MIN,434,1 ,$509.00 ,$330.85 ,$95.26 ,$509.00 ,$379.21 ,$333.40 ,$95.26 ,$268.24 ,$95.26 ,$321.18 ,$321.18 ,$321.18 ,$321.18 ,$458.10 ,$381.75 ,$95.26 ,$447.92 ,$95.26 ,$381.75 ,$381.75 ,$432.65 ,$432.65 ,$95.26 ,$432.65 ,$95.26 ,$402.11 ,$402.11 ,$402.11 ,$458.10 ,$238.15 ,$458.10 ,$95.26 ,$509.00 ,$333.40 ,$95.26 ,$220.91 , N/A ,$100.02 ,$458.10 ,$214.34 ,$321.18 ,$305.40 ,$458.10 ,$95.26 ,$458.10 ,$458.10 ,$95.26 ,$330.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400049,97166,HC OT EVAL MOD COMPLEXITY 60MIN,434,1 ,$509.00 ,$330.85 ,$95.26 ,$509.00 ,$379.21 ,$333.40 ,$95.26 ,$268.24 ,$95.26 ,$321.18 ,$321.18 ,$321.18 ,$321.18 ,$458.10 ,$381.75 ,$95.26 ,$447.92 ,$95.26 ,$381.75 ,$381.75 ,$432.65 ,$432.65 ,$95.26 ,$432.65 ,$95.26 ,$402.11 ,$402.11 ,$402.11 ,$458.10 ,$238.15 ,$458.10 ,$95.26 ,$509.00 ,$333.40 ,$95.26 ,$220.91 , N/A ,$100.02 ,$458.10 ,$214.34 ,$321.18 ,$305.40 ,$458.10 ,$95.26 ,$458.10 ,$458.10 ,$95.26 ,$330.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400050,97166,HC OT EVAL MOD COMPLEXITY 75MIN,434,1 ,$509.00 ,$330.85 ,$95.26 ,$509.00 ,$379.21 ,$333.40 ,$95.26 ,$268.24 ,$95.26 ,$321.18 ,$321.18 ,$321.18 ,$321.18 ,$458.10 ,$381.75 ,$95.26 ,$447.92 ,$95.26 ,$381.75 ,$381.75 ,$432.65 ,$432.65 ,$95.26 ,$432.65 ,$95.26 ,$402.11 ,$402.11 ,$402.11 ,$458.10 ,$238.15 ,$458.10 ,$95.26 ,$509.00 ,$333.40 ,$95.26 ,$220.91 , N/A ,$100.02 ,$458.10 ,$214.34 ,$321.18 ,$305.40 ,$458.10 ,$95.26 ,$458.10 ,$458.10 ,$95.26 ,$330.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400051,97166,HC OT EVAL MOD COMPLEXITY 90MIN,434,1 ,$509.00 ,$330.85 ,$95.26 ,$509.00 ,$379.21 ,$333.40 ,$95.26 ,$268.24 ,$95.26 ,$321.18 ,$321.18 ,$321.18 ,$321.18 ,$458.10 ,$381.75 ,$95.26 ,$447.92 ,$95.26 ,$381.75 ,$381.75 ,$432.65 ,$432.65 ,$95.26 ,$432.65 ,$95.26 ,$402.11 ,$402.11 ,$402.11 ,$458.10 ,$238.15 ,$458.10 ,$95.26 ,$509.00 ,$333.40 ,$95.26 ,$220.91 , N/A ,$100.02 ,$458.10 ,$214.34 ,$321.18 ,$305.40 ,$458.10 ,$95.26 ,$458.10 ,$458.10 ,$95.26 ,$330.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400052,97166,HC OT EVAL MOD COMPLEXITY 105MIN,434,1 ,$509.00 ,$330.85 ,$95.26 ,$509.00 ,$379.21 ,$333.40 ,$95.26 ,$268.24 ,$95.26 ,$321.18 ,$321.18 ,$321.18 ,$321.18 ,$458.10 ,$381.75 ,$95.26 ,$447.92 ,$95.26 ,$381.75 ,$381.75 ,$432.65 ,$432.65 ,$95.26 ,$432.65 ,$95.26 ,$402.11 ,$402.11 ,$402.11 ,$458.10 ,$238.15 ,$458.10 ,$95.26 ,$509.00 ,$333.40 ,$95.26 ,$220.91 , N/A ,$100.02 ,$458.10 ,$214.34 ,$321.18 ,$305.40 ,$458.10 ,$95.26 ,$458.10 ,$458.10 ,$95.26 ,$330.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400058,97167,HC OT EVAL HIGH COMPLEXITY 15MIN,434,1 ,$618.00 ,$401.70 ,$95.26 ,$618.00 ,$460.41 ,$404.79 ,$95.26 ,$325.69 ,$95.26 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$95.26 ,$543.84 ,$95.26 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$95.26 ,$525.30 ,$95.26 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$238.15 ,$556.20 ,$95.26 ,$618.00 ,$404.79 ,$95.26 ,$268.21 , N/A ,$100.02 ,$556.20 ,$214.34 ,$389.96 ,$370.80 ,$556.20 ,$95.26 ,$556.20 ,$556.20 ,$95.26 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400059,97167,HC OT EVAL HIGH COMPLEXITY 30MIN,434,1 ,$618.00 ,$401.70 ,$95.26 ,$618.00 ,$460.41 ,$404.79 ,$95.26 ,$325.69 ,$95.26 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$95.26 ,$543.84 ,$95.26 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$95.26 ,$525.30 ,$95.26 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$238.15 ,$556.20 ,$95.26 ,$618.00 ,$404.79 ,$95.26 ,$268.21 , N/A ,$100.02 ,$556.20 ,$214.34 ,$389.96 ,$370.80 ,$556.20 ,$95.26 ,$556.20 ,$556.20 ,$95.26 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400060,97167,HC OT EVAL HIGH COMPLEXITY 45MIN,434,1 ,$618.00 ,$401.70 ,$95.26 ,$618.00 ,$460.41 ,$404.79 ,$95.26 ,$325.69 ,$95.26 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$95.26 ,$543.84 ,$95.26 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$95.26 ,$525.30 ,$95.26 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$238.15 ,$556.20 ,$95.26 ,$618.00 ,$404.79 ,$95.26 ,$268.21 , N/A ,$100.02 ,$556.20 ,$214.34 ,$389.96 ,$370.80 ,$556.20 ,$95.26 ,$556.20 ,$556.20 ,$95.26 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400061,97167,HC OT EVAL HIGH COMPLEXITY 60MIN,434,1 ,$618.00 ,$401.70 ,$95.26 ,$618.00 ,$460.41 ,$404.79 ,$95.26 ,$325.69 ,$95.26 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$95.26 ,$543.84 ,$95.26 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$95.26 ,$525.30 ,$95.26 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$238.15 ,$556.20 ,$95.26 ,$618.00 ,$404.79 ,$95.26 ,$268.21 , N/A ,$100.02 ,$556.20 ,$214.34 ,$389.96 ,$370.80 ,$556.20 ,$95.26 ,$556.20 ,$556.20 ,$95.26 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400062,97167,HC OT EVAL HIGH COMPLEXITY 75MIN,434,1 ,$618.00 ,$401.70 ,$95.26 ,$618.00 ,$460.41 ,$404.79 ,$95.26 ,$325.69 ,$95.26 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$95.26 ,$543.84 ,$95.26 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$95.26 ,$525.30 ,$95.26 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$238.15 ,$556.20 ,$95.26 ,$618.00 ,$404.79 ,$95.26 ,$268.21 , N/A ,$100.02 ,$556.20 ,$214.34 ,$389.96 ,$370.80 ,$556.20 ,$95.26 ,$556.20 ,$556.20 ,$95.26 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400063,97167,HC OT EVAL HIGH COMPLEXITY 90MIN,434,1 ,$618.00 ,$401.70 ,$95.26 ,$618.00 ,$460.41 ,$404.79 ,$95.26 ,$325.69 ,$95.26 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$95.26 ,$543.84 ,$95.26 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$95.26 ,$525.30 ,$95.26 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$238.15 ,$556.20 ,$95.26 ,$618.00 ,$404.79 ,$95.26 ,$268.21 , N/A ,$100.02 ,$556.20 ,$214.34 ,$389.96 ,$370.80 ,$556.20 ,$95.26 ,$556.20 ,$556.20 ,$95.26 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400064,97167,HC OT EVAL HIGH COMPLEXITY 105MIN,434,1 ,$618.00 ,$401.70 ,$95.26 ,$618.00 ,$460.41 ,$404.79 ,$95.26 ,$325.69 ,$95.26 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$95.26 ,$543.84 ,$95.26 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$95.26 ,$525.30 ,$95.26 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$238.15 ,$556.20 ,$95.26 ,$618.00 ,$404.79 ,$95.26 ,$268.21 , N/A ,$100.02 ,$556.20 ,$214.34 ,$389.96 ,$370.80 ,$556.20 ,$95.26 ,$556.20 ,$556.20 ,$95.26 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400070,97168,HC OT RE-EVAL 15MIN,434,1 ,$214.00 ,$139.10 ,$64.11 ,$214.00 ,$159.43 ,$140.17 ,$64.11 ,$112.78 ,$64.11 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$64.11 ,$188.32 ,$64.11 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$64.11 ,$181.90 ,$64.11 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$160.28 ,$192.60 ,$64.11 ,$214.00 ,$140.17 ,$64.11 ,$92.88 , N/A ,$67.32 ,$192.60 ,$144.25 ,$135.03 ,$128.40 ,$192.60 ,$64.11 ,$192.60 ,$192.60 ,$64.11 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400071,97168,HC OT RE-EVAL 30MIN,434,1 ,$214.00 ,$139.10 ,$64.11 ,$214.00 ,$159.43 ,$140.17 ,$64.11 ,$112.78 ,$64.11 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$64.11 ,$188.32 ,$64.11 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$64.11 ,$181.90 ,$64.11 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$160.28 ,$192.60 ,$64.11 ,$214.00 ,$140.17 ,$64.11 ,$92.88 , N/A ,$67.32 ,$192.60 ,$144.25 ,$135.03 ,$128.40 ,$192.60 ,$64.11 ,$192.60 ,$192.60 ,$64.11 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400072,97168,HC OT RE-EVAL 45MIN,434,1 ,$214.00 ,$139.10 ,$64.11 ,$214.00 ,$159.43 ,$140.17 ,$64.11 ,$112.78 ,$64.11 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$64.11 ,$188.32 ,$64.11 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$64.11 ,$181.90 ,$64.11 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$160.28 ,$192.60 ,$64.11 ,$214.00 ,$140.17 ,$64.11 ,$92.88 , N/A ,$67.32 ,$192.60 ,$144.25 ,$135.03 ,$128.40 ,$192.60 ,$64.11 ,$192.60 ,$192.60 ,$64.11 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400073,97168,HC OT RE-EVAL 60MIN,434,1 ,$214.00 ,$139.10 ,$64.11 ,$214.00 ,$159.43 ,$140.17 ,$64.11 ,$112.78 ,$64.11 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$64.11 ,$188.32 ,$64.11 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$64.11 ,$181.90 ,$64.11 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$160.28 ,$192.60 ,$64.11 ,$214.00 ,$140.17 ,$64.11 ,$92.88 , N/A ,$67.32 ,$192.60 ,$144.25 ,$135.03 ,$128.40 ,$192.60 ,$64.11 ,$192.60 ,$192.60 ,$64.11 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400074,97168,HC OT RE-EVAL 75MIN,434,1 ,$214.00 ,$139.10 ,$64.11 ,$214.00 ,$159.43 ,$140.17 ,$64.11 ,$112.78 ,$64.11 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$64.11 ,$188.32 ,$64.11 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$64.11 ,$181.90 ,$64.11 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$160.28 ,$192.60 ,$64.11 ,$214.00 ,$140.17 ,$64.11 ,$92.88 , N/A ,$67.32 ,$192.60 ,$144.25 ,$135.03 ,$128.40 ,$192.60 ,$64.11 ,$192.60 ,$192.60 ,$64.11 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400075,97168,HC OT RE-EVAL 90MIN,434,1 ,$214.00 ,$139.10 ,$64.11 ,$214.00 ,$159.43 ,$140.17 ,$64.11 ,$112.78 ,$64.11 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$64.11 ,$188.32 ,$64.11 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$64.11 ,$181.90 ,$64.11 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$160.28 ,$192.60 ,$64.11 ,$214.00 ,$140.17 ,$64.11 ,$92.88 , N/A ,$67.32 ,$192.60 ,$144.25 ,$135.03 ,$128.40 ,$192.60 ,$64.11 ,$192.60 ,$192.60 ,$64.11 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),43400076,97168,HC OT RE-EVAL 105MIN,434,1 ,$214.00 ,$139.10 ,$64.11 ,$214.00 ,$159.43 ,$140.17 ,$64.11 ,$112.78 ,$64.11 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$64.11 ,$188.32 ,$64.11 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$64.11 ,$181.90 ,$64.11 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$160.28 ,$192.60 ,$64.11 ,$214.00 ,$140.17 ,$64.11 ,$92.88 , N/A ,$67.32 ,$192.60 ,$144.25 ,$135.03 ,$128.40 ,$192.60 ,$64.11 ,$192.60 ,$192.60 ,$64.11 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44000000,92507,HC SPEECH THERAPY TREATMENT 15MIN,440,1 ,$241.00 ,$156.65 ,$75.75 ,$241.00 ,$179.55 ,$157.86 ,$75.75 ,$127.01 ,$75.75 ,$152.07 ,$152.07 ,$152.07 ,$152.07 ,$216.90 ,$180.75 ,$75.75 ,$212.08 ,$75.75 ,$180.75 ,$180.75 ,$204.85 ,$204.85 ,$75.75 ,$204.85 ,$75.75 ,$190.39 ,$190.39 ,$190.39 ,$216.90 ,$189.38 ,$216.90 ,$75.75 ,$241.00 ,$157.86 ,$75.75 ,$104.59 , N/A ,$79.54 ,$216.90 ,$170.44 ,$152.07 ,$144.60 ,$216.90 ,$75.75 ,$216.90 ,$216.90 ,$75.75 ,$156.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44000001,92507,HC SPEECH THERAPY TREATMENT 30MIN,440,1 ,$241.00 ,$156.65 ,$75.75 ,$241.00 ,$179.55 ,$157.86 ,$75.75 ,$127.01 ,$75.75 ,$152.07 ,$152.07 ,$152.07 ,$152.07 ,$216.90 ,$180.75 ,$75.75 ,$212.08 ,$75.75 ,$180.75 ,$180.75 ,$204.85 ,$204.85 ,$75.75 ,$204.85 ,$75.75 ,$190.39 ,$190.39 ,$190.39 ,$216.90 ,$189.38 ,$216.90 ,$75.75 ,$241.00 ,$157.86 ,$75.75 ,$104.59 , N/A ,$79.54 ,$216.90 ,$170.44 ,$152.07 ,$144.60 ,$216.90 ,$75.75 ,$216.90 ,$216.90 ,$75.75 ,$156.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44000002,92507,HC SPEECH THERAPY TREATMENT 45MIN,440,1 ,$241.00 ,$156.65 ,$75.75 ,$241.00 ,$179.55 ,$157.86 ,$75.75 ,$127.01 ,$75.75 ,$152.07 ,$152.07 ,$152.07 ,$152.07 ,$216.90 ,$180.75 ,$75.75 ,$212.08 ,$75.75 ,$180.75 ,$180.75 ,$204.85 ,$204.85 ,$75.75 ,$204.85 ,$75.75 ,$190.39 ,$190.39 ,$190.39 ,$216.90 ,$189.38 ,$216.90 ,$75.75 ,$241.00 ,$157.86 ,$75.75 ,$104.59 , N/A ,$79.54 ,$216.90 ,$170.44 ,$152.07 ,$144.60 ,$216.90 ,$75.75 ,$216.90 ,$216.90 ,$75.75 ,$156.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44000003,92507,HC SPEECH THERAPY TREATMENT 60MIN,440,1 ,$241.00 ,$156.65 ,$75.75 ,$241.00 ,$179.55 ,$157.86 ,$75.75 ,$127.01 ,$75.75 ,$152.07 ,$152.07 ,$152.07 ,$152.07 ,$216.90 ,$180.75 ,$75.75 ,$212.08 ,$75.75 ,$180.75 ,$180.75 ,$204.85 ,$204.85 ,$75.75 ,$204.85 ,$75.75 ,$190.39 ,$190.39 ,$190.39 ,$216.90 ,$189.38 ,$216.90 ,$75.75 ,$241.00 ,$157.86 ,$75.75 ,$104.59 , N/A ,$79.54 ,$216.90 ,$170.44 ,$152.07 ,$144.60 ,$216.90 ,$75.75 ,$216.90 ,$216.90 ,$75.75 ,$156.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44000009,92526,HC DYSPHAGIA TREATMENT 15MIN,440,1 ,$152.00 ,$98.80 ,$65.97 ,$187.90 ,$113.24 ,$99.56 ,$83.51 ,$80.10 ,$83.51 ,$95.91 ,$95.91 ,$95.91 ,$95.91 ,$136.80 ,$114.00 ,$83.51 ,$133.76 ,$83.51 ,$114.00 ,$114.00 ,$129.20 ,$129.20 ,$83.51 ,$129.20 ,$83.51 ,$120.08 ,$120.08 ,$120.08 ,$136.80 ,$152.00 ,$136.80 ,$83.51 ,$152.00 ,$99.56 ,$83.51 ,$65.97 , N/A ,$87.69 ,$136.80 ,$187.90 ,$95.91 ,$91.20 ,$136.80 ,$83.51 ,$136.80 ,$136.80 ,$83.51 ,$98.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44000015,92526,HC DYSPHAGIA TREATMENT 30MIN,440,1 ,$152.00 ,$98.80 ,$65.97 ,$187.90 ,$113.24 ,$99.56 ,$83.51 ,$80.10 ,$83.51 ,$95.91 ,$95.91 ,$95.91 ,$95.91 ,$136.80 ,$114.00 ,$83.51 ,$133.76 ,$83.51 ,$114.00 ,$114.00 ,$129.20 ,$129.20 ,$83.51 ,$129.20 ,$83.51 ,$120.08 ,$120.08 ,$120.08 ,$136.80 ,$152.00 ,$136.80 ,$83.51 ,$152.00 ,$99.56 ,$83.51 ,$65.97 , N/A ,$87.69 ,$136.80 ,$187.90 ,$95.91 ,$91.20 ,$136.80 ,$83.51 ,$136.80 ,$136.80 ,$83.51 ,$98.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44000016,92526,HC DYSPHAGIA TREATMENT 45MIN,440,1 ,$152.00 ,$98.80 ,$65.97 ,$187.90 ,$113.24 ,$99.56 ,$83.51 ,$80.10 ,$83.51 ,$95.91 ,$95.91 ,$95.91 ,$95.91 ,$136.80 ,$114.00 ,$83.51 ,$133.76 ,$83.51 ,$114.00 ,$114.00 ,$129.20 ,$129.20 ,$83.51 ,$129.20 ,$83.51 ,$120.08 ,$120.08 ,$120.08 ,$136.80 ,$152.00 ,$136.80 ,$83.51 ,$152.00 ,$99.56 ,$83.51 ,$65.97 , N/A ,$87.69 ,$136.80 ,$187.90 ,$95.91 ,$91.20 ,$136.80 ,$83.51 ,$136.80 ,$136.80 ,$83.51 ,$98.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44000017,92526,HC DYSPHAGIA TREATMENT 60MIN,440,1 ,$152.00 ,$98.80 ,$65.97 ,$187.90 ,$113.24 ,$99.56 ,$83.51 ,$80.10 ,$83.51 ,$95.91 ,$95.91 ,$95.91 ,$95.91 ,$136.80 ,$114.00 ,$83.51 ,$133.76 ,$83.51 ,$114.00 ,$114.00 ,$129.20 ,$129.20 ,$83.51 ,$129.20 ,$83.51 ,$120.08 ,$120.08 ,$120.08 ,$136.80 ,$152.00 ,$136.80 ,$83.51 ,$152.00 ,$99.56 ,$83.51 ,$65.97 , N/A ,$87.69 ,$136.80 ,$187.90 ,$95.91 ,$91.20 ,$136.80 ,$83.51 ,$136.80 ,$136.80 ,$83.51 ,$98.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44000070,92507,HC EARLY INTER SPEECH THPY TX 15MIN,440,1 ,$241.00 ,$156.65 ,$75.75 ,$241.00 ,$179.55 ,$157.86 ,$75.75 ,$127.01 ,$75.75 ,$152.07 ,$152.07 ,$152.07 ,$152.07 ,$216.90 ,$180.75 ,$75.75 ,$212.08 ,$75.75 ,$180.75 ,$180.75 ,$204.85 ,$204.85 ,$75.75 ,$204.85 ,$75.75 ,$190.39 ,$190.39 ,$190.39 ,$216.90 ,$189.38 ,$216.90 ,$75.75 ,$241.00 ,$157.86 ,$75.75 ,$104.59 , N/A ,$79.54 ,$216.90 ,$170.44 ,$152.07 ,$144.60 ,$216.90 ,$75.75 ,$216.90 ,$216.90 ,$75.75 ,$156.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44000071,92507,HC EARLY INTER SPEECH THPY TX 30MIN,440,1 ,$241.00 ,$156.65 ,$75.75 ,$241.00 ,$179.55 ,$157.86 ,$75.75 ,$127.01 ,$75.75 ,$152.07 ,$152.07 ,$152.07 ,$152.07 ,$216.90 ,$180.75 ,$75.75 ,$212.08 ,$75.75 ,$180.75 ,$180.75 ,$204.85 ,$204.85 ,$75.75 ,$204.85 ,$75.75 ,$190.39 ,$190.39 ,$190.39 ,$216.90 ,$189.38 ,$216.90 ,$75.75 ,$241.00 ,$157.86 ,$75.75 ,$104.59 , N/A ,$79.54 ,$216.90 ,$170.44 ,$152.07 ,$144.60 ,$216.90 ,$75.75 ,$216.90 ,$216.90 ,$75.75 ,$156.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44000072,92507,HC EARLY INTER SPEECH THPY TX 45MIN,440,1 ,$241.00 ,$156.65 ,$75.75 ,$241.00 ,$179.55 ,$157.86 ,$75.75 ,$127.01 ,$75.75 ,$152.07 ,$152.07 ,$152.07 ,$152.07 ,$216.90 ,$180.75 ,$75.75 ,$212.08 ,$75.75 ,$180.75 ,$180.75 ,$204.85 ,$204.85 ,$75.75 ,$204.85 ,$75.75 ,$190.39 ,$190.39 ,$190.39 ,$216.90 ,$189.38 ,$216.90 ,$75.75 ,$241.00 ,$157.86 ,$75.75 ,$104.59 , N/A ,$79.54 ,$216.90 ,$170.44 ,$152.07 ,$144.60 ,$216.90 ,$75.75 ,$216.90 ,$216.90 ,$75.75 ,$156.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44000073,92507,HC EARLY INTER SPEECH THPY TX 60MIN,440,1 ,$241.00 ,$156.65 ,$75.75 ,$241.00 ,$179.55 ,$157.86 ,$75.75 ,$127.01 ,$75.75 ,$152.07 ,$152.07 ,$152.07 ,$152.07 ,$216.90 ,$180.75 ,$75.75 ,$212.08 ,$75.75 ,$180.75 ,$180.75 ,$204.85 ,$204.85 ,$75.75 ,$204.85 ,$75.75 ,$190.39 ,$190.39 ,$190.39 ,$216.90 ,$189.38 ,$216.90 ,$75.75 ,$241.00 ,$157.86 ,$75.75 ,$104.59 , N/A ,$79.54 ,$216.90 ,$170.44 ,$152.07 ,$144.60 ,$216.90 ,$75.75 ,$216.90 ,$216.90 ,$75.75 ,$156.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44000074,92507,HC EARLY INTER SPEECH THPY TX 75MIN,440,1 ,$241.00 ,$156.65 ,$75.75 ,$241.00 ,$179.55 ,$157.86 ,$75.75 ,$127.01 ,$75.75 ,$152.07 ,$152.07 ,$152.07 ,$152.07 ,$216.90 ,$180.75 ,$75.75 ,$212.08 ,$75.75 ,$180.75 ,$180.75 ,$204.85 ,$204.85 ,$75.75 ,$204.85 ,$75.75 ,$190.39 ,$190.39 ,$190.39 ,$216.90 ,$189.38 ,$216.90 ,$75.75 ,$241.00 ,$157.86 ,$75.75 ,$104.59 , N/A ,$79.54 ,$216.90 ,$170.44 ,$152.07 ,$144.60 ,$216.90 ,$75.75 ,$216.90 ,$216.90 ,$75.75 ,$156.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010001,G8996,HC SWALLOW CURRENT STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010002,G8997,HC SWALLOW GOAL STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010003,G8998,HC SWALLOW DISCHARGE STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010004,G8999,HC MOTOR SPEECH CURRENT STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010005,G9186,HC MOTOR SPEECH GOAL STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010006,G9158,HC MOTOR SPEECH DISCHARGE STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010007,G9159,HC LANG COMP CURRENT STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010008,G9160,HC LANG COMP GOAL STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010009,G9161,HC LANG COMP DISCHARGE STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010010,G9162,HC LANG EXPRESS CURRENT STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010011,G9163,HC LANG EXPRESS GOAL STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010012,G9164,HC LANG EXPRESS DISCHARGE STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010016,G9168,HC MEMORY CURRENT STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010017,G9169,HC MEMORY GOAL STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010018,G9170,HC MEMORY DISCHARGE STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010019,G9171,HC VOICE CURRENT STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010020,G9172,HC VOICE GOAL STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010021,G9173,HC VOICE DISCHARGE STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010022,G9174,HC OTHER SPEECH LANG CURRENT STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010023,G9175,HC OTHER SPEECH LANG GOAL STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44010024,G9176,HC OTHER SPEECH LANG DISCHARGE STATUS,440,1 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 , N/A ,$0.01 ,$0.01 , N/A , N/A , N/A , N/A ,$0.01 , N/A ,$0.01 ,$0.01 ,$0.01 , N/A ,$0.01 ,$0.01 , N/A ,$0.01 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44400017,92610,HC DYSPHAGIA EVALUATION 15MIN,444,1 ,$223.00 ,$144.95 ,$83.38 ,$223.00 ,$166.14 ,$146.07 ,$83.38 ,$117.52 ,$83.38 ,$140.71 ,$140.71 ,$140.71 ,$140.71 ,$200.70 ,$167.25 ,$83.38 ,$196.24 ,$83.38 ,$167.25 ,$167.25 ,$189.55 ,$189.55 ,$83.38 ,$189.55 ,$83.38 ,$176.17 ,$176.17 ,$176.17 ,$200.70 ,$208.45 ,$200.70 ,$83.38 ,$223.00 ,$146.07 ,$83.38 ,$96.78 , N/A ,$87.55 ,$200.70 ,$187.61 ,$140.71 ,$133.80 ,$200.70 ,$83.38 ,$200.70 ,$200.70 ,$83.38 ,$144.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44400018,92610,HC DYSPHAGIA EVALUATION 30MIN,444,1 ,$223.00 ,$144.95 ,$83.38 ,$223.00 ,$166.14 ,$146.07 ,$83.38 ,$117.52 ,$83.38 ,$140.71 ,$140.71 ,$140.71 ,$140.71 ,$200.70 ,$167.25 ,$83.38 ,$196.24 ,$83.38 ,$167.25 ,$167.25 ,$189.55 ,$189.55 ,$83.38 ,$189.55 ,$83.38 ,$176.17 ,$176.17 ,$176.17 ,$200.70 ,$208.45 ,$200.70 ,$83.38 ,$223.00 ,$146.07 ,$83.38 ,$96.78 , N/A ,$87.55 ,$200.70 ,$187.61 ,$140.71 ,$133.80 ,$200.70 ,$83.38 ,$200.70 ,$200.70 ,$83.38 ,$144.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44400019,92610,HC DYSPHAGIA EVALUATION 45MIN,444,1 ,$223.00 ,$144.95 ,$83.38 ,$223.00 ,$166.14 ,$146.07 ,$83.38 ,$117.52 ,$83.38 ,$140.71 ,$140.71 ,$140.71 ,$140.71 ,$200.70 ,$167.25 ,$83.38 ,$196.24 ,$83.38 ,$167.25 ,$167.25 ,$189.55 ,$189.55 ,$83.38 ,$189.55 ,$83.38 ,$176.17 ,$176.17 ,$176.17 ,$200.70 ,$208.45 ,$200.70 ,$83.38 ,$223.00 ,$146.07 ,$83.38 ,$96.78 , N/A ,$87.55 ,$200.70 ,$187.61 ,$140.71 ,$133.80 ,$200.70 ,$83.38 ,$200.70 ,$200.70 ,$83.38 ,$144.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44400020,92610,HC DYSPHAGIA EVALUATION 60MIN,444,1 ,$223.00 ,$144.95 ,$83.38 ,$223.00 ,$166.14 ,$146.07 ,$83.38 ,$117.52 ,$83.38 ,$140.71 ,$140.71 ,$140.71 ,$140.71 ,$200.70 ,$167.25 ,$83.38 ,$196.24 ,$83.38 ,$167.25 ,$167.25 ,$189.55 ,$189.55 ,$83.38 ,$189.55 ,$83.38 ,$176.17 ,$176.17 ,$176.17 ,$200.70 ,$208.45 ,$200.70 ,$83.38 ,$223.00 ,$146.07 ,$83.38 ,$96.78 , N/A ,$87.55 ,$200.70 ,$187.61 ,$140.71 ,$133.80 ,$200.70 ,$83.38 ,$200.70 ,$200.70 ,$83.38 ,$144.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44400033,92611,HC DYSPHAGIA EVAL-VIDEO,444,1 ,$277.00 ,$180.05 ,$90.57 ,$277.00 ,$206.37 ,$181.44 ,$90.57 ,$145.98 ,$90.57 ,$174.79 ,$174.79 ,$174.79 ,$174.79 ,$249.30 ,$207.75 ,$90.57 ,$243.76 ,$90.57 ,$207.75 ,$207.75 ,$235.45 ,$235.45 ,$90.57 ,$235.45 ,$90.57 ,$218.83 ,$218.83 ,$218.83 ,$249.30 ,$226.43 ,$249.30 ,$90.57 ,$277.00 ,$181.44 ,$90.57 ,$120.22 , N/A ,$95.10 ,$249.30 ,$203.78 ,$174.79 ,$166.20 ,$249.30 ,$90.57 ,$249.30 ,$249.30 ,$90.57 ,$180.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44400052,92521,HC EVALUATION OF SPEECH FLUENCY 30MIN,444,1 ,$339.00 ,$220.35 ,$132.47 ,$339.00 ,$252.56 ,$222.05 ,$132.47 ,$178.65 ,$132.47 ,$213.91 ,$213.91 ,$213.91 ,$213.91 ,$305.10 ,$254.25 ,$132.47 ,$298.32 ,$132.47 ,$254.25 ,$254.25 ,$288.15 ,$288.15 ,$132.47 ,$288.15 ,$132.47 ,$267.81 ,$267.81 ,$267.81 ,$305.10 ,$331.18 ,$305.10 ,$132.47 ,$339.00 ,$222.05 ,$132.47 ,$147.13 , N/A ,$139.09 ,$305.10 ,$298.06 ,$213.91 ,$203.40 ,$305.10 ,$132.47 ,$305.10 ,$305.10 ,$132.47 ,$220.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44400053,92521,HC EVALUATION OF SPEECH FLUENCY 45MIN,444,1 ,$339.00 ,$220.35 ,$132.47 ,$339.00 ,$252.56 ,$222.05 ,$132.47 ,$178.65 ,$132.47 ,$213.91 ,$213.91 ,$213.91 ,$213.91 ,$305.10 ,$254.25 ,$132.47 ,$298.32 ,$132.47 ,$254.25 ,$254.25 ,$288.15 ,$288.15 ,$132.47 ,$288.15 ,$132.47 ,$267.81 ,$267.81 ,$267.81 ,$305.10 ,$331.18 ,$305.10 ,$132.47 ,$339.00 ,$222.05 ,$132.47 ,$147.13 , N/A ,$139.09 ,$305.10 ,$298.06 ,$213.91 ,$203.40 ,$305.10 ,$132.47 ,$305.10 ,$305.10 ,$132.47 ,$220.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44400054,92521,HC EVALUATION OF SPEECH FLUENCY 60MIN,444,1 ,$339.00 ,$220.35 ,$132.47 ,$339.00 ,$252.56 ,$222.05 ,$132.47 ,$178.65 ,$132.47 ,$213.91 ,$213.91 ,$213.91 ,$213.91 ,$305.10 ,$254.25 ,$132.47 ,$298.32 ,$132.47 ,$254.25 ,$254.25 ,$288.15 ,$288.15 ,$132.47 ,$288.15 ,$132.47 ,$267.81 ,$267.81 ,$267.81 ,$305.10 ,$331.18 ,$305.10 ,$132.47 ,$339.00 ,$222.05 ,$132.47 ,$147.13 , N/A ,$139.09 ,$305.10 ,$298.06 ,$213.91 ,$203.40 ,$305.10 ,$132.47 ,$305.10 ,$305.10 ,$132.47 ,$220.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44400055,92522,HC EVALUATE SPEECH PRODUCTION 30MIN,444,1 ,$274.00 ,$178.10 ,$111.22 ,$274.00 ,$204.13 ,$179.47 ,$111.22 ,$144.40 ,$111.22 ,$172.89 ,$172.89 ,$172.89 ,$172.89 ,$246.60 ,$205.50 ,$111.22 ,$241.12 ,$111.22 ,$205.50 ,$205.50 ,$232.90 ,$232.90 ,$111.22 ,$232.90 ,$111.22 ,$216.46 ,$216.46 ,$216.46 ,$246.60 ,$274.00 ,$246.60 ,$111.22 ,$274.00 ,$179.47 ,$111.22 ,$118.92 , N/A ,$116.78 ,$246.60 ,$250.25 ,$172.89 ,$164.40 ,$246.60 ,$111.22 ,$246.60 ,$246.60 ,$111.22 ,$178.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44400056,92522,HC EVALUATE SPEECH PRODUCTION 45MIN,444,1 ,$274.00 ,$178.10 ,$111.22 ,$274.00 ,$204.13 ,$179.47 ,$111.22 ,$144.40 ,$111.22 ,$172.89 ,$172.89 ,$172.89 ,$172.89 ,$246.60 ,$205.50 ,$111.22 ,$241.12 ,$111.22 ,$205.50 ,$205.50 ,$232.90 ,$232.90 ,$111.22 ,$232.90 ,$111.22 ,$216.46 ,$216.46 ,$216.46 ,$246.60 ,$274.00 ,$246.60 ,$111.22 ,$274.00 ,$179.47 ,$111.22 ,$118.92 , N/A ,$116.78 ,$246.60 ,$250.25 ,$172.89 ,$164.40 ,$246.60 ,$111.22 ,$246.60 ,$246.60 ,$111.22 ,$178.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44400057,92522,HC EVALUATE SPEECH PRODUCTION 60MIN,444,1 ,$274.00 ,$178.10 ,$111.22 ,$274.00 ,$204.13 ,$179.47 ,$111.22 ,$144.40 ,$111.22 ,$172.89 ,$172.89 ,$172.89 ,$172.89 ,$246.60 ,$205.50 ,$111.22 ,$241.12 ,$111.22 ,$205.50 ,$205.50 ,$232.90 ,$232.90 ,$111.22 ,$232.90 ,$111.22 ,$216.46 ,$216.46 ,$216.46 ,$246.60 ,$274.00 ,$246.60 ,$111.22 ,$274.00 ,$179.47 ,$111.22 ,$118.92 , N/A ,$116.78 ,$246.60 ,$250.25 ,$172.89 ,$164.40 ,$246.60 ,$111.22 ,$246.60 ,$246.60 ,$111.22 ,$178.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44400058,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 30MIN,444,1 ,$573.00 ,$372.45 ,$227.69 ,$573.00 ,$426.89 ,$375.32 ,$227.69 ,$301.97 ,$227.69 ,$361.56 ,$361.56 ,$361.56 ,$361.56 ,$515.70 ,$429.75 ,$227.69 ,$504.24 ,$227.69 ,$429.75 ,$429.75 ,$487.05 ,$487.05 ,$227.69 ,$487.05 ,$227.69 ,$452.67 ,$452.67 ,$452.67 ,$515.70 ,$569.23 ,$515.70 ,$227.69 ,$573.00 ,$375.32 ,$227.69 ,$248.68 , N/A ,$239.07 ,$515.70 ,$512.30 ,$361.56 ,$343.80 ,$515.70 ,$227.69 ,$515.70 ,$515.70 ,$227.69 ,$372.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44400059,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 45MIN,444,1 ,$573.00 ,$372.45 ,$227.69 ,$573.00 ,$426.89 ,$375.32 ,$227.69 ,$301.97 ,$227.69 ,$361.56 ,$361.56 ,$361.56 ,$361.56 ,$515.70 ,$429.75 ,$227.69 ,$504.24 ,$227.69 ,$429.75 ,$429.75 ,$487.05 ,$487.05 ,$227.69 ,$487.05 ,$227.69 ,$452.67 ,$452.67 ,$452.67 ,$515.70 ,$569.23 ,$515.70 ,$227.69 ,$573.00 ,$375.32 ,$227.69 ,$248.68 , N/A ,$239.07 ,$515.70 ,$512.30 ,$361.56 ,$343.80 ,$515.70 ,$227.69 ,$515.70 ,$515.70 ,$227.69 ,$372.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44400060,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 60MIN,444,1 ,$573.00 ,$372.45 ,$227.69 ,$573.00 ,$426.89 ,$375.32 ,$227.69 ,$301.97 ,$227.69 ,$361.56 ,$361.56 ,$361.56 ,$361.56 ,$515.70 ,$429.75 ,$227.69 ,$504.24 ,$227.69 ,$429.75 ,$429.75 ,$487.05 ,$487.05 ,$227.69 ,$487.05 ,$227.69 ,$452.67 ,$452.67 ,$452.67 ,$515.70 ,$569.23 ,$515.70 ,$227.69 ,$573.00 ,$375.32 ,$227.69 ,$248.68 , N/A ,$239.07 ,$515.70 ,$512.30 ,$361.56 ,$343.80 ,$515.70 ,$227.69 ,$515.70 ,$515.70 ,$227.69 ,$372.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44400061,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 30MIN,444,1 ,$292.00 ,$189.80 ,$108.89 ,$292.00 ,$217.54 ,$191.26 ,$108.89 ,$153.88 ,$108.89 ,$184.25 ,$184.25 ,$184.25 ,$184.25 ,$262.80 ,$219.00 ,$108.89 ,$256.96 ,$108.89 ,$219.00 ,$219.00 ,$248.20 ,$248.20 ,$108.89 ,$248.20 ,$108.89 ,$230.68 ,$230.68 ,$230.68 ,$262.80 ,$272.23 ,$262.80 ,$108.89 ,$292.00 ,$191.26 ,$108.89 ,$126.73 , N/A ,$114.33 ,$262.80 ,$245.00 ,$184.25 ,$175.20 ,$262.80 ,$108.89 ,$262.80 ,$262.80 ,$108.89 ,$189.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44400062,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 45MIN,444,1 ,$292.00 ,$189.80 ,$108.89 ,$292.00 ,$217.54 ,$191.26 ,$108.89 ,$153.88 ,$108.89 ,$184.25 ,$184.25 ,$184.25 ,$184.25 ,$262.80 ,$219.00 ,$108.89 ,$256.96 ,$108.89 ,$219.00 ,$219.00 ,$248.20 ,$248.20 ,$108.89 ,$248.20 ,$108.89 ,$230.68 ,$230.68 ,$230.68 ,$262.80 ,$272.23 ,$262.80 ,$108.89 ,$292.00 ,$191.26 ,$108.89 ,$126.73 , N/A ,$114.33 ,$262.80 ,$245.00 ,$184.25 ,$175.20 ,$262.80 ,$108.89 ,$262.80 ,$262.80 ,$108.89 ,$189.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44400063,92524,HC BEHAVIORAL QUALITY ANALYSIS VOICE 60MIN,444,1 ,$292.00 ,$189.80 ,$108.89 ,$292.00 ,$217.54 ,$191.26 ,$108.89 ,$153.88 ,$108.89 ,$184.25 ,$184.25 ,$184.25 ,$184.25 ,$262.80 ,$219.00 ,$108.89 ,$256.96 ,$108.89 ,$219.00 ,$219.00 ,$248.20 ,$248.20 ,$108.89 ,$248.20 ,$108.89 ,$230.68 ,$230.68 ,$230.68 ,$262.80 ,$272.23 ,$262.80 ,$108.89 ,$292.00 ,$191.26 ,$108.89 ,$126.73 , N/A ,$114.33 ,$262.80 ,$245.00 ,$184.25 ,$175.20 ,$262.80 ,$108.89 ,$262.80 ,$262.80 ,$108.89 ,$189.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),44400087,92610,HC DYSPHAGIA EVALUATION 90MIN,444,1 ,$223.00 ,$144.95 ,$83.38 ,$223.00 ,$166.14 ,$146.07 ,$83.38 ,$117.52 ,$83.38 ,$140.71 ,$140.71 ,$140.71 ,$140.71 ,$200.70 ,$167.25 ,$83.38 ,$196.24 ,$83.38 ,$167.25 ,$167.25 ,$189.55 ,$189.55 ,$83.38 ,$189.55 ,$83.38 ,$176.17 ,$176.17 ,$176.17 ,$200.70 ,$208.45 ,$200.70 ,$83.38 ,$223.00 ,$146.07 ,$83.38 ,$96.78 , N/A ,$87.55 ,$200.70 ,$187.61 ,$140.71 ,$133.80 ,$200.70 ,$83.38 ,$200.70 ,$200.70 ,$83.38 ,$144.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000002,10061,HC I AND D ABSC CMPLX,450,1 ,$573.00 ,$372.45 ,$248.68 ,$761.90 ,$426.89 ,$375.32 ,$351.57 ,$301.97 ,$351.57 ,$361.56 ,$361.56 ,$361.56 ,$361.56 ,$515.70 ,$429.75 ,$351.57 ,$504.24 ,$351.57 ,$429.75 ,$429.75 ,$487.05 ,$487.05 ,$351.57 ,$487.05 ,$351.57 ,$452.67 ,$452.67 ,$452.67 ,$515.70 ,$573.00 ,$515.70 ,$351.57 ,$573.00 ,$375.32 ,$351.57 ,$248.68 , N/A ,$367.98 ,$515.70 ,$761.90 ,$361.56 ,$343.80 ,$515.70 ,$351.57 ,$515.70 ,$515.70 ,$351.57 ,$372.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000003,10080,HC I AND D CYST PILONIDAL SMP,450,1 ,$573.00 ,$372.45 ,$248.68 ,"$1,370.23 ",$426.89 ,$375.32 ,$573.00 ,$301.97 ,$573.00 ,$361.56 ,$361.56 ,$361.56 ,$361.56 ,$515.70 ,$429.75 ,$573.00 ,$504.24 ,$573.00 ,$429.75 ,$429.75 ,$487.05 ,$487.05 ,$573.00 ,$487.05 ,$573.00 ,$452.67 ,$452.67 ,$452.67 ,$515.70 ,$573.00 ,$515.70 ,$573.00 ,$573.00 ,$375.32 ,$573.00 ,$248.68 , N/A ,$573.00 ,$515.70 ,"$1,370.23 ",$361.56 ,$343.80 ,$515.70 ,$573.00 ,$515.70 ,$515.70 ,$573.00 ,$372.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000004,10081,HC I AND D CYST PILONIDAL CPLX,450,1 ,"$1,748.79 ","$1,136.71 ",$632.28 ,"$1,748.79 ","$1,302.85 ","$1,145.46 ",$632.28 ,$921.61 ,$632.28 ,"$1,103.49 ","$1,103.49 ","$1,103.49 ","$1,103.49 ","$1,573.91 ","$1,311.59 ",$632.28 ,"$1,538.94 ",$632.28 ,"$1,311.59 ","$1,311.59 ","$1,486.47 ","$1,486.47 ",$632.28 ,"$1,486.47 ",$632.28 ,"$1,381.54 ","$1,381.54 ","$1,381.54 ","$1,573.91 ","$1,517.82 ","$1,573.91 ",$632.28 ,"$1,748.79 ","$1,145.46 ",$632.28 ,$758.97 , N/A ,$661.80 ,"$1,573.91 ","$1,370.23 ","$1,103.49 ","$1,049.27 ","$1,573.91 ",$632.28 ,"$1,573.91 ","$1,573.91 ",$632.28 ,"$1,136.71 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000005,10120,HC INCISION/REM FB SUBQ SMP,450,1 ,$334.00 ,$217.10 ,$144.96 ,$761.90 ,$248.83 ,$218.77 ,$334.00 ,$176.02 ,$334.00 ,$210.75 ,$210.75 ,$210.75 ,$210.75 ,$300.60 ,$250.50 ,$334.00 ,$293.92 ,$334.00 ,$250.50 ,$250.50 ,$283.90 ,$283.90 ,$334.00 ,$283.90 ,$334.00 ,$263.86 ,$263.86 ,$263.86 ,$300.60 ,$334.00 ,$300.60 ,$334.00 ,$334.00 ,$218.77 ,$334.00 ,$144.96 , N/A ,$334.00 ,$300.60 ,$761.90 ,$210.75 ,$200.40 ,$300.60 ,$334.00 ,$300.60 ,$300.60 ,$334.00 ,$217.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000009,11730,HC AVULSION NAIL PLATE SINGLE FAC,450,1 ,$517.00 ,$336.05 ,$182.53 ,$517.00 ,$385.17 ,$338.64 ,$182.53 ,$272.46 ,$182.53 ,$326.23 ,$326.23 ,$326.23 ,$326.23 ,$465.30 ,$387.75 ,$182.53 ,$454.96 ,$182.53 ,$387.75 ,$387.75 ,$439.45 ,$439.45 ,$182.53 ,$439.45 ,$182.53 ,$408.43 ,$408.43 ,$408.43 ,$465.30 ,$438.16 ,$465.30 ,$182.53 ,$517.00 ,$338.64 ,$182.53 ,$224.38 , N/A ,$191.05 ,$465.30 ,$395.56 ,$326.23 ,$310.20 ,$465.30 ,$182.53 ,$465.30 ,$465.30 ,$182.53 ,$336.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000010,11732,HC AVULSION NAIL PL PT/CO EA ADDL FAC,450,1 ,$828.00 ,$538.20 ,$359.35 ,$828.00 ,$616.86 ,$542.34 , N/A ,$436.36 , N/A ,$522.47 ,$522.47 ,$522.47 ,$522.47 ,$745.20 ,$621.00 , N/A ,$728.64 , N/A ,$621.00 ,$621.00 ,$703.80 ,$703.80 , N/A ,$703.80 , N/A ,$654.12 ,$654.12 ,$654.12 ,$745.20 , N/A ,$745.20 , N/A ,$828.00 ,$542.34 , N/A ,$359.35 , N/A , N/A ,$745.20 , N/A ,$522.47 ,$496.80 ,$745.20 , N/A ,$745.20 ,$745.20 , N/A ,$538.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000011,11740,HC EVAC HEMATOMA SUBUNGAL,450,1 ,$174.00 ,$113.10 ,$75.52 ,$246.63 ,$129.63 ,$113.97 ,$113.81 ,$91.70 ,$113.81 ,$109.79 ,$109.79 ,$109.79 ,$109.79 ,$156.60 ,$130.50 ,$113.81 ,$153.12 ,$113.81 ,$130.50 ,$130.50 ,$147.90 ,$147.90 ,$113.81 ,$147.90 ,$113.81 ,$137.46 ,$137.46 ,$137.46 ,$156.60 ,$174.00 ,$156.60 ,$113.81 ,$174.00 ,$113.97 ,$113.81 ,$75.52 , N/A ,$119.12 ,$156.60 ,$246.63 ,$109.79 ,$104.40 ,$156.60 ,$113.81 ,$156.60 ,$156.60 ,$113.81 ,$113.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000011,11740,HC EVAC HEMATOMA SUBUNGAL,450,1 ,$699.00 ,$454.35 ,$113.81 ,$699.00 ,$520.76 ,$457.85 ,$113.81 ,$368.37 ,$113.81 ,$441.07 ,$441.07 ,$441.07 ,$441.07 ,$629.10 ,$524.25 ,$113.81 ,$615.12 ,$113.81 ,$524.25 ,$524.25 ,$594.15 ,$594.15 ,$113.81 ,$594.15 ,$113.81 ,$552.21 ,$552.21 ,$552.21 ,$629.10 ,$273.20 ,$629.10 ,$113.81 ,$699.00 ,$457.85 ,$113.81 ,$303.37 , N/A ,$119.12 ,$629.10 ,$246.63 ,$441.07 ,$419.40 ,$629.10 ,$113.81 ,$629.10 ,$629.10 ,$113.81 ,$454.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000012,11760,HC REPAIR NAIL BED,450,1 ,"$1,414.00 ",$919.10 ,$532.86 ,"$1,414.00 ","$1,053.43 ",$926.17 ,$532.86 ,$745.18 ,$532.86 ,$892.23 ,$892.23 ,$892.23 ,$892.23 ,"$1,272.60 ","$1,060.50 ",$532.86 ,"$1,244.32 ",$532.86 ,"$1,060.50 ","$1,060.50 ","$1,201.90 ","$1,201.90 ",$532.86 ,"$1,201.90 ",$532.86 ,"$1,117.06 ","$1,117.06 ","$1,117.06 ","$1,272.60 ","$1,279.15 ","$1,272.60 ",$532.86 ,"$1,414.00 ",$926.17 ,$532.86 ,$613.68 , N/A ,$557.73 ,"$1,272.60 ","$1,154.77 ",$892.23 ,$848.40 ,"$1,272.60 ",$532.86 ,"$1,272.60 ","$1,272.60 ",$532.86 ,$919.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000014,12001,HC SIMP S/N/AX/GN/TRK/EXT 2.5CM <,450,1 ,$348.00 ,$226.20 ,$151.03 ,$395.56 ,$259.26 ,$227.94 ,$182.53 ,$183.40 ,$182.53 ,$219.59 ,$219.59 ,$219.59 ,$219.59 ,$313.20 ,$261.00 ,$182.53 ,$306.24 ,$182.53 ,$261.00 ,$261.00 ,$295.80 ,$295.80 ,$182.53 ,$295.80 ,$182.53 ,$274.92 ,$274.92 ,$274.92 ,$313.20 ,$348.00 ,$313.20 ,$182.53 ,$348.00 ,$227.94 ,$182.53 ,$151.03 , N/A ,$191.05 ,$313.20 ,$395.56 ,$219.59 ,$208.80 ,$313.20 ,$182.53 ,$313.20 ,$313.20 ,$182.53 ,$226.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000015,12002,HC SIMP S/N/AX/GN/TRK/EXT 2.6-7.5,450,1 ,$348.00 ,$226.20 ,$151.03 ,$395.56 ,$259.26 ,$227.94 ,$182.53 ,$183.40 ,$182.53 ,$219.59 ,$219.59 ,$219.59 ,$219.59 ,$313.20 ,$261.00 ,$182.53 ,$306.24 ,$182.53 ,$261.00 ,$261.00 ,$295.80 ,$295.80 ,$182.53 ,$295.80 ,$182.53 ,$274.92 ,$274.92 ,$274.92 ,$313.20 ,$348.00 ,$313.20 ,$182.53 ,$348.00 ,$227.94 ,$182.53 ,$151.03 , N/A ,$191.05 ,$313.20 ,$395.56 ,$219.59 ,$208.80 ,$313.20 ,$182.53 ,$313.20 ,$313.20 ,$182.53 ,$226.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000016,12004,HC SIMP S/N/AX/GN/TRK/EXT7.6-12.5,450,1 ,$348.00 ,$226.20 ,$151.03 ,$395.56 ,$259.26 ,$227.94 ,$182.53 ,$183.40 ,$182.53 ,$219.59 ,$219.59 ,$219.59 ,$219.59 ,$313.20 ,$261.00 ,$182.53 ,$306.24 ,$182.53 ,$261.00 ,$261.00 ,$295.80 ,$295.80 ,$182.53 ,$295.80 ,$182.53 ,$274.92 ,$274.92 ,$274.92 ,$313.20 ,$348.00 ,$313.20 ,$182.53 ,$348.00 ,$227.94 ,$182.53 ,$151.03 , N/A ,$191.05 ,$313.20 ,$395.56 ,$219.59 ,$208.80 ,$313.20 ,$182.53 ,$313.20 ,$313.20 ,$182.53 ,$226.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000017,12005,HC SIMP S/N/AX/GN/TRK/EXT 12.6-20,450,1 ,$517.00 ,$336.05 ,$224.38 ,$761.90 ,$385.17 ,$338.64 ,$351.57 ,$272.46 ,$351.57 ,$326.23 ,$326.23 ,$326.23 ,$326.23 ,$465.30 ,$387.75 ,$351.57 ,$454.96 ,$351.57 ,$387.75 ,$387.75 ,$439.45 ,$439.45 ,$351.57 ,$439.45 ,$351.57 ,$408.43 ,$408.43 ,$408.43 ,$465.30 ,$517.00 ,$465.30 ,$351.57 ,$517.00 ,$338.64 ,$351.57 ,$224.38 , N/A ,$367.98 ,$465.30 ,$761.90 ,$326.23 ,$310.20 ,$465.30 ,$351.57 ,$465.30 ,$465.30 ,$351.57 ,$336.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000018,12006,HC SIMP S/N/AX/GN/TRK/EXT 20.1-30,450,1 ,$915.96 ,$595.37 ,$351.57 ,$915.96 ,$682.39 ,$599.95 ,$351.57 ,$482.71 ,$351.57 ,$577.97 ,$577.97 ,$577.97 ,$577.97 ,$824.36 ,$686.97 ,$351.57 ,$806.04 ,$351.57 ,$686.97 ,$686.97 ,$778.57 ,$778.57 ,$351.57 ,$778.57 ,$351.57 ,$723.61 ,$723.61 ,$723.61 ,$824.36 ,$843.97 ,$824.36 ,$351.57 ,$915.96 ,$599.95 ,$351.57 ,$397.53 , N/A ,$367.98 ,$824.36 ,$761.90 ,$577.97 ,$549.58 ,$824.36 ,$351.57 ,$824.36 ,$824.36 ,$351.57 ,$595.37 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000019,12007,HC SIMP S/N/AX/GN/TRK/EXT > 30CM,450,1 ,$540.00 ,$351.00 ,$182.53 ,$540.00 ,$402.30 ,$353.70 ,$182.53 ,$284.58 ,$182.53 ,$340.74 ,$340.74 ,$340.74 ,$340.74 ,$486.00 ,$405.00 ,$182.53 ,$475.20 ,$182.53 ,$405.00 ,$405.00 ,$459.00 ,$459.00 ,$182.53 ,$459.00 ,$182.53 ,$426.60 ,$426.60 ,$426.60 ,$486.00 ,$438.16 ,$486.00 ,$182.53 ,$540.00 ,$353.70 ,$182.53 ,$234.36 , N/A ,$191.05 ,$486.00 ,$395.56 ,$340.74 ,$324.00 ,$486.00 ,$182.53 ,$486.00 ,$486.00 ,$182.53 ,$351.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000020,12011,HC SIMP F/E/E/N/L/MM 2.5CM OR <,450,1 ,$348.00 ,$226.20 ,$151.03 ,$395.56 ,$259.26 ,$227.94 ,$182.53 ,$183.40 ,$182.53 ,$219.59 ,$219.59 ,$219.59 ,$219.59 ,$313.20 ,$261.00 ,$182.53 ,$306.24 ,$182.53 ,$261.00 ,$261.00 ,$295.80 ,$295.80 ,$182.53 ,$295.80 ,$182.53 ,$274.92 ,$274.92 ,$274.92 ,$313.20 ,$348.00 ,$313.20 ,$182.53 ,$348.00 ,$227.94 ,$182.53 ,$151.03 , N/A ,$191.05 ,$313.20 ,$395.56 ,$219.59 ,$208.80 ,$313.20 ,$182.53 ,$313.20 ,$313.20 ,$182.53 ,$226.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000021,12013,HC SIMP F/E/E/N/L/MM 2.6CM TO 5CM,450,1 ,$348.00 ,$226.20 ,$151.03 ,$395.56 ,$259.26 ,$227.94 ,$182.53 ,$183.40 ,$182.53 ,$219.59 ,$219.59 ,$219.59 ,$219.59 ,$313.20 ,$261.00 ,$182.53 ,$306.24 ,$182.53 ,$261.00 ,$261.00 ,$295.80 ,$295.80 ,$182.53 ,$295.80 ,$182.53 ,$274.92 ,$274.92 ,$274.92 ,$313.20 ,$348.00 ,$313.20 ,$182.53 ,$348.00 ,$227.94 ,$182.53 ,$151.03 , N/A ,$191.05 ,$313.20 ,$395.56 ,$219.59 ,$208.80 ,$313.20 ,$182.53 ,$313.20 ,$313.20 ,$182.53 ,$226.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000022,12014,HC SIMP F/E/E/N/L/MM 5.1-7.5CM,450,1 ,$348.00 ,$226.20 ,$151.03 ,$395.56 ,$259.26 ,$227.94 ,$182.53 ,$183.40 ,$182.53 ,$219.59 ,$219.59 ,$219.59 ,$219.59 ,$313.20 ,$261.00 ,$182.53 ,$306.24 ,$182.53 ,$261.00 ,$261.00 ,$295.80 ,$295.80 ,$182.53 ,$295.80 ,$182.53 ,$274.92 ,$274.92 ,$274.92 ,$313.20 ,$348.00 ,$313.20 ,$182.53 ,$348.00 ,$227.94 ,$182.53 ,$151.03 , N/A ,$191.05 ,$313.20 ,$395.56 ,$219.59 ,$208.80 ,$313.20 ,$182.53 ,$313.20 ,$313.20 ,$182.53 ,$226.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000023,12015,HC SIMP F/E/E/N/L/MM 7.6 -12.5CM,450,1 ,$517.00 ,$336.05 ,$182.53 ,$517.00 ,$385.17 ,$338.64 ,$182.53 ,$272.46 ,$182.53 ,$326.23 ,$326.23 ,$326.23 ,$326.23 ,$465.30 ,$387.75 ,$182.53 ,$454.96 ,$182.53 ,$387.75 ,$387.75 ,$439.45 ,$439.45 ,$182.53 ,$439.45 ,$182.53 ,$408.43 ,$408.43 ,$408.43 ,$465.30 ,$438.16 ,$465.30 ,$182.53 ,$517.00 ,$338.64 ,$182.53 ,$224.38 , N/A ,$191.05 ,$465.30 ,$395.56 ,$326.23 ,$310.20 ,$465.30 ,$182.53 ,$465.30 ,$465.30 ,$182.53 ,$336.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000024,12016,HC SIMP F/E/E/N/L/MM 12.6-20.0CM,450,1 ,$517.00 ,$336.05 ,$224.38 ,$761.90 ,$385.17 ,$338.64 ,$351.57 ,$272.46 ,$351.57 ,$326.23 ,$326.23 ,$326.23 ,$326.23 ,$465.30 ,$387.75 ,$351.57 ,$454.96 ,$351.57 ,$387.75 ,$387.75 ,$439.45 ,$439.45 ,$351.57 ,$439.45 ,$351.57 ,$408.43 ,$408.43 ,$408.43 ,$465.30 ,$517.00 ,$465.30 ,$351.57 ,$517.00 ,$338.64 ,$351.57 ,$224.38 , N/A ,$367.98 ,$465.30 ,$761.90 ,$326.23 ,$310.20 ,$465.30 ,$351.57 ,$465.30 ,$465.30 ,$351.57 ,$336.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000027,12020,HC SIMP SUPERFICIAL DEHISCENCE,450,1 ,"$1,445.00 ",$939.25 ,$532.86 ,"$1,445.00 ","$1,076.53 ",$946.48 ,$532.86 ,$761.52 ,$532.86 ,$911.80 ,$911.80 ,$911.80 ,$911.80 ,"$1,300.50 ","$1,083.75 ",$532.86 ,"$1,271.60 ",$532.86 ,"$1,083.75 ","$1,083.75 ","$1,228.25 ","$1,228.25 ",$532.86 ,"$1,228.25 ",$532.86 ,"$1,141.55 ","$1,141.55 ","$1,141.55 ","$1,300.50 ","$1,279.15 ","$1,300.50 ",$532.86 ,"$1,445.00 ",$946.48 ,$532.86 ,$627.13 , N/A ,$557.73 ,"$1,300.50 ","$1,154.77 ",$911.80 ,$867.00 ,"$1,300.50 ",$532.86 ,"$1,300.50 ","$1,300.50 ",$532.86 ,$939.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000029,12031,HC INTRM S/A/T/EXT 2.5CM OR <,450,1 ,$778.00 ,$505.70 ,$337.65 ,$778.00 ,$579.61 ,$509.59 ,$351.57 ,$410.01 ,$351.57 ,$490.92 ,$490.92 ,$490.92 ,$490.92 ,$700.20 ,$583.50 ,$351.57 ,$684.64 ,$351.57 ,$583.50 ,$583.50 ,$661.30 ,$661.30 ,$351.57 ,$661.30 ,$351.57 ,$614.62 ,$614.62 ,$614.62 ,$700.20 ,$778.00 ,$700.20 ,$351.57 ,$778.00 ,$509.59 ,$351.57 ,$337.65 , N/A ,$367.98 ,$700.20 ,$761.90 ,$490.92 ,$466.80 ,$700.20 ,$351.57 ,$700.20 ,$700.20 ,$351.57 ,$505.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000030,12032,HC INTRM S/A/T/EXT 2.6-7.5CM,450,1 ,$778.00 ,$505.70 ,$337.65 ,$778.00 ,$579.61 ,$509.59 ,$351.57 ,$410.01 ,$351.57 ,$490.92 ,$490.92 ,$490.92 ,$490.92 ,$700.20 ,$583.50 ,$351.57 ,$684.64 ,$351.57 ,$583.50 ,$583.50 ,$661.30 ,$661.30 ,$351.57 ,$661.30 ,$351.57 ,$614.62 ,$614.62 ,$614.62 ,$700.20 ,$778.00 ,$700.20 ,$351.57 ,$778.00 ,$509.59 ,$351.57 ,$337.65 , N/A ,$367.98 ,$700.20 ,$761.90 ,$490.92 ,$466.80 ,$700.20 ,$351.57 ,$700.20 ,$700.20 ,$351.57 ,$505.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000031,12034,HC INTRM S/A/T/EXT 7.6-12.5CM,450,1 ,$778.00 ,$505.70 ,$337.65 ,$778.00 ,$579.61 ,$509.59 ,$351.57 ,$410.01 ,$351.57 ,$490.92 ,$490.92 ,$490.92 ,$490.92 ,$700.20 ,$583.50 ,$351.57 ,$684.64 ,$351.57 ,$583.50 ,$583.50 ,$661.30 ,$661.30 ,$351.57 ,$661.30 ,$351.57 ,$614.62 ,$614.62 ,$614.62 ,$700.20 ,$778.00 ,$700.20 ,$351.57 ,$778.00 ,$509.59 ,$351.57 ,$337.65 , N/A ,$367.98 ,$700.20 ,$761.90 ,$490.92 ,$466.80 ,$700.20 ,$351.57 ,$700.20 ,$700.20 ,$351.57 ,$505.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000032,12035,HC INTRM S/A/T/EXT 12.6-20.0CM,450,1 ,"$1,521.00 ",$988.65 ,$351.57 ,"$1,521.00 ","$1,133.15 ",$996.26 ,$351.57 ,$801.57 ,$351.57 ,$959.75 ,$959.75 ,$959.75 ,$959.75 ,"$1,368.90 ","$1,140.75 ",$351.57 ,"$1,338.48 ",$351.57 ,"$1,140.75 ","$1,140.75 ","$1,292.85 ","$1,292.85 ",$351.57 ,"$1,292.85 ",$351.57 ,"$1,201.59 ","$1,201.59 ","$1,201.59 ","$1,368.90 ",$843.97 ,"$1,368.90 ",$351.57 ,"$1,521.00 ",$996.26 ,$351.57 ,$660.11 , N/A ,$367.98 ,"$1,368.90 ",$761.90 ,$959.75 ,$912.60 ,"$1,368.90 ",$351.57 ,"$1,368.90 ","$1,368.90 ",$351.57 ,$988.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000033,12036,HC INTRM S/A/T/EXT 20.1-30.0CM,450,1 ,"$1,478.00 ",$960.70 ,$532.86 ,"$1,478.00 ","$1,101.11 ",$968.09 ,$532.86 ,$778.91 ,$532.86 ,$932.62 ,$932.62 ,$932.62 ,$932.62 ,"$1,330.20 ","$1,108.50 ",$532.86 ,"$1,300.64 ",$532.86 ,"$1,108.50 ","$1,108.50 ","$1,256.30 ","$1,256.30 ",$532.86 ,"$1,256.30 ",$532.86 ,"$1,167.62 ","$1,167.62 ","$1,167.62 ","$1,330.20 ","$1,279.15 ","$1,330.20 ",$532.86 ,"$1,478.00 ",$968.09 ,$532.86 ,$641.45 , N/A ,$557.73 ,"$1,330.20 ","$1,154.77 ",$932.62 ,$886.80 ,"$1,330.20 ",$532.86 ,"$1,330.20 ","$1,330.20 ",$532.86 ,$960.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000035,12041,HC INTRM N/H/F/GEN 2.5CM OR <,450,1 ,$958.53 ,$623.04 ,$351.57 ,$958.53 ,$714.10 ,$627.84 ,$351.57 ,$505.15 ,$351.57 ,$604.83 ,$604.83 ,$604.83 ,$604.83 ,$862.68 ,$718.90 ,$351.57 ,$843.51 ,$351.57 ,$718.90 ,$718.90 ,$814.75 ,$814.75 ,$351.57 ,$814.75 ,$351.57 ,$757.24 ,$757.24 ,$757.24 ,$862.68 ,$843.97 ,$862.68 ,$351.57 ,$958.53 ,$627.84 ,$351.57 ,$416.00 , N/A ,$367.98 ,$862.68 ,$761.90 ,$604.83 ,$575.12 ,$862.68 ,$351.57 ,$862.68 ,$862.68 ,$351.57 ,$623.04 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000036,12042,HC INTRM N/H/F/GEN 2.6-7.5CM,450,1 ,$778.00 ,$505.70 ,$337.65 ,$778.00 ,$579.61 ,$509.59 ,$351.57 ,$410.01 ,$351.57 ,$490.92 ,$490.92 ,$490.92 ,$490.92 ,$700.20 ,$583.50 ,$351.57 ,$684.64 ,$351.57 ,$583.50 ,$583.50 ,$661.30 ,$661.30 ,$351.57 ,$661.30 ,$351.57 ,$614.62 ,$614.62 ,$614.62 ,$700.20 ,$778.00 ,$700.20 ,$351.57 ,$778.00 ,$509.59 ,$351.57 ,$337.65 , N/A ,$367.98 ,$700.20 ,$761.90 ,$490.92 ,$466.80 ,$700.20 ,$351.57 ,$700.20 ,$700.20 ,$351.57 ,$505.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000041,12051,HC INTRM F/E/E/N/L/MM 2.5CM OR <,450,1 ,$778.00 ,$505.70 ,$337.65 ,$778.00 ,$579.61 ,$509.59 ,$351.57 ,$410.01 ,$351.57 ,$490.92 ,$490.92 ,$490.92 ,$490.92 ,$700.20 ,$583.50 ,$351.57 ,$684.64 ,$351.57 ,$583.50 ,$583.50 ,$661.30 ,$661.30 ,$351.57 ,$661.30 ,$351.57 ,$614.62 ,$614.62 ,$614.62 ,$700.20 ,$778.00 ,$700.20 ,$351.57 ,$778.00 ,$509.59 ,$351.57 ,$337.65 , N/A ,$367.98 ,$700.20 ,$761.90 ,$490.92 ,$466.80 ,$700.20 ,$351.57 ,$700.20 ,$700.20 ,$351.57 ,$505.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000042,12052,HC INTRM F/E/E/N/L/MM 2.6-5.0CM,450,1 ,$778.00 ,$505.70 ,$337.65 ,$778.00 ,$579.61 ,$509.59 ,$351.57 ,$410.01 ,$351.57 ,$490.92 ,$490.92 ,$490.92 ,$490.92 ,$700.20 ,$583.50 ,$351.57 ,$684.64 ,$351.57 ,$583.50 ,$583.50 ,$661.30 ,$661.30 ,$351.57 ,$661.30 ,$351.57 ,$614.62 ,$614.62 ,$614.62 ,$700.20 ,$778.00 ,$700.20 ,$351.57 ,$778.00 ,$509.59 ,$351.57 ,$337.65 , N/A ,$367.98 ,$700.20 ,$761.90 ,$490.92 ,$466.80 ,$700.20 ,$351.57 ,$700.20 ,$700.20 ,$351.57 ,$505.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000043,12053,HC INTRM F/E/E/N/L/MM 5.1-7.5CM,450,1 ,$778.00 ,$505.70 ,$337.65 ,$778.00 ,$579.61 ,$509.59 ,$351.57 ,$410.01 ,$351.57 ,$490.92 ,$490.92 ,$490.92 ,$490.92 ,$700.20 ,$583.50 ,$351.57 ,$684.64 ,$351.57 ,$583.50 ,$583.50 ,$661.30 ,$661.30 ,$351.57 ,$661.30 ,$351.57 ,$614.62 ,$614.62 ,$614.62 ,$700.20 ,$778.00 ,$700.20 ,$351.57 ,$778.00 ,$509.59 ,$351.57 ,$337.65 , N/A ,$367.98 ,$700.20 ,$761.90 ,$490.92 ,$466.80 ,$700.20 ,$351.57 ,$700.20 ,$700.20 ,$351.57 ,$505.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000044,12054,HC INTRM F/E/E/N/L/MM 7.6-12.5CM,450,1 ,$778.00 ,$505.70 ,$337.65 ,$778.00 ,$579.61 ,$509.59 ,$351.57 ,$410.01 ,$351.57 ,$490.92 ,$490.92 ,$490.92 ,$490.92 ,$700.20 ,$583.50 ,$351.57 ,$684.64 ,$351.57 ,$583.50 ,$583.50 ,$661.30 ,$661.30 ,$351.57 ,$661.30 ,$351.57 ,$614.62 ,$614.62 ,$614.62 ,$700.20 ,$778.00 ,$700.20 ,$351.57 ,$778.00 ,$509.59 ,$351.57 ,$337.65 , N/A ,$367.98 ,$700.20 ,$761.90 ,$490.92 ,$466.80 ,$700.20 ,$351.57 ,$700.20 ,$700.20 ,$351.57 ,$505.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000059,13152,HC CMPLX E/N/E/L 2.6-7.5 CM,450,1 ,"$1,521.00 ",$988.65 ,$532.86 ,"$1,521.00 ","$1,133.15 ",$996.26 ,$532.86 ,$801.57 ,$532.86 ,$959.75 ,$959.75 ,$959.75 ,$959.75 ,"$1,368.90 ","$1,140.75 ",$532.86 ,"$1,338.48 ",$532.86 ,"$1,140.75 ","$1,140.75 ","$1,292.85 ","$1,292.85 ",$532.86 ,"$1,292.85 ",$532.86 ,"$1,201.59 ","$1,201.59 ","$1,201.59 ","$1,368.90 ","$1,279.15 ","$1,368.90 ",$532.86 ,"$1,521.00 ",$996.26 ,$532.86 ,$660.11 , N/A ,$557.73 ,"$1,368.90 ","$1,154.77 ",$959.75 ,$912.60 ,"$1,368.90 ",$532.86 ,"$1,368.90 ","$1,368.90 ",$532.86 ,$988.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000062,16020,HC DRESS/DEB BURN <5% TOTAL SM,450,1 ,$537.00 ,$349.05 ,$182.53 ,$537.00 ,$400.07 ,$351.74 ,$182.53 ,$283.00 ,$182.53 ,$338.85 ,$338.85 ,$338.85 ,$338.85 ,$483.30 ,$402.75 ,$182.53 ,$472.56 ,$182.53 ,$402.75 ,$402.75 ,$456.45 ,$456.45 ,$182.53 ,$456.45 ,$182.53 ,$424.23 ,$424.23 ,$424.23 ,$483.30 ,$438.16 ,$483.30 ,$182.53 ,$537.00 ,$351.74 ,$182.53 ,$233.06 , N/A ,$191.05 ,$483.30 ,$395.56 ,$338.85 ,$322.20 ,$483.30 ,$182.53 ,$483.30 ,$483.30 ,$182.53 ,$349.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000063,16025,HC DRESS/DEB BURN 5-10% TOTAL MED,450,1 ,$561.00 ,$364.65 ,$182.53 ,$561.00 ,$417.95 ,$367.46 ,$182.53 ,$295.65 ,$182.53 ,$353.99 ,$353.99 ,$353.99 ,$353.99 ,$504.90 ,$420.75 ,$182.53 ,$493.68 ,$182.53 ,$420.75 ,$420.75 ,$476.85 ,$476.85 ,$182.53 ,$476.85 ,$182.53 ,$443.19 ,$443.19 ,$443.19 ,$504.90 ,$438.16 ,$504.90 ,$182.53 ,$561.00 ,$367.46 ,$182.53 ,$243.47 , N/A ,$191.05 ,$504.90 ,$395.56 ,$353.99 ,$336.60 ,$504.90 ,$182.53 ,$504.90 ,$504.90 ,$182.53 ,$364.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000064,16030,HC DRESS/DEBR BURN >10% TOTAL LRG,450,1 ,$561.00 ,$364.65 ,$243.47 ,$761.90 ,$417.95 ,$367.46 ,$351.57 ,$295.65 ,$351.57 ,$353.99 ,$353.99 ,$353.99 ,$353.99 ,$504.90 ,$420.75 ,$351.57 ,$493.68 ,$351.57 ,$420.75 ,$420.75 ,$476.85 ,$476.85 ,$351.57 ,$476.85 ,$351.57 ,$443.19 ,$443.19 ,$443.19 ,$504.90 ,$561.00 ,$504.90 ,$351.57 ,$561.00 ,$367.46 ,$351.57 ,$243.47 , N/A ,$367.98 ,$504.90 ,$761.90 ,$353.99 ,$336.60 ,$504.90 ,$351.57 ,$504.90 ,$504.90 ,$351.57 ,$364.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000067,17250,HC CAUT CHEM TISSUE GRANULATION,450,1 ,$536.00 ,$348.40 ,$182.53 ,$536.00 ,$399.32 ,$351.08 ,$182.53 ,$282.47 ,$182.53 ,$338.22 ,$338.22 ,$338.22 ,$338.22 ,$482.40 ,$402.00 ,$182.53 ,$471.68 ,$182.53 ,$402.00 ,$402.00 ,$455.60 ,$455.60 ,$182.53 ,$455.60 ,$182.53 ,$423.44 ,$423.44 ,$423.44 ,$482.40 ,$438.16 ,$482.40 ,$182.53 ,$536.00 ,$351.08 ,$182.53 ,$232.62 , N/A ,$191.05 ,$482.40 ,$395.56 ,$338.22 ,$321.60 ,$482.40 ,$182.53 ,$482.40 ,$482.40 ,$182.53 ,$348.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000070,20605,HC ARTHROCNT ASP/INJ JT INTRM,450,1 ,$921.00 ,$598.65 ,$265.50 ,$921.00 ,$686.15 ,$603.26 ,$265.50 ,$485.37 ,$265.50 ,$581.15 ,$581.15 ,$581.15 ,$581.15 ,$828.90 ,$690.75 ,$265.50 ,$810.48 ,$265.50 ,$690.75 ,$690.75 ,$782.85 ,$782.85 ,$265.50 ,$782.85 ,$265.50 ,$727.59 ,$727.59 ,$727.59 ,$828.90 ,$637.34 ,$828.90 ,$265.50 ,$921.00 ,$603.26 ,$265.50 ,$399.71 , N/A ,$277.89 ,$828.90 ,$575.37 ,$581.15 ,$552.60 ,$828.90 ,$265.50 ,$828.90 ,$828.90 ,$265.50 ,$598.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,$921.00 ,$598.65 ,$265.50 ,$921.00 ,$686.15 ,$603.26 ,$265.50 ,$485.37 ,$265.50 ,$581.15 ,$581.15 ,$581.15 ,$581.15 ,$828.90 ,$690.75 ,$265.50 ,$810.48 ,$265.50 ,$690.75 ,$690.75 ,$782.85 ,$782.85 ,$265.50 ,$782.85 ,$265.50 ,$727.59 ,$727.59 ,$727.59 ,$828.90 ,$637.34 ,$828.90 ,$265.50 ,$921.00 ,$603.26 ,$265.50 ,$399.71 , N/A ,$277.89 ,$828.90 ,$575.37 ,$581.15 ,$552.60 ,$828.90 ,$265.50 ,$828.90 ,$828.90 ,$265.50 ,$598.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000071,20610,HC ASPIR/INJECT MAJOR JOINT OR BURSA,450,1 ,"$1,382.00 ",$898.30 ,$398.25 ,"$1,382.00 ","$1,029.59 ",$905.21 ,$398.25 ,$728.31 ,$398.25 ,$872.04 ,$872.04 ,$872.04 ,$872.04 ,"$1,243.80 ","$1,036.50 ",$398.25 ,"$1,216.16 ",$398.25 ,"$1,036.50 ","$1,036.50 ","$1,174.70 ","$1,174.70 ",$398.25 ,"$1,174.70 ",$398.25 ,"$1,091.78 ","$1,091.78 ","$1,091.78 ","$1,243.80 ",$956.02 ,"$1,243.80 ",$398.25 ,"$1,382.00 ",$905.21 ,$398.25 ,$599.79 , N/A ,$416.84 ,"$1,243.80 ",$863.05 ,$872.04 ,$829.20 ,"$1,243.80 ",$398.25 ,"$1,243.80 ","$1,243.80 ",$398.25 ,$898.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000074,23650,HC TX DISL SHLDR W/MAN CLS,450,1 ,$756.00 ,$491.40 ,$209.61 ,$756.00 ,$563.22 ,$495.18 ,$209.61 ,$398.41 ,$209.61 ,$477.04 ,$477.04 ,$477.04 ,$477.04 ,$680.40 ,$567.00 ,$209.61 ,$665.28 ,$209.61 ,$567.00 ,$567.00 ,$642.60 ,$642.60 ,$209.61 ,$642.60 ,$209.61 ,$597.24 ,$597.24 ,$597.24 ,$680.40 ,$503.17 ,$680.40 ,$209.61 ,$756.00 ,$495.18 ,$209.61 ,$328.10 , N/A ,$219.39 ,$680.40 ,$454.25 ,$477.04 ,$453.60 ,$680.40 ,$209.61 ,$680.40 ,$680.40 ,$209.61 ,$491.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000076,24600,HC TX DISL ELBOW W/O ANES CLS,450,1 ,$736.00 ,$478.40 ,$209.61 ,$736.00 ,$548.32 ,$482.08 ,$209.61 ,$387.87 ,$209.61 ,$464.42 ,$464.42 ,$464.42 ,$464.42 ,$662.40 ,$552.00 ,$209.61 ,$647.68 ,$209.61 ,$552.00 ,$552.00 ,$625.60 ,$625.60 ,$209.61 ,$625.60 ,$209.61 ,$581.44 ,$581.44 ,$581.44 ,$662.40 ,$503.17 ,$662.40 ,$209.61 ,$736.00 ,$482.08 ,$209.61 ,$319.42 , N/A ,$219.39 ,$662.40 ,$454.25 ,$464.42 ,$441.60 ,$662.40 ,$209.61 ,$662.40 ,$662.40 ,$209.61 ,$478.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000079,24640,HC DISLOCATION NURSEMAID ELBOW,450,1 ,$711.00 ,$462.15 ,$209.61 ,$711.00 ,$529.70 ,$465.71 ,$209.61 ,$374.70 ,$209.61 ,$448.64 ,$448.64 ,$448.64 ,$448.64 ,$639.90 ,$533.25 ,$209.61 ,$625.68 ,$209.61 ,$533.25 ,$533.25 ,$604.35 ,$604.35 ,$209.61 ,$604.35 ,$209.61 ,$561.69 ,$561.69 ,$561.69 ,$639.90 ,$503.17 ,$639.90 ,$209.61 ,$711.00 ,$465.71 ,$209.61 ,$308.57 , N/A ,$219.39 ,$639.90 ,$454.25 ,$448.64 ,$426.60 ,$639.90 ,$209.61 ,$639.90 ,$639.90 ,$209.61 ,$462.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000081,25565,HC CL TX RADIAL/ULNAR SHAFT FX W MANIP,450,1 ,"$3,643.00 ","$2,367.95 ","$1,415.42 ","$3,643.00 ","$2,714.04 ","$2,386.17 ","$1,415.42 ","$1,919.86 ","$1,415.42 ","$2,298.73 ","$2,298.73 ","$2,298.73 ","$2,298.73 ","$3,278.70 ","$2,732.25 ","$1,415.42 ","$3,205.84 ","$1,415.42 ","$2,732.25 ","$2,732.25 ","$3,096.55 ","$3,096.55 ","$1,415.42 ","$3,096.55 ","$1,415.42 ","$2,877.97 ","$2,877.97 ","$2,877.97 ","$3,278.70 ","$3,397.81 ","$3,278.70 ","$1,415.42 ","$3,643.00 ","$2,386.17 ","$1,415.42 ","$1,581.06 ", N/A ,"$1,481.50 ","$3,278.70 ","$3,067.41 ","$2,298.73 ","$2,185.80 ","$3,278.70 ","$1,415.42 ","$3,278.70 ","$3,278.70 ","$1,415.42 ","$2,367.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000082,25605,HC CL TX DIS RADIAL FX/EPIP SEP,450,1 ,"$2,523.00 ","$1,639.95 ","$1,094.98 ","$3,067.41 ","$1,879.64 ","$1,652.57 ","$1,415.42 ","$1,329.62 ","$1,415.42 ","$1,592.01 ","$1,592.01 ","$1,592.01 ","$1,592.01 ","$2,270.70 ","$1,892.25 ","$1,415.42 ","$2,220.24 ","$1,415.42 ","$1,892.25 ","$1,892.25 ","$2,144.55 ","$2,144.55 ","$1,415.42 ","$2,144.55 ","$1,415.42 ","$1,993.17 ","$1,993.17 ","$1,993.17 ","$2,270.70 ","$2,523.00 ","$2,270.70 ","$1,415.42 ","$2,523.00 ","$1,652.57 ","$1,415.42 ","$1,094.98 ", N/A ,"$1,481.50 ","$2,270.70 ","$3,067.41 ","$1,592.01 ","$1,513.80 ","$2,270.70 ","$1,415.42 ","$2,270.70 ","$2,270.70 ","$1,415.42 ","$1,639.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000087,26725,HC TX FX PHALANX PROX W/MAN CLS,450,1 ,$618.21 ,$401.84 ,$209.61 ,$618.21 ,$460.57 ,$404.93 ,$209.61 ,$325.80 ,$209.61 ,$390.09 ,$390.09 ,$390.09 ,$390.09 ,$556.39 ,$463.66 ,$209.61 ,$544.02 ,$209.61 ,$463.66 ,$463.66 ,$525.48 ,$525.48 ,$209.61 ,$525.48 ,$209.61 ,$488.39 ,$488.39 ,$488.39 ,$556.39 ,$503.17 ,$556.39 ,$209.61 ,$618.21 ,$404.93 ,$209.61 ,$268.30 , N/A ,$219.39 ,$556.39 ,$454.25 ,$390.09 ,$370.93 ,$556.39 ,$209.61 ,$556.39 ,$556.39 ,$209.61 ,$401.84 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000090,26770,HC TX DISL (I-P) HAND W/O ANES,450,1 ,$598.00 ,$388.70 ,$209.61 ,$598.00 ,$445.51 ,$391.69 ,$209.61 ,$315.15 ,$209.61 ,$377.34 ,$377.34 ,$377.34 ,$377.34 ,$538.20 ,$448.50 ,$209.61 ,$526.24 ,$209.61 ,$448.50 ,$448.50 ,$508.30 ,$508.30 ,$209.61 ,$508.30 ,$209.61 ,$472.42 ,$472.42 ,$472.42 ,$538.20 ,$503.17 ,$538.20 ,$209.61 ,$598.00 ,$391.69 ,$209.61 ,$259.53 , N/A ,$219.39 ,$538.20 ,$454.25 ,$377.34 ,$358.80 ,$538.20 ,$209.61 ,$538.20 ,$538.20 ,$209.61 ,$388.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000091,26951,HC AMPUT FINGER/THUMB SGL CLSR,450,1 ,"$7,847.73 ","$5,101.02 ","$2,877.30 ","$7,847.73 ","$5,846.56 ","$5,140.26 ","$2,877.30 ","$4,135.75 ","$2,877.30 ","$4,951.92 ","$4,951.92 ","$4,951.92 ","$4,951.92 ","$7,062.96 ","$5,885.80 ","$2,877.30 ","$6,906.00 ","$2,877.30 ","$5,885.80 ","$5,885.80 ","$6,670.57 ","$6,670.57 ","$2,877.30 ","$6,670.57 ","$2,877.30 ","$6,199.71 ","$6,199.71 ","$6,199.71 ","$7,062.96 ","$6,907.14 ","$7,062.96 ","$2,877.30 ","$7,847.73 ","$5,140.26 ","$2,877.30 ","$3,405.91 ", N/A ,"$3,011.63 ","$7,062.96 ","$6,235.50 ","$4,951.92 ","$4,708.64 ","$7,062.96 ","$2,877.30 ","$7,062.96 ","$7,062.96 ","$2,877.30 ","$5,101.02 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000094,27265,HC CL TX POST HIP ARTHROPLASTY DISLOCAT,450,1 ,$641.00 ,$416.65 ,$209.61 ,$641.00 ,$477.55 ,$419.86 ,$209.61 ,$337.81 ,$209.61 ,$404.47 ,$404.47 ,$404.47 ,$404.47 ,$576.90 ,$480.75 ,$209.61 ,$564.08 ,$209.61 ,$480.75 ,$480.75 ,$544.85 ,$544.85 ,$209.61 ,$544.85 ,$209.61 ,$506.39 ,$506.39 ,$506.39 ,$576.90 ,$503.17 ,$576.90 ,$209.61 ,$641.00 ,$419.86 ,$209.61 ,$278.19 , N/A ,$219.39 ,$576.90 ,$454.25 ,$404.47 ,$384.60 ,$576.90 ,$209.61 ,$576.90 ,$576.90 ,$209.61 ,$416.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000096,27560,HC TX DSL PTLR W/O ANS CL,450,1 ,$599.00 ,$389.35 ,$209.61 ,$599.00 ,$446.26 ,$392.35 ,$209.61 ,$315.67 ,$209.61 ,$377.97 ,$377.97 ,$377.97 ,$377.97 ,$539.10 ,$449.25 ,$209.61 ,$527.12 ,$209.61 ,$449.25 ,$449.25 ,$509.15 ,$509.15 ,$209.61 ,$509.15 ,$209.61 ,$473.21 ,$473.21 ,$473.21 ,$539.10 ,$503.17 ,$539.10 ,$209.61 ,$599.00 ,$392.35 ,$209.61 ,$259.97 , N/A ,$219.39 ,$539.10 ,$454.25 ,$377.97 ,$359.40 ,$539.10 ,$209.61 ,$539.10 ,$539.10 ,$209.61 ,$389.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000100,29105,HC APPL SPLNT ARM LONG,450,1 ,$425.00 ,$276.25 ,$143.52 ,$425.00 ,$316.63 ,$278.38 ,$143.52 ,$223.98 ,$143.52 ,$268.18 ,$268.18 ,$268.18 ,$268.18 ,$382.50 ,$318.75 ,$143.52 ,$374.00 ,$143.52 ,$318.75 ,$318.75 ,$361.25 ,$361.25 ,$143.52 ,$361.25 ,$143.52 ,$335.75 ,$335.75 ,$335.75 ,$382.50 ,$344.53 ,$382.50 ,$143.52 ,$425.00 ,$278.38 ,$143.52 ,$184.45 , N/A ,$150.22 ,$382.50 ,$311.03 ,$268.18 ,$255.00 ,$382.50 ,$143.52 ,$382.50 ,$382.50 ,$143.52 ,$276.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000101,29125,HC APPL SPLINT ARM SHORT STATIC,450,1 ,$438.00 ,$284.70 ,$113.81 ,$438.00 ,$326.31 ,$286.89 ,$113.81 ,$230.83 ,$113.81 ,$276.38 ,$276.38 ,$276.38 ,$276.38 ,$394.20 ,$328.50 ,$113.81 ,$385.44 ,$113.81 ,$328.50 ,$328.50 ,$372.30 ,$372.30 ,$113.81 ,$372.30 ,$113.81 ,$346.02 ,$346.02 ,$346.02 ,$394.20 ,$273.20 ,$394.20 ,$113.81 ,$438.00 ,$286.89 ,$113.81 ,$190.09 , N/A ,$119.12 ,$394.20 ,$246.63 ,$276.38 ,$262.80 ,$394.20 ,$113.81 ,$394.20 ,$394.20 ,$113.81 ,$284.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000102,29126,HC APPL SHRT ARM SPLNT DYNAM,450,1 ,$312.57 ,$203.17 ,$113.81 ,$312.57 ,$232.86 ,$204.73 ,$113.81 ,$164.72 ,$113.81 ,$197.23 ,$197.23 ,$197.23 ,$197.23 ,$281.31 ,$234.43 ,$113.81 ,$275.06 ,$113.81 ,$234.43 ,$234.43 ,$265.68 ,$265.68 ,$113.81 ,$265.68 ,$113.81 ,$246.93 ,$246.93 ,$246.93 ,$281.31 ,$273.20 ,$281.31 ,$113.81 ,$312.57 ,$204.73 ,$113.81 ,$135.66 , N/A ,$119.12 ,$281.31 ,$246.63 ,$197.23 ,$187.54 ,$281.31 ,$113.81 ,$281.31 ,$281.31 ,$113.81 ,$203.17 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000103,29130,HC APPL SPLNT FINGER STATIC,450,1 ,$185.00 ,$120.25 ,$80.29 ,$246.63 ,$137.83 ,$121.18 ,$113.81 ,$97.50 ,$113.81 ,$116.74 ,$116.74 ,$116.74 ,$116.74 ,$166.50 ,$138.75 ,$113.81 ,$162.80 ,$113.81 ,$138.75 ,$138.75 ,$157.25 ,$157.25 ,$113.81 ,$157.25 ,$113.81 ,$146.15 ,$146.15 ,$146.15 ,$166.50 ,$185.00 ,$166.50 ,$113.81 ,$185.00 ,$121.18 ,$113.81 ,$80.29 , N/A ,$119.12 ,$166.50 ,$246.63 ,$116.74 ,$111.00 ,$166.50 ,$113.81 ,$166.50 ,$166.50 ,$113.81 ,$120.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000105,29240,HC STRAPPING SHLDR,450,1 ,$185.00 ,$120.25 ,$80.29 ,$246.63 ,$137.83 ,$121.18 ,$113.81 ,$97.50 ,$113.81 ,$116.74 ,$116.74 ,$116.74 ,$116.74 ,$166.50 ,$138.75 ,$113.81 ,$162.80 ,$113.81 ,$138.75 ,$138.75 ,$157.25 ,$157.25 ,$113.81 ,$157.25 ,$113.81 ,$146.15 ,$146.15 ,$146.15 ,$166.50 ,$185.00 ,$166.50 ,$113.81 ,$185.00 ,$121.18 ,$113.81 ,$80.29 , N/A ,$119.12 ,$166.50 ,$246.63 ,$116.74 ,$111.00 ,$166.50 ,$113.81 ,$166.50 ,$166.50 ,$113.81 ,$120.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000106,29405,HC APPL CAST SHORT LEG,450,1 ,$742.00 ,$482.30 ,$245.17 ,$742.00 ,$552.79 ,$486.01 ,$245.17 ,$391.03 ,$245.17 ,$468.20 ,$468.20 ,$468.20 ,$468.20 ,$667.80 ,$556.50 ,$245.17 ,$652.96 ,$245.17 ,$556.50 ,$556.50 ,$630.70 ,$630.70 ,$245.17 ,$630.70 ,$245.17 ,$586.18 ,$586.18 ,$586.18 ,$667.80 ,$588.54 ,$667.80 ,$245.17 ,$742.00 ,$486.01 ,$245.17 ,$322.03 , N/A ,$256.61 ,$667.80 ,$531.31 ,$468.20 ,$445.20 ,$667.80 ,$245.17 ,$667.80 ,$667.80 ,$245.17 ,$482.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000107,29505,HC APPL LONG LEG SPLNT,450,1 ,$425.00 ,$276.25 ,$143.52 ,$425.00 ,$316.63 ,$278.38 ,$143.52 ,$223.98 ,$143.52 ,$268.18 ,$268.18 ,$268.18 ,$268.18 ,$382.50 ,$318.75 ,$143.52 ,$374.00 ,$143.52 ,$318.75 ,$318.75 ,$361.25 ,$361.25 ,$143.52 ,$361.25 ,$143.52 ,$335.75 ,$335.75 ,$335.75 ,$382.50 ,$344.53 ,$382.50 ,$143.52 ,$425.00 ,$278.38 ,$143.52 ,$184.45 , N/A ,$150.22 ,$382.50 ,$311.03 ,$268.18 ,$255.00 ,$382.50 ,$143.52 ,$382.50 ,$382.50 ,$143.52 ,$276.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000108,29515,HC APPL SHRT LEG SPLNT FAC,450,1 ,$425.00 ,$276.25 ,$143.52 ,$425.00 ,$316.63 ,$278.38 ,$143.52 ,$223.98 ,$143.52 ,$268.18 ,$268.18 ,$268.18 ,$268.18 ,$382.50 ,$318.75 ,$143.52 ,$374.00 ,$143.52 ,$318.75 ,$318.75 ,$361.25 ,$361.25 ,$143.52 ,$361.25 ,$143.52 ,$335.75 ,$335.75 ,$335.75 ,$382.50 ,$344.53 ,$382.50 ,$143.52 ,$425.00 ,$278.38 ,$143.52 ,$184.45 , N/A ,$150.22 ,$382.50 ,$311.03 ,$268.18 ,$255.00 ,$382.50 ,$143.52 ,$382.50 ,$382.50 ,$143.52 ,$276.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000110,30300,HC REM FB INTRANASAL,450,1 ,$466.00 ,$302.90 ,$113.81 ,$466.00 ,$347.17 ,$305.23 ,$113.81 ,$245.58 ,$113.81 ,$294.05 ,$294.05 ,$294.05 ,$294.05 ,$419.40 ,$349.50 ,$113.81 ,$410.08 ,$113.81 ,$349.50 ,$349.50 ,$396.10 ,$396.10 ,$113.81 ,$396.10 ,$113.81 ,$368.14 ,$368.14 ,$368.14 ,$419.40 ,$273.20 ,$419.40 ,$113.81 ,$466.00 ,$305.23 ,$113.81 ,$202.24 , N/A ,$119.12 ,$419.40 ,$246.63 ,$294.05 ,$279.60 ,$419.40 ,$113.81 ,$419.40 ,$419.40 ,$113.81 ,$302.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000111,30901,HC CNTRL NOSEBLEED ANT SMP,450,1 ,$466.00 ,$302.90 ,$113.81 ,$466.00 ,$347.17 ,$305.23 ,$113.81 ,$245.58 ,$113.81 ,$294.05 ,$294.05 ,$294.05 ,$294.05 ,$419.40 ,$349.50 ,$113.81 ,$410.08 ,$113.81 ,$349.50 ,$349.50 ,$396.10 ,$396.10 ,$113.81 ,$396.10 ,$113.81 ,$368.14 ,$368.14 ,$368.14 ,$419.40 ,$273.20 ,$419.40 ,$113.81 ,$466.00 ,$305.23 ,$113.81 ,$202.24 , N/A ,$119.12 ,$419.40 ,$246.63 ,$294.05 ,$279.60 ,$419.40 ,$113.81 ,$419.40 ,$419.40 ,$113.81 ,$302.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000113,30905,HC CNTRL NOSEBLEED POST INIT,450,1 ,$459.00 ,$298.35 ,$113.81 ,$459.00 ,$341.96 ,$300.65 ,$113.81 ,$241.89 ,$113.81 ,$289.63 ,$289.63 ,$289.63 ,$289.63 ,$413.10 ,$344.25 ,$113.81 ,$403.92 ,$113.81 ,$344.25 ,$344.25 ,$390.15 ,$390.15 ,$113.81 ,$390.15 ,$113.81 ,$362.61 ,$362.61 ,$362.61 ,$413.10 ,$273.20 ,$413.10 ,$113.81 ,$459.00 ,$300.65 ,$113.81 ,$199.21 , N/A ,$119.12 ,$413.10 ,$246.63 ,$289.63 ,$275.40 ,$413.10 ,$113.81 ,$413.10 ,$413.10 ,$113.81 ,$298.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000123,36400,HC IV START < 3 YEARS OLD (MD),450,1 ,$382.00 ,$248.30 ,$165.79 ,$382.00 ,$284.59 ,$250.21 , N/A ,$201.31 , N/A ,$241.04 ,$241.04 ,$241.04 ,$241.04 ,$343.80 ,$286.50 , N/A ,$336.16 , N/A ,$286.50 ,$286.50 ,$324.70 ,$324.70 , N/A ,$324.70 , N/A ,$301.78 ,$301.78 ,$301.78 ,$343.80 , N/A ,$343.80 , N/A ,$382.00 ,$250.21 , N/A ,$165.79 , N/A , N/A ,$343.80 , N/A ,$241.04 ,$229.20 ,$343.80 , N/A ,$343.80 ,$343.80 , N/A ,$248.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000124,36406,HC VENIPUNCTURE <3YR VEIN OTHR,450,1 ,$10.00 ,$6.50 ,$4.34 ,$10.00 ,$7.45 ,$6.55 , N/A ,$5.27 , N/A ,$6.31 ,$6.31 ,$6.31 ,$6.31 ,$9.00 ,$7.50 , N/A ,$8.80 , N/A ,$7.50 ,$7.50 ,$8.50 ,$8.50 , N/A ,$8.50 , N/A ,$7.90 ,$7.90 ,$7.90 ,$9.00 , N/A ,$9.00 , N/A ,$10.00 ,$6.55 , N/A ,$4.34 , N/A , N/A ,$9.00 , N/A ,$6.31 ,$6.00 ,$9.00 , N/A ,$9.00 ,$9.00 , N/A ,$6.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000132,36680,HC PLACE NDL INFS INTRAOSSEOUS,450,1 ,$824.00 ,$535.60 ,$274.70 ,$824.00 ,$613.88 ,$539.72 ,$274.70 ,$434.25 ,$274.70 ,$519.94 ,$519.94 ,$519.94 ,$519.94 ,$741.60 ,$618.00 ,$274.70 ,$725.12 ,$274.70 ,$618.00 ,$618.00 ,$700.40 ,$700.40 ,$274.70 ,$700.40 ,$274.70 ,$650.96 ,$650.96 ,$650.96 ,$741.60 ,$659.43 ,$741.60 ,$274.70 ,$824.00 ,$539.72 ,$274.70 ,$357.62 , N/A ,$287.52 ,$741.60 ,$595.31 ,$519.94 ,$494.40 ,$741.60 ,$274.70 ,$741.60 ,$741.60 ,$274.70 ,$535.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000136,40800,HC DRAINAGE MOUTH LESION,450,1 ,"$1,748.79 ","$1,136.71 ",$632.28 ,"$1,748.79 ","$1,302.85 ","$1,145.46 ",$632.28 ,$921.61 ,$632.28 ,"$1,103.49 ","$1,103.49 ","$1,103.49 ","$1,103.49 ","$1,573.91 ","$1,311.59 ",$632.28 ,"$1,538.94 ",$632.28 ,"$1,311.59 ","$1,311.59 ","$1,486.47 ","$1,486.47 ",$632.28 ,"$1,486.47 ",$632.28 ,"$1,381.54 ","$1,381.54 ","$1,381.54 ","$1,573.91 ","$1,517.82 ","$1,573.91 ",$632.28 ,"$1,748.79 ","$1,145.46 ",$632.28 ,$758.97 , N/A ,$661.80 ,"$1,573.91 ","$1,370.23 ","$1,103.49 ","$1,049.27 ","$1,573.91 ",$632.28 ,"$1,573.91 ","$1,573.91 ",$632.28 ,"$1,136.71 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000137,40830,HC LAC REPAIR VESTIBULE MOUTH 2.5 CM OR LESS,450,1 ,$583.80 ,$379.47 ,$215.11 ,$583.80 ,$434.93 ,$382.39 ,$215.11 ,$307.66 ,$215.11 ,$368.38 ,$368.38 ,$368.38 ,$368.38 ,$525.42 ,$437.85 ,$215.11 ,$513.74 ,$215.11 ,$437.85 ,$437.85 ,$496.23 ,$496.23 ,$215.11 ,$496.23 ,$215.11 ,$461.20 ,$461.20 ,$461.20 ,$525.42 ,$516.38 ,$525.42 ,$215.11 ,$583.80 ,$382.39 ,$215.11 ,$253.37 , N/A ,$225.15 ,$525.42 ,$466.16 ,$368.38 ,$350.28 ,$525.42 ,$215.11 ,$525.42 ,$525.42 ,$215.11 ,$379.47 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000138,41250,HC RPR LAC MOUTH/TONGUE <2.5CM,450,1 ,$337.00 ,$219.05 ,$146.26 ,$595.31 ,$251.07 ,$220.74 ,$274.70 ,$177.60 ,$274.70 ,$212.65 ,$212.65 ,$212.65 ,$212.65 ,$303.30 ,$252.75 ,$274.70 ,$296.56 ,$274.70 ,$252.75 ,$252.75 ,$286.45 ,$286.45 ,$274.70 ,$286.45 ,$274.70 ,$266.23 ,$266.23 ,$266.23 ,$303.30 ,$337.00 ,$303.30 ,$274.70 ,$337.00 ,$220.74 ,$274.70 ,$146.26 , N/A ,$287.52 ,$303.30 ,$595.31 ,$212.65 ,$202.20 ,$303.30 ,$274.70 ,$303.30 ,$303.30 ,$274.70 ,$219.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000139,41800,HC DRAIN ABSC/CYST DENTOALVLR,450,1 ,$573.00 ,$372.45 ,$113.81 ,$573.00 ,$426.89 ,$375.32 ,$113.81 ,$301.97 ,$113.81 ,$361.56 ,$361.56 ,$361.56 ,$361.56 ,$515.70 ,$429.75 ,$113.81 ,$504.24 ,$113.81 ,$429.75 ,$429.75 ,$487.05 ,$487.05 ,$113.81 ,$487.05 ,$113.81 ,$452.67 ,$452.67 ,$452.67 ,$515.70 ,$273.20 ,$515.70 ,$113.81 ,$573.00 ,$375.32 ,$113.81 ,$248.68 , N/A ,$119.12 ,$515.70 ,$246.63 ,$361.56 ,$343.80 ,$515.70 ,$113.81 ,$515.70 ,$515.70 ,$113.81 ,$372.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000148,46083,HC INC HEMORRHOID EXTERNAL,450,1 ,$687.00 ,$446.55 ,$270.55 ,$687.00 ,$511.82 ,$449.99 ,$270.55 ,$362.05 ,$270.55 ,$433.50 ,$433.50 ,$433.50 ,$433.50 ,$618.30 ,$515.25 ,$270.55 ,$604.56 ,$270.55 ,$515.25 ,$515.25 ,$583.95 ,$583.95 ,$270.55 ,$583.95 ,$270.55 ,$542.73 ,$542.73 ,$542.73 ,$618.30 ,$649.47 ,$618.30 ,$270.55 ,$687.00 ,$449.99 ,$270.55 ,$298.16 , N/A ,$283.18 ,$618.30 ,$586.32 ,$433.50 ,$412.20 ,$618.30 ,$270.55 ,$618.30 ,$618.30 ,$270.55 ,$446.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000156,51700,HC IRRIG/LAVG/INSTL BLADDER,450,1 ,$646.00 ,$419.90 ,$270.55 ,$646.00 ,$481.27 ,$423.13 ,$270.55 ,$340.44 ,$270.55 ,$407.63 ,$407.63 ,$407.63 ,$407.63 ,$581.40 ,$484.50 ,$270.55 ,$568.48 ,$270.55 ,$484.50 ,$484.50 ,$549.10 ,$549.10 ,$270.55 ,$549.10 ,$270.55 ,$510.34 ,$510.34 ,$510.34 ,$581.40 ,$646.00 ,$581.40 ,$270.55 ,$646.00 ,$423.13 ,$270.55 ,$280.36 , N/A ,$283.18 ,$581.40 ,$586.32 ,$407.63 ,$387.60 ,$581.40 ,$270.55 ,$581.40 ,$581.40 ,$270.55 ,$419.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000157,51705,HC CHG TUBE CYSTOSTOMY SMP,450,1 ,$756.00 ,$491.40 ,$270.55 ,$756.00 ,$563.22 ,$495.18 ,$270.55 ,$398.41 ,$270.55 ,$477.04 ,$477.04 ,$477.04 ,$477.04 ,$680.40 ,$567.00 ,$270.55 ,$665.28 ,$270.55 ,$567.00 ,$567.00 ,$642.60 ,$642.60 ,$270.55 ,$642.60 ,$270.55 ,$597.24 ,$597.24 ,$597.24 ,$680.40 ,$649.47 ,$680.40 ,$270.55 ,$756.00 ,$495.18 ,$270.55 ,$328.10 , N/A ,$283.18 ,$680.40 ,$586.32 ,$477.04 ,$453.60 ,$680.40 ,$270.55 ,$680.40 ,$680.40 ,$270.55 ,$491.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000159,54220,HC IRRIG CORPORA CAVNOSA,450,1 ,$708.00 ,$460.20 ,$270.55 ,$708.00 ,$527.46 ,$463.74 ,$270.55 ,$373.12 ,$270.55 ,$446.75 ,$446.75 ,$446.75 ,$446.75 ,$637.20 ,$531.00 ,$270.55 ,$623.04 ,$270.55 ,$531.00 ,$531.00 ,$601.80 ,$601.80 ,$270.55 ,$601.80 ,$270.55 ,$559.32 ,$559.32 ,$559.32 ,$637.20 ,$649.47 ,$637.20 ,$270.55 ,$708.00 ,$463.74 ,$270.55 ,$307.27 , N/A ,$283.18 ,$637.20 ,$586.32 ,$446.75 ,$424.80 ,$637.20 ,$270.55 ,$637.20 ,$637.20 ,$270.55 ,$460.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000160,54450,HC MANIP FORESKIN STRETCH,450,1 ,$708.00 ,$460.20 ,$270.55 ,$708.00 ,$527.46 ,$463.74 ,$270.55 ,$373.12 ,$270.55 ,$446.75 ,$446.75 ,$446.75 ,$446.75 ,$637.20 ,$531.00 ,$270.55 ,$623.04 ,$270.55 ,$531.00 ,$531.00 ,$601.80 ,$601.80 ,$270.55 ,$601.80 ,$270.55 ,$559.32 ,$559.32 ,$559.32 ,$637.20 ,$649.47 ,$637.20 ,$270.55 ,$708.00 ,$463.74 ,$270.55 ,$307.27 , N/A ,$283.18 ,$637.20 ,$586.32 ,$446.75 ,$424.80 ,$637.20 ,$270.55 ,$637.20 ,$637.20 ,$270.55 ,$460.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000161,54700,HC I AND D EPIDIDYMIS TESTIS OR SCROTAL SPACE,450,1 ,"$5,078.67 ","$3,301.14 ","$1,822.70 ","$5,078.67 ","$3,783.61 ","$3,326.53 ","$1,822.70 ","$2,676.46 ","$1,822.70 ","$3,204.64 ","$3,204.64 ","$3,204.64 ","$3,204.64 ","$4,570.80 ","$3,809.00 ","$1,822.70 ","$4,469.23 ","$1,822.70 ","$3,809.00 ","$3,809.00 ","$4,316.87 ","$4,316.87 ","$1,822.70 ","$4,316.87 ","$1,822.70 ","$4,012.15 ","$4,012.15 ","$4,012.15 ","$4,570.80 ","$4,375.51 ","$4,570.80 ","$1,822.70 ","$5,078.67 ","$3,326.53 ","$1,822.70 ","$2,204.14 ", N/A ,"$1,907.80 ","$4,570.80 ","$3,950.04 ","$3,204.64 ","$3,047.20 ","$4,570.80 ","$1,822.70 ","$4,570.80 ","$4,570.80 ","$1,822.70 ","$3,301.14 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000163,56405,HC I AND D ABSC VULVA/PERINEAL,450,1 ,$800.00 ,$520.00 ,$286.14 ,$800.00 ,$596.00 ,$524.00 ,$286.14 ,$421.60 ,$286.14 ,$504.80 ,$504.80 ,$504.80 ,$504.80 ,$720.00 ,$600.00 ,$286.14 ,$704.00 ,$286.14 ,$600.00 ,$600.00 ,$680.00 ,$680.00 ,$286.14 ,$680.00 ,$286.14 ,$632.00 ,$632.00 ,$632.00 ,$720.00 ,$686.91 ,$720.00 ,$286.14 ,$800.00 ,$524.00 ,$286.14 ,$347.20 , N/A ,$299.50 ,$720.00 ,$620.11 ,$504.80 ,$480.00 ,$720.00 ,$286.14 ,$720.00 ,$720.00 ,$286.14 ,$520.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000164,56420,HC I AND D ABSC GLAND BARTHOLIN'S,450,1 ,$476.04 ,$309.43 ,$173.14 ,$476.04 ,$354.65 ,$311.81 ,$173.14 ,$250.87 ,$173.14 ,$300.38 ,$300.38 ,$300.38 ,$300.38 ,$428.44 ,$357.03 ,$173.14 ,$418.92 ,$173.14 ,$357.03 ,$357.03 ,$404.63 ,$404.63 ,$173.14 ,$404.63 ,$173.14 ,$376.07 ,$376.07 ,$376.07 ,$428.44 ,$415.64 ,$428.44 ,$173.14 ,$476.04 ,$311.81 ,$173.14 ,$206.60 , N/A ,$181.23 ,$428.44 ,$375.22 ,$300.38 ,$285.62 ,$428.44 ,$173.14 ,$428.44 ,$428.44 ,$173.14 ,$309.43 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000169,64999,HC INJECTION FACIAL NERVE,450,1 ,$497.00 ,$323.05 ,$215.70 ,$575.37 ,$370.27 ,$325.54 ,$265.50 ,$261.92 ,$265.50 ,$313.61 ,$313.61 ,$313.61 ,$313.61 ,$447.30 ,$372.75 ,$265.50 ,$437.36 ,$265.50 ,$372.75 ,$372.75 ,$422.45 ,$422.45 ,$265.50 ,$422.45 ,$265.50 ,$392.63 ,$392.63 ,$392.63 ,$447.30 ,$497.00 ,$447.30 ,$265.50 ,$497.00 ,$325.54 ,$265.50 ,$215.70 , N/A ,$277.89 ,$447.30 ,$575.37 ,$313.61 ,$298.20 ,$447.30 ,$265.50 ,$447.30 ,$447.30 ,$265.50 ,$323.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000170,64450,HC INJ ANES NERVE PERIPHERAL,450,1 ,"$1,698.00 ","$1,103.70 ",$645.11 ,"$1,698.00 ","$1,265.01 ","$1,112.19 ",$645.11 ,$894.85 ,$645.11 ,"$1,071.44 ","$1,071.44 ","$1,071.44 ","$1,071.44 ","$1,528.20 ","$1,273.50 ",$645.11 ,"$1,494.24 ",$645.11 ,"$1,273.50 ","$1,273.50 ","$1,443.30 ","$1,443.30 ",$645.11 ,"$1,443.30 ",$645.11 ,"$1,341.42 ","$1,341.42 ","$1,341.42 ","$1,528.20 ","$1,548.62 ","$1,528.20 ",$645.11 ,"$1,698.00 ","$1,112.19 ",$645.11 ,$736.93 , N/A ,$675.22 ,"$1,528.20 ","$1,398.03 ","$1,071.44 ","$1,018.80 ","$1,528.20 ",$645.11 ,"$1,528.20 ","$1,528.20 ",$645.11 ,"$1,103.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000170,64450,HC INJ ANES NERVE PERIPHERAL,450,1 ,"$2,548.00 ","$1,656.20 ",$967.66 ,"$2,548.00 ","$1,898.26 ","$1,668.94 ",$967.66 ,"$1,342.80 ",$967.66 ,"$1,607.79 ","$1,607.79 ","$1,607.79 ","$1,607.79 ","$2,293.20 ","$1,911.00 ",$967.66 ,"$2,242.24 ",$967.66 ,"$1,911.00 ","$1,911.00 ","$2,165.80 ","$2,165.80 ",$967.66 ,"$2,165.80 ",$967.66 ,"$2,012.92 ","$2,012.92 ","$2,012.92 ","$2,293.20 ","$2,322.92 ","$2,293.20 ",$967.66 ,"$2,548.00 ","$1,668.94 ",$967.66 ,"$1,105.83 ", N/A ,"$1,012.83 ","$2,293.20 ","$2,097.05 ","$1,607.79 ","$1,528.80 ","$2,293.20 ",$967.66 ,"$2,293.20 ","$2,293.20 ",$967.66 ,"$1,656.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000171,65205,HC REM EYE FB CONJUCT SUPER,450,1 ,$370.00 ,$240.50 ,$113.81 ,$370.00 ,$275.65 ,$242.35 ,$113.81 ,$194.99 ,$113.81 ,$233.47 ,$233.47 ,$233.47 ,$233.47 ,$333.00 ,$277.50 ,$113.81 ,$325.60 ,$113.81 ,$277.50 ,$277.50 ,$314.50 ,$314.50 ,$113.81 ,$314.50 ,$113.81 ,$292.30 ,$292.30 ,$292.30 ,$333.00 ,$273.20 ,$333.00 ,$113.81 ,$370.00 ,$242.35 ,$113.81 ,$160.58 , N/A ,$119.12 ,$333.00 ,$246.63 ,$233.47 ,$222.00 ,$333.00 ,$113.81 ,$333.00 ,$333.00 ,$113.81 ,$240.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000172,65210,HC REM EYE FB CONJUCT EMBED,450,1 ,"$1,042.35 ",$677.53 ,$274.70 ,"$1,042.35 ",$776.55 ,$682.74 ,$274.70 ,$549.32 ,$274.70 ,$657.72 ,$657.72 ,$657.72 ,$657.72 ,$938.12 ,$781.76 ,$274.70 ,$917.27 ,$274.70 ,$781.76 ,$781.76 ,$886.00 ,$886.00 ,$274.70 ,$886.00 ,$274.70 ,$823.46 ,$823.46 ,$823.46 ,$938.12 ,$659.43 ,$938.12 ,$274.70 ,"$1,042.35 ",$682.74 ,$274.70 ,$452.38 , N/A ,$287.52 ,$938.12 ,$595.31 ,$657.72 ,$625.41 ,$938.12 ,$274.70 ,$938.12 ,$938.12 ,$274.70 ,$677.53 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000173,65220,HC REM FB CORNL W/O SLIT LA,450,1 ,$370.00 ,$240.50 ,$160.58 ,$595.31 ,$275.65 ,$242.35 ,$274.70 ,$194.99 ,$274.70 ,$233.47 ,$233.47 ,$233.47 ,$233.47 ,$333.00 ,$277.50 ,$274.70 ,$325.60 ,$274.70 ,$277.50 ,$277.50 ,$314.50 ,$314.50 ,$274.70 ,$314.50 ,$274.70 ,$292.30 ,$292.30 ,$292.30 ,$333.00 ,$370.00 ,$333.00 ,$274.70 ,$370.00 ,$242.35 ,$274.70 ,$160.58 , N/A ,$287.52 ,$333.00 ,$595.31 ,$233.47 ,$222.00 ,$333.00 ,$274.70 ,$333.00 ,$333.00 ,$274.70 ,$240.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000174,65222,HC REM FB CORNL W/ SLIT LA,450,1 ,$370.00 ,$240.50 ,$113.81 ,$370.00 ,$275.65 ,$242.35 ,$113.81 ,$194.99 ,$113.81 ,$233.47 ,$233.47 ,$233.47 ,$233.47 ,$333.00 ,$277.50 ,$113.81 ,$325.60 ,$113.81 ,$277.50 ,$277.50 ,$314.50 ,$314.50 ,$113.81 ,$314.50 ,$113.81 ,$292.30 ,$292.30 ,$292.30 ,$333.00 ,$273.20 ,$333.00 ,$113.81 ,$370.00 ,$242.35 ,$113.81 ,$160.58 , N/A ,$119.12 ,$333.00 ,$246.63 ,$233.47 ,$222.00 ,$333.00 ,$113.81 ,$333.00 ,$333.00 ,$113.81 ,$240.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000178,67938,HC REMOVE EMBEDDED FB EYELID,450,1 ,"$1,096.00 ",$712.40 ,$265.61 ,"$1,096.00 ",$816.52 ,$717.88 ,$265.61 ,$577.59 ,$265.61 ,$691.58 ,$691.58 ,$691.58 ,$691.58 ,$986.40 ,$822.00 ,$265.61 ,$964.48 ,$265.61 ,$822.00 ,$822.00 ,$931.60 ,$931.60 ,$265.61 ,$931.60 ,$265.61 ,$865.84 ,$865.84 ,$865.84 ,$986.40 ,$637.61 ,$986.40 ,$265.61 ,"$1,096.00 ",$717.88 ,$265.61 ,$475.66 , N/A ,$278.01 ,$986.40 ,$575.61 ,$691.58 ,$657.60 ,$986.40 ,$265.61 ,$986.40 ,$986.40 ,$265.61 ,$712.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000179,69000,HC DRAIN ABSC/HEMA EAR EXT SMP,450,1 ,"$1,748.79 ","$1,136.71 ",$632.28 ,"$1,748.79 ","$1,302.85 ","$1,145.46 ",$632.28 ,$921.61 ,$632.28 ,"$1,103.49 ","$1,103.49 ","$1,103.49 ","$1,103.49 ","$1,573.91 ","$1,311.59 ",$632.28 ,"$1,538.94 ",$632.28 ,"$1,311.59 ","$1,311.59 ","$1,486.47 ","$1,486.47 ",$632.28 ,"$1,486.47 ",$632.28 ,"$1,381.54 ","$1,381.54 ","$1,381.54 ","$1,573.91 ","$1,517.82 ","$1,573.91 ",$632.28 ,"$1,748.79 ","$1,145.46 ",$632.28 ,$758.97 , N/A ,$661.80 ,"$1,573.91 ","$1,370.23 ","$1,103.49 ","$1,049.27 ","$1,573.91 ",$632.28 ,"$1,573.91 ","$1,573.91 ",$632.28 ,"$1,136.71 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000181,69200,HC FB REMOVAL EAR,450,1 ,$466.00 ,$302.90 ,$113.81 ,$466.00 ,$347.17 ,$305.23 ,$113.81 ,$245.58 ,$113.81 ,$294.05 ,$294.05 ,$294.05 ,$294.05 ,$419.40 ,$349.50 ,$113.81 ,$410.08 ,$113.81 ,$349.50 ,$349.50 ,$396.10 ,$396.10 ,$113.81 ,$396.10 ,$113.81 ,$368.14 ,$368.14 ,$368.14 ,$419.40 ,$273.20 ,$419.40 ,$113.81 ,$466.00 ,$305.23 ,$113.81 ,$202.24 , N/A ,$119.12 ,$419.40 ,$246.63 ,$294.05 ,$279.60 ,$419.40 ,$113.81 ,$419.40 ,$419.40 ,$113.81 ,$302.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000183,69210,HC REMOVE CERUMEN IMPACTED BY INSTRUMENTATION,450,1 ,$185.00 ,$120.25 ,$56.58 ,$185.00 ,$137.83 ,$121.18 ,$56.58 ,$97.50 ,$56.58 ,$116.74 ,$116.74 ,$116.74 ,$116.74 ,$166.50 ,$138.75 ,$56.58 ,$162.80 ,$56.58 ,$138.75 ,$138.75 ,$157.25 ,$157.25 ,$56.58 ,$157.25 ,$56.58 ,$146.15 ,$146.15 ,$146.15 ,$166.50 ,$135.83 ,$166.50 ,$56.58 ,$185.00 ,$121.18 ,$56.58 ,$80.29 , N/A ,$59.22 ,$166.50 ,$122.62 ,$116.74 ,$111.00 ,$166.50 ,$56.58 ,$166.50 ,$166.50 ,$56.58 ,$120.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000188,99281,HC ER LEVEL 1,450,1 ,$259.00 ,$168.35 ,$73.80 ,$259.00 ,$192.96 ,$169.65 ,$73.80 ,$136.49 ,$73.80 ,$163.43 ,$163.43 ,$163.43 ,$163.43 ,$233.10 ,$194.25 ,$73.80 ,$227.92 ,$73.80 ,$194.25 ,$194.25 ,$220.15 ,$220.15 ,$73.80 ,$220.15 ,$73.80 ,$204.61 ,$204.61 ,$204.61 ,$233.10 ,$177.17 ,$233.10 ,$73.80 ,$259.00 ,$169.65 ,$73.80 ,$112.41 , N/A ,$77.25 ,$233.10 ,$159.94 ,$163.43 ,$155.40 ,$233.10 ,$73.80 ,$233.10 ,$233.10 ,$73.80 ,$168.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000189,99282,HC ER LEVEL 2,450,1 ,$454.00 ,$295.10 ,$133.77 ,$454.00 ,$338.23 ,$297.37 ,$133.77 ,$239.26 ,$133.77 ,$286.47 ,$286.47 ,$286.47 ,$286.47 ,$408.60 ,$340.50 ,$133.77 ,$399.52 ,$133.77 ,$340.50 ,$340.50 ,$385.90 ,$385.90 ,$133.77 ,$385.90 ,$133.77 ,$358.66 ,$358.66 ,$358.66 ,$408.60 ,$321.12 ,$408.60 ,$133.77 ,$454.00 ,$297.37 ,$133.77 ,$197.04 , N/A ,$140.02 ,$408.60 ,$289.90 ,$286.47 ,$272.40 ,$408.60 ,$133.77 ,$408.60 ,$408.60 ,$133.77 ,$295.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000190,99283,HC ER LEVEL 3,450,1 ,$827.00 ,$537.55 ,$235.44 ,$827.00 ,$616.12 ,$541.69 ,$235.44 ,$435.83 ,$235.44 ,$521.84 ,$521.84 ,$521.84 ,$521.84 ,$744.30 ,$620.25 ,$235.44 ,$727.76 ,$235.44 ,$620.25 ,$620.25 ,$702.95 ,$702.95 ,$235.44 ,$702.95 ,$235.44 ,$653.33 ,$653.33 ,$653.33 ,$744.30 ,$565.18 ,$744.30 ,$235.44 ,$827.00 ,$541.69 ,$235.44 ,$358.92 , N/A ,$246.43 ,$744.30 ,$510.23 ,$521.84 ,$496.20 ,$744.30 ,$235.44 ,$744.30 ,$744.30 ,$235.44 ,$537.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000191,99284,HC ER LEVEL 4,450,1 ,"$1,206.00 ",$783.90 ,$369.77 ,"$1,206.00 ",$898.47 ,$789.93 ,$369.77 ,$635.56 ,$369.77 ,$760.99 ,$760.99 ,$760.99 ,$760.99 ,"$1,085.40 ",$904.50 ,$369.77 ,"$1,061.28 ",$369.77 ,$904.50 ,$904.50 ,"$1,025.10 ","$1,025.10 ",$369.77 ,"$1,025.10 ",$369.77 ,$952.74 ,$952.74 ,$952.74 ,"$1,085.40 ",$887.65 ,"$1,085.40 ",$369.77 ,"$1,206.00 ",$789.93 ,$369.77 ,$523.40 , N/A ,$387.03 ,"$1,085.40 ",$801.34 ,$760.99 ,$723.60 ,"$1,085.40 ",$369.77 ,"$1,085.40 ","$1,085.40 ",$369.77 ,$783.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000192,99285,HC ER LEVEL 5,450,1 ,"$1,746.00 ","$1,134.90 ",$530.77 ,"$1,746.00 ","$1,300.77 ","$1,143.63 ",$530.77 ,$920.14 ,$530.77 ,"$1,101.73 ","$1,101.73 ","$1,101.73 ","$1,101.73 ","$1,571.40 ","$1,309.50 ",$530.77 ,"$1,536.48 ",$530.77 ,"$1,309.50 ","$1,309.50 ","$1,484.10 ","$1,484.10 ",$530.77 ,"$1,484.10 ",$530.77 ,"$1,379.34 ","$1,379.34 ","$1,379.34 ","$1,571.40 ","$1,274.15 ","$1,571.40 ",$530.77 ,"$1,746.00 ","$1,143.63 ",$530.77 ,$757.76 , N/A ,$555.55 ,"$1,571.40 ","$1,150.25 ","$1,101.73 ","$1,047.60 ","$1,571.40 ",$530.77 ,"$1,571.40 ","$1,571.40 ",$530.77 ,"$1,134.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000193,99291,HC CRITICAL CARE 30-74 MIN,450,1 ,"$2,727.00 ","$1,772.55 ",$704.16 ,"$2,727.00 ","$2,031.62 ","$1,786.19 ",$704.16 ,"$1,437.13 ",$704.16 ,"$1,720.74 ","$1,720.74 ","$1,720.74 ","$1,720.74 ","$2,454.30 ","$2,045.25 ",$704.16 ,"$2,399.76 ",$704.16 ,"$2,045.25 ","$2,045.25 ","$2,317.95 ","$2,317.95 ",$704.16 ,"$2,317.95 ",$704.16 ,"$2,154.33 ","$2,154.33 ","$2,154.33 ","$2,454.30 ","$1,690.38 ","$2,454.30 ",$704.16 ,"$2,727.00 ","$1,786.19 ",$704.16 ,"$1,183.52 ", N/A ,$737.03 ,"$2,454.30 ","$1,526.01 ","$1,720.74 ","$1,636.20 ","$2,454.30 ",$704.16 ,"$2,454.30 ","$2,454.30 ",$704.16 ,"$1,772.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000195,99292,HC CRITICAL CARE EA ADDN'T 30 MIN,450,1 ,"$1,319.00 ",$857.35 ,$572.45 ,"$1,319.00 ",$982.66 ,$863.95 , N/A ,$695.11 , N/A ,$832.29 ,$832.29 ,$832.29 ,$832.29 ,"$1,187.10 ",$989.25 , N/A ,"$1,160.72 ", N/A ,$989.25 ,$989.25 ,"$1,121.15 ","$1,121.15 ", N/A ,"$1,121.15 ", N/A ,"$1,042.01 ","$1,042.01 ","$1,042.01 ","$1,187.10 ", N/A ,"$1,187.10 ", N/A ,"$1,319.00 ",$863.95 , N/A ,$572.45 , N/A , N/A ,"$1,187.10 ", N/A ,$832.29 ,$791.40 ,"$1,187.10 ", N/A ,"$1,187.10 ","$1,187.10 ", N/A ,$857.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000196,27810,HC TX FX BIM ANKLE W/MAN CLS,450,1 ,"$3,885.63 ","$2,525.66 ","$1,415.42 ","$3,885.63 ","$2,894.79 ","$2,545.09 ","$1,415.42 ","$2,047.73 ","$1,415.42 ","$2,451.83 ","$2,451.83 ","$2,451.83 ","$2,451.83 ","$3,497.07 ","$2,914.22 ","$1,415.42 ","$3,419.35 ","$1,415.42 ","$2,914.22 ","$2,914.22 ","$3,302.79 ","$3,302.79 ","$1,415.42 ","$3,302.79 ","$1,415.42 ","$3,069.65 ","$3,069.65 ","$3,069.65 ","$3,497.07 ","$3,397.81 ","$3,497.07 ","$1,415.42 ","$3,885.63 ","$2,545.09 ","$1,415.42 ","$1,686.36 ", N/A ,"$1,481.50 ","$3,497.07 ","$3,067.41 ","$2,451.83 ","$2,331.38 ","$3,497.07 ","$1,415.42 ","$3,497.07 ","$3,497.07 ","$1,415.42 ","$2,525.66 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000197,26700,HC TX DISL (M-P) W/O ANES CLS,450,1 ,$618.21 ,$401.84 ,$209.61 ,$618.21 ,$460.57 ,$404.93 ,$209.61 ,$325.80 ,$209.61 ,$390.09 ,$390.09 ,$390.09 ,$390.09 ,$556.39 ,$463.66 ,$209.61 ,$544.02 ,$209.61 ,$463.66 ,$463.66 ,$525.48 ,$525.48 ,$209.61 ,$525.48 ,$209.61 ,$488.39 ,$488.39 ,$488.39 ,$556.39 ,$503.17 ,$556.39 ,$209.61 ,$618.21 ,$404.93 ,$209.61 ,$268.30 , N/A ,$219.39 ,$556.39 ,$454.25 ,$390.09 ,$370.93 ,$556.39 ,$209.61 ,$556.39 ,$556.39 ,$209.61 ,$401.84 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000198,21480,HC TX DISL JAW CLS-UNI,450,1 ,$459.00 ,$298.35 ,$199.21 ,$459.00 ,$341.96 ,$300.65 ,$209.61 ,$241.89 ,$209.61 ,$289.63 ,$289.63 ,$289.63 ,$289.63 ,$413.10 ,$344.25 ,$209.61 ,$403.92 ,$209.61 ,$344.25 ,$344.25 ,$390.15 ,$390.15 ,$209.61 ,$390.15 ,$209.61 ,$362.61 ,$362.61 ,$362.61 ,$413.10 ,$459.00 ,$413.10 ,$209.61 ,$459.00 ,$300.65 ,$209.61 ,$199.21 , N/A ,$219.39 ,$413.10 ,$454.25 ,$289.63 ,$275.40 ,$413.10 ,$209.61 ,$413.10 ,$413.10 ,$209.61 ,$298.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000203,27840,HC TX DISL ANKE W/O ANES CLS,450,1 ,$756.00 ,$491.40 ,$209.61 ,$756.00 ,$563.22 ,$495.18 ,$209.61 ,$398.41 ,$209.61 ,$477.04 ,$477.04 ,$477.04 ,$477.04 ,$680.40 ,$567.00 ,$209.61 ,$665.28 ,$209.61 ,$567.00 ,$567.00 ,$642.60 ,$642.60 ,$209.61 ,$642.60 ,$209.61 ,$597.24 ,$597.24 ,$597.24 ,$680.40 ,$503.17 ,$680.40 ,$209.61 ,$756.00 ,$495.18 ,$209.61 ,$328.10 , N/A ,$219.39 ,$680.40 ,$454.25 ,$477.04 ,$453.60 ,$680.40 ,$209.61 ,$680.40 ,$680.40 ,$209.61 ,$491.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000206,36405,HC VENIPUNCTURE SCALP VEIN <3YRS,450,1 ,$382.00 ,$248.30 ,$165.79 ,$382.00 ,$284.59 ,$250.21 , N/A ,$201.31 , N/A ,$241.04 ,$241.04 ,$241.04 ,$241.04 ,$343.80 ,$286.50 , N/A ,$336.16 , N/A ,$286.50 ,$286.50 ,$324.70 ,$324.70 , N/A ,$324.70 , N/A ,$301.78 ,$301.78 ,$301.78 ,$343.80 , N/A ,$343.80 , N/A ,$382.00 ,$250.21 , N/A ,$165.79 , N/A , N/A ,$343.80 , N/A ,$241.04 ,$229.20 ,$343.80 , N/A ,$343.80 ,$343.80 , N/A ,$248.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000214,37195,HC THROMBOLYSIS;CEREB IV,450,1 ,$819.00 ,$532.35 ,$315.90 ,$819.00 ,$610.16 ,$536.45 ,$315.90 ,$431.61 ,$315.90 ,$516.79 ,$516.79 ,$516.79 ,$516.79 ,$737.10 ,$614.25 ,$315.90 ,$720.72 ,$315.90 ,$614.25 ,$614.25 ,$696.15 ,$696.15 ,$315.90 ,$696.15 ,$315.90 ,$647.01 ,$647.01 ,$647.01 ,$737.10 ,$758.34 ,$737.10 ,$315.90 ,$819.00 ,$536.45 ,$315.90 ,$355.45 , N/A ,$330.65 ,$737.10 ,$684.60 ,$516.79 ,$491.40 ,$737.10 ,$315.90 ,$737.10 ,$737.10 ,$315.90 ,$532.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000219,27818,HC TRIMALLEOLAR ANKLE FX W/MANIP,450,1 ,"$3,094.00 ","$2,011.10 ","$1,342.80 ","$3,094.00 ","$2,305.03 ","$2,026.57 ","$1,415.42 ","$1,630.54 ","$1,415.42 ","$1,952.31 ","$1,952.31 ","$1,952.31 ","$1,952.31 ","$2,784.60 ","$2,320.50 ","$1,415.42 ","$2,722.72 ","$1,415.42 ","$2,320.50 ","$2,320.50 ","$2,629.90 ","$2,629.90 ","$1,415.42 ","$2,629.90 ","$1,415.42 ","$2,444.26 ","$2,444.26 ","$2,444.26 ","$2,784.60 ","$3,094.00 ","$2,784.60 ","$1,415.42 ","$3,094.00 ","$2,026.57 ","$1,415.42 ","$1,342.80 ", N/A ,"$1,481.50 ","$2,784.60 ","$3,067.41 ","$1,952.31 ","$1,856.40 ","$2,784.60 ","$1,415.42 ","$2,784.60 ","$2,784.60 ","$1,415.42 ","$2,011.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000230,26605,HC CLSD METACARPAL FX W/MANIP,450,1 ,$689.00 ,$447.85 ,$209.61 ,$689.00 ,$513.31 ,$451.30 ,$209.61 ,$363.10 ,$209.61 ,$434.76 ,$434.76 ,$434.76 ,$434.76 ,$620.10 ,$516.75 ,$209.61 ,$606.32 ,$209.61 ,$516.75 ,$516.75 ,$585.65 ,$585.65 ,$209.61 ,$585.65 ,$209.61 ,$544.31 ,$544.31 ,$544.31 ,$620.10 ,$503.17 ,$620.10 ,$209.61 ,$689.00 ,$451.30 ,$209.61 ,$299.03 , N/A ,$219.39 ,$620.10 ,$454.25 ,$434.76 ,$413.40 ,$620.10 ,$209.61 ,$620.10 ,$620.10 ,$209.61 ,$447.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000246,24505,HC HUMERAL CLOSED RED FX,450,1 ,"$4,020.00 ","$2,613.00 ","$1,415.42 ","$4,020.00 ","$2,994.90 ","$2,633.10 ","$1,415.42 ","$2,118.54 ","$1,415.42 ","$2,536.62 ","$2,536.62 ","$2,536.62 ","$2,536.62 ","$3,618.00 ","$3,015.00 ","$1,415.42 ","$3,537.60 ","$1,415.42 ","$3,015.00 ","$3,015.00 ","$3,417.00 ","$3,417.00 ","$1,415.42 ","$3,417.00 ","$1,415.42 ","$3,175.80 ","$3,175.80 ","$3,175.80 ","$3,618.00 ","$3,397.81 ","$3,618.00 ","$1,415.42 ","$4,020.00 ","$2,633.10 ","$1,415.42 ","$1,744.68 ", N/A ,"$1,481.50 ","$3,618.00 ","$3,067.41 ","$2,536.62 ","$2,412.00 ","$3,618.00 ","$1,415.42 ","$3,618.00 ","$3,618.00 ","$1,415.42 ","$2,613.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000248,28475,HC CLSD METATARSAL W/MANIP,450,1 ,$618.21 ,$401.84 ,$209.61 ,$618.21 ,$460.57 ,$404.93 ,$209.61 ,$325.80 ,$209.61 ,$390.09 ,$390.09 ,$390.09 ,$390.09 ,$556.39 ,$463.66 ,$209.61 ,$544.02 ,$209.61 ,$463.66 ,$463.66 ,$525.48 ,$525.48 ,$209.61 ,$525.48 ,$209.61 ,$488.39 ,$488.39 ,$488.39 ,$556.39 ,$503.17 ,$556.39 ,$209.61 ,$618.21 ,$404.93 ,$209.61 ,$268.30 , N/A ,$219.39 ,$556.39 ,$454.25 ,$390.09 ,$370.93 ,$556.39 ,$209.61 ,$556.39 ,$556.39 ,$209.61 ,$401.84 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000249,28515,HC TOE FX W/MANIP,450,1 ,$756.00 ,$491.40 ,$209.61 ,$756.00 ,$563.22 ,$495.18 ,$209.61 ,$398.41 ,$209.61 ,$477.04 ,$477.04 ,$477.04 ,$477.04 ,$680.40 ,$567.00 ,$209.61 ,$665.28 ,$209.61 ,$567.00 ,$567.00 ,$642.60 ,$642.60 ,$209.61 ,$642.60 ,$209.61 ,$597.24 ,$597.24 ,$597.24 ,$680.40 ,$503.17 ,$680.40 ,$209.61 ,$756.00 ,$495.18 ,$209.61 ,$328.10 , N/A ,$219.39 ,$680.40 ,$454.25 ,$477.04 ,$453.60 ,$680.40 ,$209.61 ,$680.40 ,$680.40 ,$209.61 ,$491.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000259,28630,HC FOOT DISCL W/O ANES,450,1 ,$756.00 ,$491.40 ,$209.61 ,$756.00 ,$563.22 ,$495.18 ,$209.61 ,$398.41 ,$209.61 ,$477.04 ,$477.04 ,$477.04 ,$477.04 ,$680.40 ,$567.00 ,$209.61 ,$665.28 ,$209.61 ,$567.00 ,$567.00 ,$642.60 ,$642.60 ,$209.61 ,$642.60 ,$209.61 ,$597.24 ,$597.24 ,$597.24 ,$680.40 ,$503.17 ,$680.40 ,$209.61 ,$756.00 ,$495.18 ,$209.61 ,$328.10 , N/A ,$219.39 ,$680.40 ,$454.25 ,$477.04 ,$453.60 ,$680.40 ,$209.61 ,$680.40 ,$680.40 ,$209.61 ,$491.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000272,20611,HC ARTHROCNT ASP/INJ JT MAJOR W/ ULTRA,450,1 ,"$1,929.80 ","$1,254.37 ",$265.50 ,"$1,929.80 ","$1,437.70 ","$1,264.02 ",$265.50 ,"$1,017.00 ",$265.50 ,"$1,217.70 ","$1,217.70 ","$1,217.70 ","$1,217.70 ","$1,736.82 ","$1,447.35 ",$265.50 ,"$1,698.22 ",$265.50 ,"$1,447.35 ","$1,447.35 ","$1,640.33 ","$1,640.33 ",$265.50 ,"$1,640.33 ",$265.50 ,"$1,524.54 ","$1,524.54 ","$1,524.54 ","$1,736.82 ",$637.34 ,"$1,736.82 ",$265.50 ,"$1,929.80 ","$1,264.02 ",$265.50 ,$837.53 , N/A ,$277.89 ,"$1,736.82 ",$575.37 ,"$1,217.70 ","$1,157.88 ","$1,736.82 ",$265.50 ,"$1,736.82 ","$1,736.82 ",$265.50 ,"$1,254.37 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000273,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI,450,1 ,$165.03 ,$107.27 ,$56.58 ,$165.03 ,$122.95 ,$108.09 ,$56.58 ,$86.97 ,$56.58 ,$104.13 ,$104.13 ,$104.13 ,$104.13 ,$148.53 ,$123.77 ,$56.58 ,$145.23 ,$56.58 ,$123.77 ,$123.77 ,$140.28 ,$140.28 ,$56.58 ,$140.28 ,$56.58 ,$130.37 ,$130.37 ,$130.37 ,$148.53 ,$135.83 ,$148.53 ,$56.58 ,$165.03 ,$108.09 ,$56.58 ,$71.62 , N/A ,$59.22 ,$148.53 ,$122.62 ,$104.13 ,$99.02 ,$148.53 ,$56.58 ,$148.53 ,$148.53 ,$56.58 ,$107.27 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000303,24620,HC CLOSED TX ELBOW FRACTURE W/MANIP,450,1 ,"$4,017.00 ","$2,611.05 ","$1,415.42 ","$4,017.00 ","$2,992.67 ","$2,631.14 ","$1,415.42 ","$2,116.96 ","$1,415.42 ","$2,534.73 ","$2,534.73 ","$2,534.73 ","$2,534.73 ","$3,615.30 ","$3,012.75 ","$1,415.42 ","$3,534.96 ","$1,415.42 ","$3,012.75 ","$3,012.75 ","$3,414.45 ","$3,414.45 ","$1,415.42 ","$3,414.45 ","$1,415.42 ","$3,173.43 ","$3,173.43 ","$3,173.43 ","$3,615.30 ","$3,397.81 ","$3,615.30 ","$1,415.42 ","$4,017.00 ","$2,631.14 ","$1,415.42 ","$1,743.38 ", N/A ,"$1,481.50 ","$3,615.30 ","$3,067.41 ","$2,534.73 ","$2,410.20 ","$3,615.30 ","$1,415.42 ","$3,615.30 ","$3,615.30 ","$1,415.42 ","$2,611.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000309,28660,HC CLOSED TX I-P JOINT DISLOCATION W/O ANES,450,1 ,$618.21 ,$401.84 ,$209.61 ,$618.21 ,$460.57 ,$404.93 ,$209.61 ,$325.80 ,$209.61 ,$390.09 ,$390.09 ,$390.09 ,$390.09 ,$556.39 ,$463.66 ,$209.61 ,$544.02 ,$209.61 ,$463.66 ,$463.66 ,$525.48 ,$525.48 ,$209.61 ,$525.48 ,$209.61 ,$488.39 ,$488.39 ,$488.39 ,$556.39 ,$503.17 ,$556.39 ,$209.61 ,$618.21 ,$404.93 ,$209.61 ,$268.30 , N/A ,$219.39 ,$556.39 ,$454.25 ,$390.09 ,$370.93 ,$556.39 ,$209.61 ,$556.39 ,$556.39 ,$209.61 ,$401.84 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000329,27752,HC CLSD TX FX TIBIAL SHAFT W/MANIP,450,1 ,"$3,094.00 ","$2,011.10 ","$1,342.80 ","$3,094.00 ","$2,305.03 ","$2,026.57 ","$1,415.42 ","$1,630.54 ","$1,415.42 ","$1,952.31 ","$1,952.31 ","$1,952.31 ","$1,952.31 ","$2,784.60 ","$2,320.50 ","$1,415.42 ","$2,722.72 ","$1,415.42 ","$2,320.50 ","$2,320.50 ","$2,629.90 ","$2,629.90 ","$1,415.42 ","$2,629.90 ","$1,415.42 ","$2,444.26 ","$2,444.26 ","$2,444.26 ","$2,784.60 ","$3,094.00 ","$2,784.60 ","$1,415.42 ","$3,094.00 ","$2,026.57 ","$1,415.42 ","$1,342.80 ", N/A ,"$1,481.50 ","$2,784.60 ","$3,067.41 ","$1,952.31 ","$1,856.40 ","$2,784.60 ","$1,415.42 ","$2,784.60 ","$2,784.60 ","$1,415.42 ","$2,011.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000335,29530,HC STRAPPING KNEE,450,1 ,$185.00 ,$120.25 ,$80.29 ,$246.63 ,$137.83 ,$121.18 ,$113.81 ,$97.50 ,$113.81 ,$116.74 ,$116.74 ,$116.74 ,$116.74 ,$166.50 ,$138.75 ,$113.81 ,$162.80 ,$113.81 ,$138.75 ,$138.75 ,$157.25 ,$157.25 ,$113.81 ,$157.25 ,$113.81 ,$146.15 ,$146.15 ,$146.15 ,$166.50 ,$185.00 ,$166.50 ,$113.81 ,$185.00 ,$121.18 ,$113.81 ,$80.29 , N/A ,$119.12 ,$166.50 ,$246.63 ,$116.74 ,$111.00 ,$166.50 ,$113.81 ,$166.50 ,$166.50 ,$113.81 ,$120.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000336,29550,HC STRAPPING TOES,450,1 ,$165.03 ,$107.27 ,$56.58 ,$165.03 ,$122.95 ,$108.09 ,$56.58 ,$86.97 ,$56.58 ,$104.13 ,$104.13 ,$104.13 ,$104.13 ,$148.53 ,$123.77 ,$56.58 ,$145.23 ,$56.58 ,$123.77 ,$123.77 ,$140.28 ,$140.28 ,$56.58 ,$140.28 ,$56.58 ,$130.37 ,$130.37 ,$130.37 ,$148.53 ,$135.83 ,$148.53 ,$56.58 ,$165.03 ,$108.09 ,$56.58 ,$71.62 , N/A ,$59.22 ,$148.53 ,$122.62 ,$104.13 ,$99.02 ,$148.53 ,$56.58 ,$148.53 ,$148.53 ,$56.58 ,$107.27 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000350,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI-LT,450,1 ,$165.03 ,$107.27 ,$56.58 ,$165.03 ,$122.95 ,$108.09 ,$56.58 ,$86.97 ,$56.58 ,$104.13 ,$104.13 ,$104.13 ,$104.13 ,$148.53 ,$123.77 ,$56.58 ,$145.23 ,$56.58 ,$123.77 ,$123.77 ,$140.28 ,$140.28 ,$56.58 ,$140.28 ,$56.58 ,$130.37 ,$130.37 ,$130.37 ,$148.53 ,$135.83 ,$148.53 ,$56.58 ,$165.03 ,$108.09 ,$56.58 ,$71.62 , N/A ,$59.22 ,$148.53 ,$122.62 ,$104.13 ,$99.02 ,$148.53 ,$56.58 ,$148.53 ,$148.53 ,$56.58 ,$107.27 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000351,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI-RT,450,1 ,$165.03 ,$107.27 ,$56.58 ,$165.03 ,$122.95 ,$108.09 ,$56.58 ,$86.97 ,$56.58 ,$104.13 ,$104.13 ,$104.13 ,$104.13 ,$148.53 ,$123.77 ,$56.58 ,$145.23 ,$56.58 ,$123.77 ,$123.77 ,$140.28 ,$140.28 ,$56.58 ,$140.28 ,$56.58 ,$130.37 ,$130.37 ,$130.37 ,$148.53 ,$135.83 ,$148.53 ,$56.58 ,$165.03 ,$108.09 ,$56.58 ,$71.62 , N/A ,$59.22 ,$148.53 ,$122.62 ,$104.13 ,$99.02 ,$148.53 ,$56.58 ,$148.53 ,$148.53 ,$56.58 ,$107.27 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000352,69209,HC REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE UNI-50,450,1 ,$247.55 ,$160.91 ,$56.58 ,$247.55 ,$184.42 ,$162.15 ,$56.58 ,$130.46 ,$56.58 ,$156.20 ,$156.20 ,$156.20 ,$156.20 ,$222.80 ,$185.66 ,$56.58 ,$217.84 ,$56.58 ,$185.66 ,$185.66 ,$210.42 ,$210.42 ,$56.58 ,$210.42 ,$56.58 ,$195.56 ,$195.56 ,$195.56 ,$222.80 ,$135.83 ,$222.80 ,$56.58 ,$247.55 ,$162.15 ,$56.58 ,$107.44 , N/A ,$59.22 ,$222.80 ,$122.62 ,$156.20 ,$148.53 ,$222.80 ,$56.58 ,$222.80 ,$222.80 ,$56.58 ,$160.91 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000439,64450,HC INJ ANES OTHER THAN PERIPHERAL-LT,450,1 ,"$1,698.00 ","$1,103.70 ",$645.11 ,"$1,698.00 ","$1,265.01 ","$1,112.19 ",$645.11 ,$894.85 ,$645.11 ,"$1,071.44 ","$1,071.44 ","$1,071.44 ","$1,071.44 ","$1,528.20 ","$1,273.50 ",$645.11 ,"$1,494.24 ",$645.11 ,"$1,273.50 ","$1,273.50 ","$1,443.30 ","$1,443.30 ",$645.11 ,"$1,443.30 ",$645.11 ,"$1,341.42 ","$1,341.42 ","$1,341.42 ","$1,528.20 ","$1,548.62 ","$1,528.20 ",$645.11 ,"$1,698.00 ","$1,112.19 ",$645.11 ,$736.93 , N/A ,$675.22 ,"$1,528.20 ","$1,398.03 ","$1,071.44 ","$1,018.80 ","$1,528.20 ",$645.11 ,"$1,528.20 ","$1,528.20 ",$645.11 ,"$1,103.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000440,64450,HC INJ ANES OTHER THAN PERIPHERAL-RT,450,1 ,"$1,698.00 ","$1,103.70 ",$645.11 ,"$1,698.00 ","$1,265.01 ","$1,112.19 ",$645.11 ,$894.85 ,$645.11 ,"$1,071.44 ","$1,071.44 ","$1,071.44 ","$1,071.44 ","$1,528.20 ","$1,273.50 ",$645.11 ,"$1,494.24 ",$645.11 ,"$1,273.50 ","$1,273.50 ","$1,443.30 ","$1,443.30 ",$645.11 ,"$1,443.30 ",$645.11 ,"$1,341.42 ","$1,341.42 ","$1,341.42 ","$1,528.20 ","$1,548.62 ","$1,528.20 ",$645.11 ,"$1,698.00 ","$1,112.19 ",$645.11 ,$736.93 , N/A ,$675.22 ,"$1,528.20 ","$1,398.03 ","$1,071.44 ","$1,018.80 ","$1,528.20 ",$645.11 ,"$1,528.20 ","$1,528.20 ",$645.11 ,"$1,103.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000451,69000,HC DRAIN ABSC/HEMA EAR EXT SMP-LT,450,1 ,"$1,748.79 ","$1,136.71 ",$632.28 ,"$1,748.79 ","$1,302.85 ","$1,145.46 ",$632.28 ,$921.61 ,$632.28 ,"$1,103.49 ","$1,103.49 ","$1,103.49 ","$1,103.49 ","$1,573.91 ","$1,311.59 ",$632.28 ,"$1,538.94 ",$632.28 ,"$1,311.59 ","$1,311.59 ","$1,486.47 ","$1,486.47 ",$632.28 ,"$1,486.47 ",$632.28 ,"$1,381.54 ","$1,381.54 ","$1,381.54 ","$1,573.91 ","$1,517.82 ","$1,573.91 ",$632.28 ,"$1,748.79 ","$1,145.46 ",$632.28 ,$758.97 , N/A ,$661.80 ,"$1,573.91 ","$1,370.23 ","$1,103.49 ","$1,049.27 ","$1,573.91 ",$632.28 ,"$1,573.91 ","$1,573.91 ",$632.28 ,"$1,136.71 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000452,69000,HC DRAIN ABSC/HEMA EAR EXT SMP-RT,450,1 ,"$1,748.79 ","$1,136.71 ",$632.28 ,"$1,748.79 ","$1,302.85 ","$1,145.46 ",$632.28 ,$921.61 ,$632.28 ,"$1,103.49 ","$1,103.49 ","$1,103.49 ","$1,103.49 ","$1,573.91 ","$1,311.59 ",$632.28 ,"$1,538.94 ",$632.28 ,"$1,311.59 ","$1,311.59 ","$1,486.47 ","$1,486.47 ",$632.28 ,"$1,486.47 ",$632.28 ,"$1,381.54 ","$1,381.54 ","$1,381.54 ","$1,573.91 ","$1,517.82 ","$1,573.91 ",$632.28 ,"$1,748.79 ","$1,145.46 ",$632.28 ,$758.97 , N/A ,$661.80 ,"$1,573.91 ","$1,370.23 ","$1,103.49 ","$1,049.27 ","$1,573.91 ",$632.28 ,"$1,573.91 ","$1,573.91 ",$632.28 ,"$1,136.71 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000455,69210,HC REMOVE CERUMEN IMPACTED W/INSTRUMENT-LT,450,1 ,$185.00 ,$120.25 ,$56.58 ,$185.00 ,$137.83 ,$121.18 ,$56.58 ,$97.50 ,$56.58 ,$116.74 ,$116.74 ,$116.74 ,$116.74 ,$166.50 ,$138.75 ,$56.58 ,$162.80 ,$56.58 ,$138.75 ,$138.75 ,$157.25 ,$157.25 ,$56.58 ,$157.25 ,$56.58 ,$146.15 ,$146.15 ,$146.15 ,$166.50 ,$135.83 ,$166.50 ,$56.58 ,$185.00 ,$121.18 ,$56.58 ,$80.29 , N/A ,$59.22 ,$166.50 ,$122.62 ,$116.74 ,$111.00 ,$166.50 ,$56.58 ,$166.50 ,$166.50 ,$56.58 ,$120.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000456,69210,HC REMOVE CERUMEN IMPACTED W/INSTRUMENT-RT,450,1 ,$185.00 ,$120.25 ,$56.58 ,$185.00 ,$137.83 ,$121.18 ,$56.58 ,$97.50 ,$56.58 ,$116.74 ,$116.74 ,$116.74 ,$116.74 ,$166.50 ,$138.75 ,$56.58 ,$162.80 ,$56.58 ,$138.75 ,$138.75 ,$157.25 ,$157.25 ,$56.58 ,$157.25 ,$56.58 ,$146.15 ,$146.15 ,$146.15 ,$166.50 ,$135.83 ,$166.50 ,$56.58 ,$185.00 ,$121.18 ,$56.58 ,$80.29 , N/A ,$59.22 ,$166.50 ,$122.62 ,$116.74 ,$111.00 ,$166.50 ,$56.58 ,$166.50 ,$166.50 ,$56.58 ,$120.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000493,36600,HC ARTERIAL PUNCTURE,450,1 ,$29.00 ,$18.85 ,$12.59 ,$246.63 ,$21.61 ,$19.00 ,$29.00 ,$15.28 ,$29.00 ,$18.30 ,$18.30 ,$18.30 ,$18.30 ,$26.10 ,$21.75 ,$29.00 ,$25.52 ,$29.00 ,$21.75 ,$21.75 ,$24.65 ,$24.65 ,$29.00 ,$24.65 ,$29.00 ,$22.91 ,$22.91 ,$22.91 ,$26.10 ,$29.00 ,$26.10 ,$29.00 ,$29.00 ,$19.00 ,$29.00 ,$12.59 , N/A ,$29.00 ,$26.10 ,$246.63 ,$18.30 ,$17.40 ,$26.10 ,$29.00 ,$26.10 ,$26.10 ,$29.00 ,$18.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000498,69210,HC REMOVE CERUMEN IMPACTED W/INSTRUMENT-BIL,450,1 ,$278.00 ,$180.70 ,$56.58 ,$278.00 ,$207.11 ,$182.09 ,$56.58 ,$146.51 ,$56.58 ,$175.42 ,$175.42 ,$175.42 ,$175.42 ,$250.20 ,$208.50 ,$56.58 ,$244.64 ,$56.58 ,$208.50 ,$208.50 ,$236.30 ,$236.30 ,$56.58 ,$236.30 ,$56.58 ,$219.62 ,$219.62 ,$219.62 ,$250.20 ,$135.83 ,$250.20 ,$56.58 ,$278.00 ,$182.09 ,$56.58 ,$120.65 , N/A ,$59.22 ,$250.20 ,$122.62 ,$175.42 ,$166.80 ,$250.20 ,$56.58 ,$250.20 ,$250.20 ,$56.58 ,$180.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000500,57200,HC REPAIR SUTURE VAGINA COLPORRHAPHY,450,1 ,"$5,538.00 ","$3,599.70 ","$2,403.49 ","$5,779.05 ","$4,125.81 ","$3,627.39 ","$2,666.68 ","$2,918.53 ","$2,666.68 ","$3,494.48 ","$3,494.48 ","$3,494.48 ","$3,494.48 ","$4,984.20 ","$4,153.50 ","$2,666.68 ","$4,873.44 ","$2,666.68 ","$4,153.50 ","$4,153.50 ","$4,707.30 ","$4,707.30 ","$2,666.68 ","$4,707.30 ","$2,666.68 ","$4,375.02 ","$4,375.02 ","$4,375.02 ","$4,984.20 ","$5,538.00 ","$4,984.20 ","$2,666.68 ","$5,538.00 ","$3,627.39 ","$2,666.68 ","$2,403.49 ", N/A ,"$2,791.18 ","$4,984.20 ","$5,779.05 ","$3,494.48 ","$3,322.80 ","$4,984.20 ","$2,666.68 ","$4,984.20 ","$4,984.20 ","$2,666.68 ","$3,599.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000513,29580,HC APPLY UNNA BOOT-LT,450,1 ,$404.00 ,$262.60 ,$143.52 ,$404.00 ,$300.98 ,$264.62 ,$143.52 ,$212.91 ,$143.52 ,$254.92 ,$254.92 ,$254.92 ,$254.92 ,$363.60 ,$303.00 ,$143.52 ,$355.52 ,$143.52 ,$303.00 ,$303.00 ,$343.40 ,$343.40 ,$143.52 ,$343.40 ,$143.52 ,$319.16 ,$319.16 ,$319.16 ,$363.60 ,$344.53 ,$363.60 ,$143.52 ,$404.00 ,$264.62 ,$143.52 ,$175.34 , N/A ,$150.22 ,$363.60 ,$311.03 ,$254.92 ,$242.40 ,$363.60 ,$143.52 ,$363.60 ,$363.60 ,$143.52 ,$262.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000514,29580,HC APPLY UNNA BOOT-RT,450,1 ,$404.00 ,$262.60 ,$143.52 ,$404.00 ,$300.98 ,$264.62 ,$143.52 ,$212.91 ,$143.52 ,$254.92 ,$254.92 ,$254.92 ,$254.92 ,$363.60 ,$303.00 ,$143.52 ,$355.52 ,$143.52 ,$303.00 ,$303.00 ,$343.40 ,$343.40 ,$143.52 ,$343.40 ,$143.52 ,$319.16 ,$319.16 ,$319.16 ,$363.60 ,$344.53 ,$363.60 ,$143.52 ,$404.00 ,$264.62 ,$143.52 ,$175.34 , N/A ,$150.22 ,$363.60 ,$311.03 ,$254.92 ,$242.40 ,$363.60 ,$143.52 ,$363.60 ,$363.60 ,$143.52 ,$262.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000554,29581,HC APPLY MULTI COMP LOWER LEG-LT,450,1 ,$404.00 ,$262.60 ,$143.52 ,$404.00 ,$300.98 ,$264.62 ,$143.52 ,$212.91 ,$143.52 ,$254.92 ,$254.92 ,$254.92 ,$254.92 ,$363.60 ,$303.00 ,$143.52 ,$355.52 ,$143.52 ,$303.00 ,$303.00 ,$343.40 ,$343.40 ,$143.52 ,$343.40 ,$143.52 ,$319.16 ,$319.16 ,$319.16 ,$363.60 ,$344.53 ,$363.60 ,$143.52 ,$404.00 ,$264.62 ,$143.52 ,$175.34 , N/A ,$150.22 ,$363.60 ,$311.03 ,$254.92 ,$242.40 ,$363.60 ,$143.52 ,$363.60 ,$363.60 ,$143.52 ,$262.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45000555,29581,HC APPLY MULTI COMP LOWER LEG-RT,450,1 ,$404.00 ,$262.60 ,$143.52 ,$404.00 ,$300.98 ,$264.62 ,$143.52 ,$212.91 ,$143.52 ,$254.92 ,$254.92 ,$254.92 ,$254.92 ,$363.60 ,$303.00 ,$143.52 ,$355.52 ,$143.52 ,$303.00 ,$303.00 ,$343.40 ,$343.40 ,$143.52 ,$343.40 ,$143.52 ,$319.16 ,$319.16 ,$319.16 ,$363.60 ,$344.53 ,$363.60 ,$143.52 ,$404.00 ,$264.62 ,$143.52 ,$175.34 , N/A ,$150.22 ,$363.60 ,$311.03 ,$254.92 ,$242.40 ,$363.60 ,$143.52 ,$363.60 ,$363.60 ,$143.52 ,$262.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45001273,23675,HC TX FX DISLOC SHOULDER W/PROX HUM W/MANIP,450,1 ,"$3,885.63 ","$2,525.66 ","$1,415.42 ","$3,885.63 ","$2,894.79 ","$2,545.09 ","$1,415.42 ","$2,047.73 ","$1,415.42 ","$2,451.83 ","$2,451.83 ","$2,451.83 ","$2,451.83 ","$3,497.07 ","$2,914.22 ","$1,415.42 ","$3,419.35 ","$1,415.42 ","$2,914.22 ","$2,914.22 ","$3,302.79 ","$3,302.79 ","$1,415.42 ","$3,302.79 ","$1,415.42 ","$3,069.65 ","$3,069.65 ","$3,069.65 ","$3,497.07 ","$3,397.81 ","$3,497.07 ","$1,415.42 ","$3,885.63 ","$2,545.09 ","$1,415.42 ","$1,686.36 ", N/A ,"$1,481.50 ","$3,497.07 ","$3,067.41 ","$2,451.83 ","$2,331.38 ","$3,497.07 ","$1,415.42 ","$3,497.07 ","$3,497.07 ","$1,415.42 ","$2,525.66 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45001296,27762,HC TX FX CLOSED MEDIAL MALLEOLUS W/MANIP,450,1 ,"$3,094.00 ","$2,011.10 ","$1,342.80 ","$3,094.00 ","$2,305.03 ","$2,026.57 ","$1,415.42 ","$1,630.54 ","$1,415.42 ","$1,952.31 ","$1,952.31 ","$1,952.31 ","$1,952.31 ","$2,784.60 ","$2,320.50 ","$1,415.42 ","$2,722.72 ","$1,415.42 ","$2,320.50 ","$2,320.50 ","$2,629.90 ","$2,629.90 ","$1,415.42 ","$2,629.90 ","$1,415.42 ","$2,444.26 ","$2,444.26 ","$2,444.26 ","$2,784.60 ","$3,094.00 ","$2,784.60 ","$1,415.42 ","$3,094.00 ","$2,026.57 ","$1,415.42 ","$1,342.80 ", N/A ,"$1,481.50 ","$2,784.60 ","$3,067.41 ","$1,952.31 ","$1,856.40 ","$2,784.60 ","$1,415.42 ","$2,784.60 ","$2,784.60 ","$1,415.42 ","$2,011.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45001317,67935,HC REPAIR EYELID WOUND FULL THICKNESS,450,1 ,"$5,547.84 ","$3,606.10 ","$2,035.53 ","$5,547.84 ","$4,133.14 ","$3,633.84 ","$2,035.53 ","$2,923.71 ","$2,035.53 ","$3,500.69 ","$3,500.69 ","$3,500.69 ","$3,500.69 ","$4,993.06 ","$4,160.88 ","$2,035.53 ","$4,882.10 ","$2,035.53 ","$4,160.88 ","$4,160.88 ","$4,715.66 ","$4,715.66 ","$2,035.53 ","$4,715.66 ","$2,035.53 ","$4,382.79 ","$4,382.79 ","$4,382.79 ","$4,993.06 ","$4,886.42 ","$4,993.06 ","$2,035.53 ","$5,547.84 ","$3,633.84 ","$2,035.53 ","$2,407.76 ", N/A ,"$2,130.56 ","$4,993.06 ","$4,411.27 ","$3,500.69 ","$3,328.70 ","$4,993.06 ","$2,035.53 ","$4,993.06 ","$4,993.06 ","$2,035.53 ","$3,606.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45001331,43762,HC REPLACE GASTRO TUBE PERC,450,1 ,$672.00 ,$436.80 ,$270.55 ,$672.00 ,$500.64 ,$440.16 ,$270.55 ,$354.14 ,$270.55 ,$424.03 ,$424.03 ,$424.03 ,$424.03 ,$604.80 ,$504.00 ,$270.55 ,$591.36 ,$270.55 ,$504.00 ,$504.00 ,$571.20 ,$571.20 ,$270.55 ,$571.20 ,$270.55 ,$530.88 ,$530.88 ,$530.88 ,$604.80 ,$649.47 ,$604.80 ,$270.55 ,$672.00 ,$440.16 ,$270.55 ,$291.65 , N/A ,$283.18 ,$604.80 ,$586.32 ,$424.03 ,$403.20 ,$604.80 ,$270.55 ,$604.80 ,$604.80 ,$270.55 ,$436.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45001332,43763,HC REPLACE GASTRO TUBE PERC W/REVISE TRACT,450,1 ,$717.00 ,$466.05 ,$270.55 ,$717.00 ,$534.17 ,$469.64 ,$270.55 ,$377.86 ,$270.55 ,$452.43 ,$452.43 ,$452.43 ,$452.43 ,$645.30 ,$537.75 ,$270.55 ,$630.96 ,$270.55 ,$537.75 ,$537.75 ,$609.45 ,$609.45 ,$270.55 ,$609.45 ,$270.55 ,$566.43 ,$566.43 ,$566.43 ,$645.30 ,$649.47 ,$645.30 ,$270.55 ,$717.00 ,$469.64 ,$270.55 ,$311.18 , N/A ,$283.18 ,$645.30 ,$586.32 ,$452.43 ,$430.20 ,$645.30 ,$270.55 ,$645.30 ,$645.30 ,$270.55 ,$466.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45001347,27503,HC CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/MANJ,450,1 ,"$3,885.63 ","$2,525.66 ","$1,415.42 ","$3,885.63 ","$2,894.79 ","$2,545.09 ","$1,415.42 ","$2,047.73 ","$1,415.42 ","$2,451.83 ","$2,451.83 ","$2,451.83 ","$2,451.83 ","$3,497.07 ","$2,914.22 ","$1,415.42 ","$3,419.35 ","$1,415.42 ","$2,914.22 ","$2,914.22 ","$3,302.79 ","$3,302.79 ","$1,415.42 ","$3,302.79 ","$1,415.42 ","$3,069.65 ","$3,069.65 ","$3,069.65 ","$3,497.07 ","$3,397.81 ","$3,497.07 ","$1,415.42 ","$3,885.63 ","$2,545.09 ","$1,415.42 ","$1,686.36 ", N/A ,"$1,481.50 ","$3,497.07 ","$3,067.41 ","$2,451.83 ","$2,331.38 ","$3,497.07 ","$1,415.42 ","$3,497.07 ","$3,497.07 ","$1,415.42 ","$2,525.66 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45001350,P9612,HC STRAIGHT CATH FOR URINE SPECIMEN,450,1 ,$201.00 ,$130.65 ,$3.21 ,$201.00 ,$149.75 ,$131.66 ,$3.21 ,$105.93 ,$3.21 ,$126.83 ,$126.83 ,$126.83 ,$126.83 ,$180.90 ,$150.75 ,$3.21 ,$176.88 ,$3.21 ,$150.75 ,$150.75 ,$170.85 ,$170.85 ,$3.21 ,$170.85 ,$3.21 ,$158.79 ,$158.79 ,$158.79 ,$180.90 ,$7.71 ,$180.90 ,$3.21 ,$201.00 ,$131.66 ,$3.21 ,$87.23 , N/A ,$3.36 ,$180.90 ,$6.96 ,$126.83 ,$120.60 ,$180.90 ,$3.21 ,$180.90 ,$180.90 ,$3.21 ,$130.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),45001352,26545,HC RECONSTRUCT FINGER JOINT,450,1 ,"$7,847.37 ","$5,100.79 ","$2,877.30 ","$7,847.37 ","$5,846.29 ","$5,140.03 ","$2,877.30 ","$4,135.56 ","$2,877.30 ","$4,951.69 ","$4,951.69 ","$4,951.69 ","$4,951.69 ","$7,062.63 ","$5,885.53 ","$2,877.30 ","$6,905.69 ","$2,877.30 ","$5,885.53 ","$5,885.53 ","$6,670.26 ","$6,670.26 ","$2,877.30 ","$6,670.26 ","$2,877.30 ","$6,199.42 ","$6,199.42 ","$6,199.42 ","$7,062.63 ","$6,907.14 ","$7,062.63 ","$2,877.30 ","$7,847.37 ","$5,140.03 ","$2,877.30 ","$3,405.76 ", N/A ,"$3,011.63 ","$7,062.63 ","$6,235.50 ","$4,951.69 ","$4,708.42 ","$7,062.63 ","$2,877.30 ","$7,062.63 ","$7,062.63 ","$2,877.30 ","$5,100.79 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),46000002,94010,HC SPIROMETRY/PFT PKG,460,1 ,$150.00 ,$97.50 ,$65.10 ,$307.44 ,$111.75 ,$98.25 ,$141.86 ,$79.05 ,$141.86 ,$94.65 ,$94.65 ,$94.65 ,$94.65 ,$135.00 ,$112.50 ,$141.86 ,$132.00 ,$141.86 ,$112.50 ,$112.50 ,$127.50 ,$127.50 ,$141.86 ,$127.50 ,$141.86 ,$118.50 ,$118.50 ,$118.50 ,$135.00 ,$150.00 ,$135.00 ,$141.86 ,$150.00 ,$98.25 ,$141.86 ,$65.10 , N/A ,$148.49 ,$135.00 ,$307.44 ,$94.65 ,$90.00 ,$135.00 ,$141.86 ,$135.00 ,$135.00 ,$141.86 ,$97.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),46000004,94060,HC SPIROMETRY/PFT PRE AND POST,460,1 ,$574.00 ,$373.10 ,$249.12 ,$582.60 ,$427.63 ,$375.97 ,$268.83 ,$302.50 ,$268.83 ,$362.19 ,$362.19 ,$362.19 ,$362.19 ,$516.60 ,$430.50 ,$268.83 ,$505.12 ,$268.83 ,$430.50 ,$430.50 ,$487.90 ,$487.90 ,$268.83 ,$487.90 ,$268.83 ,$453.46 ,$453.46 ,$453.46 ,$516.60 ,$574.00 ,$516.60 ,$268.83 ,$574.00 ,$375.97 ,$268.83 ,$249.12 , N/A ,$281.38 ,$516.60 ,$582.60 ,$362.19 ,$344.40 ,$516.60 ,$268.83 ,$516.60 ,$516.60 ,$268.83 ,$373.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),46000006,94070,HC SPIROMETRY/PFT CPLX,460,1 ,"$1,430.00 ",$929.50 ,$268.83 ,"$1,430.00 ","$1,065.35 ",$936.65 ,$268.83 ,$753.61 ,$268.83 ,$902.33 ,$902.33 ,$902.33 ,$902.33 ,"$1,287.00 ","$1,072.50 ",$268.83 ,"$1,258.40 ",$268.83 ,"$1,072.50 ","$1,072.50 ","$1,215.50 ","$1,215.50 ",$268.83 ,"$1,215.50 ",$268.83 ,"$1,129.70 ","$1,129.70 ","$1,129.70 ","$1,287.00 ",$645.35 ,"$1,287.00 ",$268.83 ,"$1,430.00 ",$936.65 ,$268.83 ,$620.62 , N/A ,$281.38 ,"$1,287.00 ",$582.60 ,$902.33 ,$858.00 ,"$1,287.00 ",$268.83 ,"$1,287.00 ","$1,287.00 ",$268.83 ,$929.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),46000007,94150,HC VITAL CAPACITY TOTAL,460,1 ,$415.05 ,$269.78 ,$141.86 ,$415.05 ,$309.21 ,$271.86 ,$141.86 ,$218.73 ,$141.86 ,$261.90 ,$261.90 ,$261.90 ,$261.90 ,$373.55 ,$311.29 ,$141.86 ,$365.24 ,$141.86 ,$311.29 ,$311.29 ,$352.79 ,$352.79 ,$141.86 ,$352.79 ,$141.86 ,$327.89 ,$327.89 ,$327.89 ,$373.55 ,$340.55 ,$373.55 ,$141.86 ,$415.05 ,$271.86 ,$141.86 ,$180.13 , N/A ,$148.49 ,$373.55 ,$307.44 ,$261.90 ,$249.03 ,$373.55 ,$141.86 ,$373.55 ,$373.55 ,$141.86 ,$269.78 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),46000013,94726,HC PLETHYSMOGRAPHY,460,1 ,$293.00 ,$190.45 ,$127.16 ,$582.60 ,$218.29 ,$191.92 ,$268.83 ,$154.41 ,$268.83 ,$184.88 ,$184.88 ,$184.88 ,$184.88 ,$263.70 ,$219.75 ,$268.83 ,$257.84 ,$268.83 ,$219.75 ,$219.75 ,$249.05 ,$249.05 ,$268.83 ,$249.05 ,$268.83 ,$231.47 ,$231.47 ,$231.47 ,$263.70 ,$293.00 ,$263.70 ,$268.83 ,$293.00 ,$191.92 ,$268.83 ,$127.16 , N/A ,$281.38 ,$263.70 ,$582.60 ,$184.88 ,$175.80 ,$263.70 ,$268.83 ,$263.70 ,$263.70 ,$268.83 ,$190.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),46000014,94618,HC WALK TEST 6 MIN,460,1 ,$456.00 ,$296.40 ,$113.81 ,$456.00 ,$339.72 ,$298.68 ,$113.81 ,$240.31 ,$113.81 ,$287.74 ,$287.74 ,$287.74 ,$287.74 ,$410.40 ,$342.00 ,$113.81 ,$401.28 ,$113.81 ,$342.00 ,$342.00 ,$387.60 ,$387.60 ,$113.81 ,$387.60 ,$113.81 ,$360.24 ,$360.24 ,$360.24 ,$410.40 ,$273.20 ,$410.40 ,$113.81 ,$456.00 ,$298.68 ,$113.81 ,$197.90 , N/A ,$119.12 ,$410.40 ,$246.63 ,$287.74 ,$273.60 ,$410.40 ,$113.81 ,$410.40 ,$410.40 ,$113.81 ,$296.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),46000017,94729,HC CARBON MONOXIDE DIFF (DLCO),460,1 ,$204.00 ,$132.60 ,$88.54 ,$204.00 ,$151.98 ,$133.62 , N/A ,$107.51 , N/A ,$128.72 ,$128.72 ,$128.72 ,$128.72 ,$183.60 ,$153.00 , N/A ,$179.52 , N/A ,$153.00 ,$153.00 ,$173.40 ,$173.40 , N/A ,$173.40 , N/A ,$161.16 ,$161.16 ,$161.16 ,$183.60 , N/A ,$183.60 , N/A ,$204.00 ,$133.62 , N/A ,$88.54 , N/A , N/A ,$183.60 , N/A ,$128.72 ,$122.40 ,$183.60 , N/A ,$183.60 ,$183.60 , N/A ,$132.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),46000021,94760,HC PULSE OX SINGLE,460,1 ,$70.00 ,$45.50 ,$30.38 ,$70.00 ,$52.15 ,$45.85 , N/A ,$36.89 , N/A ,$44.17 ,$44.17 ,$44.17 ,$44.17 ,$63.00 ,$52.50 , N/A ,$61.60 , N/A ,$52.50 ,$52.50 ,$59.50 ,$59.50 , N/A ,$59.50 , N/A ,$55.30 ,$55.30 ,$55.30 ,$63.00 , N/A ,$63.00 , N/A ,$70.00 ,$45.85 , N/A ,$30.38 , N/A , N/A ,$63.00 , N/A ,$44.17 ,$42.00 ,$63.00 , N/A ,$63.00 ,$63.00 , N/A ,$45.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),47000001,92587,HC DISTORTION EVOKED POTENT LTD,470,1 ,$48.00 ,$31.20 ,$20.83 ,$582.60 ,$35.76 ,$31.44 ,$48.00 ,$25.30 ,$48.00 ,$30.29 ,$30.29 ,$30.29 ,$30.29 ,$43.20 ,$36.00 ,$48.00 ,$42.24 ,$48.00 ,$36.00 ,$36.00 ,$40.80 ,$40.80 ,$48.00 ,$40.80 ,$48.00 ,$37.92 ,$37.92 ,$37.92 ,$43.20 ,$48.00 ,$43.20 ,$48.00 ,$48.00 ,$31.44 ,$48.00 ,$20.83 , N/A ,$48.00 ,$43.20 ,$582.60 ,$30.29 ,$28.80 ,$43.20 ,$48.00 ,$43.20 ,$43.20 ,$48.00 ,$31.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),47000003,92586,HC NEWBORN HEARING SCREENING,470,1 ,$415.00 ,$269.75 ,$180.11 ,$415.00 ,$309.18 ,$271.83 , N/A ,$218.71 , N/A ,$261.87 ,$261.87 ,$261.87 ,$261.87 ,$373.50 ,$311.25 , N/A ,$365.20 , N/A ,$311.25 ,$311.25 ,$352.75 ,$352.75 , N/A ,$352.75 , N/A ,$327.85 ,$327.85 ,$327.85 ,$373.50 , N/A ,$373.50 , N/A ,$415.00 ,$271.83 , N/A ,$180.11 , N/A , N/A ,$373.50 , N/A ,$261.87 ,$249.00 ,$373.50 , N/A ,$373.50 ,$373.50 , N/A ,$269.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),47100009,92558,HC AUD EVOKED OTOACOUS EMISSIONS SCREENING,471,1 ,$253.00 ,$164.45 ,$109.80 ,$253.00 ,$188.49 ,$165.72 , N/A ,$133.33 , N/A ,$159.64 ,$159.64 ,$159.64 ,$159.64 ,$227.70 ,$189.75 , N/A ,$222.64 , N/A ,$189.75 ,$189.75 ,$215.05 ,$215.05 , N/A ,$215.05 , N/A ,$199.87 ,$199.87 ,$199.87 ,$227.70 , N/A ,$227.70 , N/A ,$253.00 ,$165.72 , N/A ,$109.80 , N/A , N/A ,$227.70 , N/A ,$159.64 ,$151.80 ,$227.70 , N/A ,$227.70 ,$227.70 , N/A ,$164.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48000005,92960,HC CARDIOVERSION EXTERNAL,480,1 ,"$1,627.00 ","$1,057.55 ",$571.22 ,"$1,627.00 ","$1,212.12 ","$1,065.69 ",$571.22 ,$857.43 ,$571.22 ,"$1,026.64 ","$1,026.64 ","$1,026.64 ","$1,026.64 ","$1,464.30 ","$1,220.25 ",$571.22 ,"$1,431.76 ",$571.22 ,"$1,220.25 ","$1,220.25 ","$1,382.95 ","$1,382.95 ",$571.22 ,"$1,382.95 ",$571.22 ,"$1,285.33 ","$1,285.33 ","$1,285.33 ","$1,464.30 ","$1,371.25 ","$1,464.30 ",$571.22 ,"$1,627.00 ","$1,065.69 ",$571.22 ,$706.12 , N/A ,$597.89 ,"$1,464.30 ","$1,237.91 ","$1,026.64 ",$976.20 ,"$1,464.30 ",$571.22 ,"$1,464.30 ","$1,464.30 ",$571.22 ,"$1,057.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48000008,G0269,HC PLACE OCCLUSIVE DEVICE A/VV G0269,480,1 ,"$1,135.00 ",$737.75 ,$492.59 ,"$1,135.00 ",$845.58 ,$743.43 , N/A ,$598.15 , N/A ,$716.19 ,$716.19 ,$716.19 ,$716.19 ,"$1,021.50 ",$851.25 , N/A ,$998.80 , N/A ,$851.25 ,$851.25 ,$964.75 ,$964.75 , N/A ,$964.75 , N/A ,$896.65 ,$896.65 ,$896.65 ,"$1,021.50 ", N/A ,"$1,021.50 ", N/A ,"$1,135.00 ",$743.43 , N/A ,$492.59 , N/A , N/A ,"$1,021.50 ", N/A ,$716.19 ,$681.00 ,"$1,021.50 ", N/A ,"$1,021.50 ","$1,021.50 ", N/A ,$737.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48000023,93799,HC RECORDER CARDIOGRAM REAL TIME,480,1 ,$358.00 ,$232.70 ,$141.86 ,$358.00 ,$266.71 ,$234.49 ,$141.86 ,$188.67 ,$141.86 ,$225.90 ,$225.90 ,$225.90 ,$225.90 ,$322.20 ,$268.50 ,$141.86 ,$315.04 ,$141.86 ,$268.50 ,$268.50 ,$304.30 ,$304.30 ,$141.86 ,$304.30 ,$141.86 ,$282.82 ,$282.82 ,$282.82 ,$322.20 ,$340.55 ,$322.20 ,$141.86 ,$358.00 ,$234.49 ,$141.86 ,$155.37 , N/A ,$148.49 ,$322.20 ,$307.44 ,$225.90 ,$214.80 ,$322.20 ,$141.86 ,$322.20 ,$322.20 ,$141.86 ,$232.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48000024,93668,HC PAD REHAB PER SESSION,480,1 ,$157.71 ,$102.51 ,$56.58 ,$157.71 ,$117.49 ,$103.30 ,$56.58 ,$83.11 ,$56.58 ,$99.52 ,$99.52 ,$99.52 ,$99.52 ,$141.94 ,$118.28 ,$56.58 ,$138.78 ,$56.58 ,$118.28 ,$118.28 ,$134.05 ,$134.05 ,$56.58 ,$134.05 ,$56.58 ,$124.59 ,$124.59 ,$124.59 ,$141.94 ,$135.83 ,$141.94 ,$56.58 ,$157.71 ,$103.30 ,$56.58 ,$68.45 , N/A ,$59.22 ,$141.94 ,$122.62 ,$99.52 ,$94.63 ,$141.94 ,$56.58 ,$141.94 ,$141.94 ,$56.58 ,$102.51 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100002,33206,HC INS/REPL PCMKR PERM ATRIAL 33206,481,1 ,"$18,303.00 ","$11,896.95 ","$7,943.50 ","$22,912.02 ","$13,635.74 ","$11,988.47 ","$10,572.50 ","$9,645.68 ","$10,572.50 ","$11,549.19 ","$11,549.19 ","$11,549.19 ","$11,549.19 ","$16,472.70 ","$13,727.25 ","$10,572.50 ","$16,106.64 ","$10,572.50 ","$13,727.25 ","$13,727.25 ","$15,557.55 ","$15,557.55 ","$10,572.50 ","$15,557.55 ","$10,572.50 ","$14,459.37 ","$14,459.37 ","$14,459.37 ","$16,472.70 ","$18,303.00 ","$16,472.70 ","$10,572.50 ","$18,303.00 ","$11,988.47 ","$10,572.50 ","$7,943.50 ", N/A ,"$11,066.08 ","$16,472.70 ","$22,912.02 ","$11,549.19 ","$10,981.80 ","$16,472.70 ","$10,572.50 ","$16,472.70 ","$16,472.70 ","$10,572.50 ","$11,896.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100003,33207,HC INS/REPL PACEMKR PERM VENTRIC 33207,481,1 ,"$18,303.00 ","$11,896.95 ","$7,943.50 ","$22,912.02 ","$13,635.74 ","$11,988.47 ","$10,572.50 ","$9,645.68 ","$10,572.50 ","$11,549.19 ","$11,549.19 ","$11,549.19 ","$11,549.19 ","$16,472.70 ","$13,727.25 ","$10,572.50 ","$16,106.64 ","$10,572.50 ","$13,727.25 ","$13,727.25 ","$15,557.55 ","$15,557.55 ","$10,572.50 ","$15,557.55 ","$10,572.50 ","$14,459.37 ","$14,459.37 ","$14,459.37 ","$16,472.70 ","$18,303.00 ","$16,472.70 ","$10,572.50 ","$18,303.00 ","$11,988.47 ","$10,572.50 ","$7,943.50 ", N/A ,"$11,066.08 ","$16,472.70 ","$22,912.02 ","$11,549.19 ","$10,981.80 ","$16,472.70 ","$10,572.50 ","$16,472.70 ","$16,472.70 ","$10,572.50 ","$11,896.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100004,33208,HC INS/REPL PACEMKR PERM A/V 33208,481,1 ,"$19,937.00 ","$12,959.05 ","$8,652.66 ","$22,912.02 ","$14,853.07 ","$13,058.74 ","$10,572.50 ","$10,506.80 ","$10,572.50 ","$12,580.25 ","$12,580.25 ","$12,580.25 ","$12,580.25 ","$17,943.30 ","$14,952.75 ","$10,572.50 ","$17,544.56 ","$10,572.50 ","$14,952.75 ","$14,952.75 ","$16,946.45 ","$16,946.45 ","$10,572.50 ","$16,946.45 ","$10,572.50 ","$15,750.23 ","$15,750.23 ","$15,750.23 ","$17,943.30 ","$19,937.00 ","$17,943.30 ","$10,572.50 ","$19,937.00 ","$13,058.74 ","$10,572.50 ","$8,652.66 ", N/A ,"$11,066.08 ","$17,943.30 ","$22,912.02 ","$12,580.25 ","$11,962.20 ","$17,943.30 ","$10,572.50 ","$17,943.30 ","$17,943.30 ","$10,572.50 ","$12,959.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100005,33210,HC INS/REPL TPM SGL ELEC/CATH 33210,481,1 ,"$2,715.00 ","$1,764.75 ","$1,178.31 ","$17,960.52 ","$2,022.68 ","$1,778.33 ","$2,715.00 ","$1,430.81 ","$2,715.00 ","$1,713.17 ","$1,713.17 ","$1,713.17 ","$1,713.17 ","$2,443.50 ","$2,036.25 ","$2,715.00 ","$2,389.20 ","$2,715.00 ","$2,036.25 ","$2,036.25 ","$2,307.75 ","$2,307.75 ","$2,715.00 ","$2,307.75 ","$2,715.00 ","$2,144.85 ","$2,144.85 ","$2,144.85 ","$2,443.50 ","$2,715.00 ","$2,443.50 ","$2,715.00 ","$2,715.00 ","$1,778.33 ","$2,715.00 ","$1,178.31 ", N/A ,"$2,715.00 ","$2,443.50 ","$17,960.52 ","$1,713.17 ","$1,629.00 ","$2,443.50 ","$2,715.00 ","$2,443.50 ","$2,443.50 ","$2,715.00 ","$1,764.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100006,33212,HC INS PULSE GEN SGL CHAMBER 33212,481,1 ,"$19,879.00 ","$12,921.35 ","$8,287.68 ","$19,879.00 ","$14,809.86 ","$13,020.75 ","$8,287.68 ","$10,476.23 ","$8,287.68 ","$12,543.65 ","$12,543.65 ","$12,543.65 ","$12,543.65 ","$17,891.10 ","$14,909.25 ","$8,287.68 ","$17,493.52 ","$8,287.68 ","$14,909.25 ","$14,909.25 ","$16,897.15 ","$16,897.15 ","$8,287.68 ","$16,897.15 ","$8,287.68 ","$15,704.41 ","$15,704.41 ","$15,704.41 ","$17,891.10 ","$19,879.00 ","$17,891.10 ","$8,287.68 ","$19,879.00 ","$13,020.75 ","$8,287.68 ","$8,627.49 ", N/A ,"$8,674.60 ","$17,891.10 ","$17,960.52 ","$12,543.65 ","$11,927.40 ","$17,891.10 ","$8,287.68 ","$17,891.10 ","$17,891.10 ","$8,287.68 ","$12,921.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100007,33213,HC INS PULSE GEN DUAL CHAMBER 33213,481,1 ,"$27,525.00 ","$17,891.25 ","$10,572.50 ","$27,525.00 ","$20,506.13 ","$18,028.88 ","$10,572.50 ","$14,505.68 ","$10,572.50 ","$17,368.28 ","$17,368.28 ","$17,368.28 ","$17,368.28 ","$24,772.50 ","$20,643.75 ","$10,572.50 ","$24,222.00 ","$10,572.50 ","$20,643.75 ","$20,643.75 ","$23,396.25 ","$23,396.25 ","$10,572.50 ","$23,396.25 ","$10,572.50 ","$21,744.75 ","$21,744.75 ","$21,744.75 ","$24,772.50 ","$25,379.92 ","$24,772.50 ","$10,572.50 ","$27,525.00 ","$18,028.88 ","$10,572.50 ","$11,945.85 ", N/A ,"$11,066.08 ","$24,772.50 ","$22,912.02 ","$17,368.28 ","$16,515.00 ","$24,772.50 ","$10,572.50 ","$24,772.50 ","$24,772.50 ","$10,572.50 ","$17,891.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100008,33214,HC UPGRADE PACEMAKER SYSTEM 33214,481,1 ,"$27,525.00 ","$17,891.25 ","$10,572.50 ","$27,525.00 ","$20,506.13 ","$18,028.88 ","$10,572.50 ","$14,505.68 ","$10,572.50 ","$17,368.28 ","$17,368.28 ","$17,368.28 ","$17,368.28 ","$24,772.50 ","$20,643.75 ","$10,572.50 ","$24,222.00 ","$10,572.50 ","$20,643.75 ","$20,643.75 ","$23,396.25 ","$23,396.25 ","$10,572.50 ","$23,396.25 ","$10,572.50 ","$21,744.75 ","$21,744.75 ","$21,744.75 ","$24,772.50 ","$25,379.92 ","$24,772.50 ","$10,572.50 ","$27,525.00 ","$18,028.88 ","$10,572.50 ","$11,945.85 ", N/A ,"$11,066.08 ","$24,772.50 ","$22,912.02 ","$17,368.28 ","$16,515.00 ","$24,772.50 ","$10,572.50 ","$24,772.50 ","$24,772.50 ","$10,572.50 ","$17,891.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100010,33216,HC INS ELECTRODE SGL CHAMBER 33216,481,1 ,"$19,879.00 ","$12,921.35 ","$8,287.68 ","$19,879.00 ","$14,809.86 ","$13,020.75 ","$8,287.68 ","$10,476.23 ","$8,287.68 ","$12,543.65 ","$12,543.65 ","$12,543.65 ","$12,543.65 ","$17,891.10 ","$14,909.25 ","$8,287.68 ","$17,493.52 ","$8,287.68 ","$14,909.25 ","$14,909.25 ","$16,897.15 ","$16,897.15 ","$8,287.68 ","$16,897.15 ","$8,287.68 ","$15,704.41 ","$15,704.41 ","$15,704.41 ","$17,891.10 ","$19,879.00 ","$17,891.10 ","$8,287.68 ","$19,879.00 ","$13,020.75 ","$8,287.68 ","$8,627.49 ", N/A ,"$8,674.60 ","$17,891.10 ","$17,960.52 ","$12,543.65 ","$11,927.40 ","$17,891.10 ","$8,287.68 ","$17,891.10 ","$17,891.10 ","$8,287.68 ","$12,921.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100011,33217,HC INS ELECTRODE DUAL CHAMBER 33217,481,1 ,"$19,879.00 ","$12,921.35 ","$8,287.68 ","$19,879.00 ","$14,809.86 ","$13,020.75 ","$8,287.68 ","$10,476.23 ","$8,287.68 ","$12,543.65 ","$12,543.65 ","$12,543.65 ","$12,543.65 ","$17,891.10 ","$14,909.25 ","$8,287.68 ","$17,493.52 ","$8,287.68 ","$14,909.25 ","$14,909.25 ","$16,897.15 ","$16,897.15 ","$8,287.68 ","$16,897.15 ","$8,287.68 ","$15,704.41 ","$15,704.41 ","$15,704.41 ","$17,891.10 ","$19,879.00 ","$17,891.10 ","$8,287.68 ","$19,879.00 ","$13,020.75 ","$8,287.68 ","$8,627.49 ", N/A ,"$8,674.60 ","$17,891.10 ","$17,960.52 ","$12,543.65 ","$11,927.40 ","$17,891.10 ","$8,287.68 ","$17,891.10 ","$17,891.10 ","$8,287.68 ","$12,921.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100014,33224,HC INSERT LV PACING ELECTRODE 33224,481,1 ,"$27,525.00 ","$17,891.25 ","$10,572.50 ","$27,525.00 ","$20,506.13 ","$18,028.88 ","$10,572.50 ","$14,505.68 ","$10,572.50 ","$17,368.28 ","$17,368.28 ","$17,368.28 ","$17,368.28 ","$24,772.50 ","$20,643.75 ","$10,572.50 ","$24,222.00 ","$10,572.50 ","$20,643.75 ","$20,643.75 ","$23,396.25 ","$23,396.25 ","$10,572.50 ","$23,396.25 ","$10,572.50 ","$21,744.75 ","$21,744.75 ","$21,744.75 ","$24,772.50 ","$25,379.92 ","$24,772.50 ","$10,572.50 ","$27,525.00 ","$18,028.88 ","$10,572.50 ","$11,945.85 ", N/A ,"$11,066.08 ","$24,772.50 ","$22,912.02 ","$17,368.28 ","$16,515.00 ","$24,772.50 ","$10,572.50 ","$24,772.50 ","$24,772.50 ","$10,572.50 ","$17,891.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100015,33225,HC INS LV PACING ELCT W/C-D/PACE 33225,481,1 ,"$11,262.00 ","$7,320.30 ","$4,887.71 ","$11,262.00 ","$8,390.19 ","$7,376.61 ", N/A ,"$5,935.07 ", N/A ,"$7,106.32 ","$7,106.32 ","$7,106.32 ","$7,106.32 ","$10,135.80 ","$8,446.50 ", N/A ,"$9,910.56 ", N/A ,"$8,446.50 ","$8,446.50 ","$9,572.70 ","$9,572.70 ", N/A ,"$9,572.70 ", N/A ,"$8,896.98 ","$8,896.98 ","$8,896.98 ","$10,135.80 ", N/A ,"$10,135.80 ", N/A ,"$11,262.00 ","$7,376.61 ", N/A ,"$4,887.71 ", N/A , N/A ,"$10,135.80 ", N/A ,"$7,106.32 ","$6,757.20 ","$10,135.80 ", N/A ,"$10,135.80 ","$10,135.80 ", N/A ,"$7,320.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100016,33226,HC REPOSITION LV ELECTRODE 33226,481,1 ,"$7,447.00 ","$4,840.55 ","$2,909.08 ","$7,447.00 ","$5,548.02 ","$4,877.79 ","$2,909.08 ","$3,924.57 ","$2,909.08 ","$4,699.06 ","$4,699.06 ","$4,699.06 ","$4,699.06 ","$6,702.30 ","$5,585.25 ","$2,909.08 ","$6,553.36 ","$2,909.08 ","$5,585.25 ","$5,585.25 ","$6,329.95 ","$6,329.95 ","$2,909.08 ","$6,329.95 ","$2,909.08 ","$5,883.13 ","$5,883.13 ","$5,883.13 ","$6,702.30 ","$6,983.43 ","$6,702.30 ","$2,909.08 ","$7,447.00 ","$4,877.79 ","$2,909.08 ","$3,232.00 ", N/A ,"$3,044.89 ","$6,702.30 ","$6,304.37 ","$4,699.06 ","$4,468.20 ","$6,702.30 ","$2,909.08 ","$6,702.30 ","$6,702.30 ","$2,909.08 ","$4,840.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100024,33249,HC INS/REPOS DEFIB LEAD/GEN 33249,481,1 ,"$31,436.00 ","$20,433.40 ","$13,643.22 ","$72,345.61 ","$23,419.82 ","$20,590.58 ","$31,436.00 ","$16,566.77 ","$31,436.00 ","$19,836.12 ","$19,836.12 ","$19,836.12 ","$19,836.12 ","$28,292.40 ","$23,577.00 ","$31,436.00 ","$27,663.68 ","$31,436.00 ","$23,577.00 ","$23,577.00 ","$26,720.60 ","$26,720.60 ","$31,436.00 ","$26,720.60 ","$31,436.00 ","$24,834.44 ","$24,834.44 ","$24,834.44 ","$28,292.40 ","$31,436.00 ","$28,292.40 ","$31,436.00 ","$31,436.00 ","$20,590.58 ","$31,436.00 ","$13,643.22 ", N/A ,"$31,436.00 ","$28,292.40 ","$72,345.61 ","$19,836.12 ","$18,861.60 ","$28,292.40 ","$31,436.00 ","$28,292.40 ","$28,292.40 ","$31,436.00 ","$20,433.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100028,33285,HC IMPLANT CARDIAC EVENT RECORDER,481,1 ,"$21,733.00 ","$14,126.45 ","$8,287.68 ","$21,733.00 ","$16,191.09 ","$14,235.12 ","$8,287.68 ","$11,453.29 ","$8,287.68 ","$13,713.52 ","$13,713.52 ","$13,713.52 ","$13,713.52 ","$19,559.70 ","$16,299.75 ","$8,287.68 ","$19,125.04 ","$8,287.68 ","$16,299.75 ","$16,299.75 ","$18,473.05 ","$18,473.05 ","$8,287.68 ","$18,473.05 ","$8,287.68 ","$17,169.07 ","$17,169.07 ","$17,169.07 ","$19,559.70 ","$19,895.08 ","$19,559.70 ","$8,287.68 ","$21,733.00 ","$14,235.12 ","$8,287.68 ","$9,432.12 ", N/A ,"$8,674.60 ","$19,559.70 ","$17,960.52 ","$13,713.52 ","$13,039.80 ","$19,559.70 ","$8,287.68 ","$19,559.70 ","$19,559.70 ","$8,287.68 ","$14,126.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100029,33286,HC REMOVE CARDIAC EVENT RECORDER,481,1 ,"$2,796.00 ","$1,817.40 ",$632.28 ,"$2,796.00 ","$2,083.02 ","$1,831.38 ",$632.28 ,"$1,473.49 ",$632.28 ,"$1,764.28 ","$1,764.28 ","$1,764.28 ","$1,764.28 ","$2,516.40 ","$2,097.00 ",$632.28 ,"$2,460.48 ",$632.28 ,"$2,097.00 ","$2,097.00 ","$2,376.60 ","$2,376.60 ",$632.28 ,"$2,376.60 ",$632.28 ,"$2,208.84 ","$2,208.84 ","$2,208.84 ","$2,516.40 ","$1,517.82 ","$2,516.40 ",$632.28 ,"$2,796.00 ","$1,831.38 ",$632.28 ,"$1,213.46 ", N/A ,$661.80 ,"$2,516.40 ","$1,370.23 ","$1,764.28 ","$1,677.60 ","$2,516.40 ",$632.28 ,"$2,516.40 ","$2,516.40 ",$632.28 ,"$1,817.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100030,33967,HC IABP INSERTION 33967,481,1 ,"$6,123.00 ","$3,979.95 ","$2,657.38 ","$6,123.00 ","$4,561.64 ","$4,010.57 ", N/A ,"$3,226.82 ", N/A ,"$3,863.61 ","$3,863.61 ","$3,863.61 ","$3,863.61 ","$5,510.70 ","$4,592.25 ", N/A ,"$5,388.24 ", N/A ,"$4,592.25 ","$4,592.25 ","$5,204.55 ","$5,204.55 ", N/A ,"$5,204.55 ", N/A ,"$4,837.17 ","$4,837.17 ","$4,837.17 ","$5,510.70 ", N/A ,"$5,510.70 ", N/A ,"$6,123.00 ","$4,010.57 ", N/A ,"$2,657.38 ", N/A , N/A ,"$5,510.70 ", N/A ,"$3,863.61 ","$3,673.80 ","$5,510.70 ", N/A ,"$5,510.70 ","$5,510.70 ", N/A ,"$3,979.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100031,G0365,HC VESSEL MAPPING FOR HEMO ACCESS,323,1 ,"$1,059.00 ",$688.35 ,$459.61 ,"$1,059.00 ",$788.96 ,$693.65 , N/A ,$558.09 , N/A ,$668.23 ,$668.23 ,$668.23 ,$668.23 ,$953.10 ,$794.25 , N/A ,$931.92 , N/A ,$794.25 ,$794.25 ,$900.15 ,$900.15 , N/A ,$900.15 , N/A ,$836.61 ,$836.61 ,$836.61 ,$953.10 , N/A ,$953.10 , N/A ,"$1,059.00 ",$693.65 , N/A ,$459.61 , N/A , N/A ,$953.10 , N/A ,$668.23 ,$635.40 ,$953.10 , N/A ,$953.10 ,$953.10 , N/A ,$688.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100039,36010,HC INTRO CATH VENA CAVA SUP/IN,481,1 ,"$2,035.00 ","$1,322.75 ",$883.19 ,"$2,035.00 ","$1,516.08 ","$1,332.93 ", N/A ,"$1,072.45 ", N/A ,"$1,284.09 ","$1,284.09 ","$1,284.09 ","$1,284.09 ","$1,831.50 ","$1,526.25 ", N/A ,"$1,790.80 ", N/A ,"$1,526.25 ","$1,526.25 ","$1,729.75 ","$1,729.75 ", N/A ,"$1,729.75 ", N/A ,"$1,607.65 ","$1,607.65 ","$1,607.65 ","$1,831.50 ", N/A ,"$1,831.50 ", N/A ,"$2,035.00 ","$1,332.93 ", N/A ,$883.19 , N/A , N/A ,"$1,831.50 ", N/A ,"$1,284.09 ","$1,221.00 ","$1,831.50 ", N/A ,"$1,831.50 ","$1,831.50 ", N/A ,"$1,322.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100040,36011,"HC CATH PLCMT VENOUS, 1ST ORDER",481,1 ,"$1,925.00 ","$1,251.25 ",$835.45 ,"$1,925.00 ","$1,434.13 ","$1,260.88 ", N/A ,"$1,014.48 ", N/A ,"$1,214.68 ","$1,214.68 ","$1,214.68 ","$1,214.68 ","$1,732.50 ","$1,443.75 ", N/A ,"$1,694.00 ", N/A ,"$1,443.75 ","$1,443.75 ","$1,636.25 ","$1,636.25 ", N/A ,"$1,636.25 ", N/A ,"$1,520.75 ","$1,520.75 ","$1,520.75 ","$1,732.50 ", N/A ,"$1,732.50 ", N/A ,"$1,925.00 ","$1,260.88 ", N/A ,$835.45 , N/A , N/A ,"$1,732.50 ", N/A ,"$1,214.68 ","$1,155.00 ","$1,732.50 ", N/A ,"$1,732.50 ","$1,732.50 ", N/A ,"$1,251.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100040,36011,"HC CATH PLCMT VENOUS, 1ST ORDER",481,1 ,"$2,888.00 ","$1,877.20 ","$1,253.39 ","$2,888.00 ","$2,151.56 ","$1,891.64 ", N/A ,"$1,521.98 ", N/A ,"$1,822.33 ","$1,822.33 ","$1,822.33 ","$1,822.33 ","$2,599.20 ","$2,166.00 ", N/A ,"$2,541.44 ", N/A ,"$2,166.00 ","$2,166.00 ","$2,454.80 ","$2,454.80 ", N/A ,"$2,454.80 ", N/A ,"$2,281.52 ","$2,281.52 ","$2,281.52 ","$2,599.20 ", N/A ,"$2,599.20 ", N/A ,"$2,888.00 ","$1,891.64 ", N/A ,"$1,253.39 ", N/A , N/A ,"$2,599.20 ", N/A ,"$1,822.33 ","$1,732.80 ","$2,599.20 ", N/A ,"$2,599.20 ","$2,599.20 ", N/A ,"$1,877.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100041,36012,"HC CATH PLCMT VENOUS, 2ND ORDER",481,1 ,"$2,216.00 ","$1,440.40 ",$961.74 ,"$2,216.00 ","$1,650.92 ","$1,451.48 ", N/A ,"$1,167.83 ", N/A ,"$1,398.30 ","$1,398.30 ","$1,398.30 ","$1,398.30 ","$1,994.40 ","$1,662.00 ", N/A ,"$1,950.08 ", N/A ,"$1,662.00 ","$1,662.00 ","$1,883.60 ","$1,883.60 ", N/A ,"$1,883.60 ", N/A ,"$1,750.64 ","$1,750.64 ","$1,750.64 ","$1,994.40 ", N/A ,"$1,994.40 ", N/A ,"$2,216.00 ","$1,451.48 ", N/A ,$961.74 , N/A , N/A ,"$1,994.40 ", N/A ,"$1,398.30 ","$1,329.60 ","$1,994.40 ", N/A ,"$1,994.40 ","$1,994.40 ", N/A ,"$1,440.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100041,36012,"HC CATH PLCMT VENOUS, 2ND ORDER",481,1 ,"$3,323.00 ","$2,159.95 ","$1,442.18 ","$3,323.00 ","$2,475.64 ","$2,176.57 ", N/A ,"$1,751.22 ", N/A ,"$2,096.81 ","$2,096.81 ","$2,096.81 ","$2,096.81 ","$2,990.70 ","$2,492.25 ", N/A ,"$2,924.24 ", N/A ,"$2,492.25 ","$2,492.25 ","$2,824.55 ","$2,824.55 ", N/A ,"$2,824.55 ", N/A ,"$2,625.17 ","$2,625.17 ","$2,625.17 ","$2,990.70 ", N/A ,"$2,990.70 ", N/A ,"$3,323.00 ","$2,176.57 ", N/A ,"$1,442.18 ", N/A , N/A ,"$2,990.70 ", N/A ,"$2,096.81 ","$1,993.80 ","$2,990.70 ", N/A ,"$2,990.70 ","$2,990.70 ", N/A ,"$2,159.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100047,36140,HC INTRO NDL/CATH ARTERY EXTREM 36140,481,1 ,"$2,047.00 ","$1,330.55 ",$888.40 ,"$2,047.00 ","$1,525.02 ","$1,340.79 ", N/A ,"$1,078.77 ", N/A ,"$1,291.66 ","$1,291.66 ","$1,291.66 ","$1,291.66 ","$1,842.30 ","$1,535.25 ", N/A ,"$1,801.36 ", N/A ,"$1,535.25 ","$1,535.25 ","$1,739.95 ","$1,739.95 ", N/A ,"$1,739.95 ", N/A ,"$1,617.13 ","$1,617.13 ","$1,617.13 ","$1,842.30 ", N/A ,"$1,842.30 ", N/A ,"$2,047.00 ","$1,340.79 ", N/A ,$888.40 , N/A , N/A ,"$1,842.30 ", N/A ,"$1,291.66 ","$1,228.20 ","$1,842.30 ", N/A ,"$1,842.30 ","$1,842.30 ", N/A ,"$1,330.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100051,36200,HC INTRO CATH AORTA 36200,481,1 ,"$2,596.00 ","$1,687.40 ","$1,126.66 ","$2,596.00 ","$1,934.02 ","$1,700.38 ", N/A ,"$1,368.09 ", N/A ,"$1,638.08 ","$1,638.08 ","$1,638.08 ","$1,638.08 ","$2,336.40 ","$1,947.00 ", N/A ,"$2,284.48 ", N/A ,"$1,947.00 ","$1,947.00 ","$2,206.60 ","$2,206.60 ", N/A ,"$2,206.60 ", N/A ,"$2,050.84 ","$2,050.84 ","$2,050.84 ","$2,336.40 ", N/A ,"$2,336.40 ", N/A ,"$2,596.00 ","$1,700.38 ", N/A ,"$1,126.66 ", N/A , N/A ,"$2,336.40 ", N/A ,"$1,638.08 ","$1,557.60 ","$2,336.40 ", N/A ,"$2,336.40 ","$2,336.40 ", N/A ,"$1,687.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100052,36215,HC PLACE CATH THOR/BRAC 1ST ORDER 36215,481,1 ,"$2,689.00 ","$1,747.85 ","$1,167.03 ","$2,689.00 ","$2,003.31 ","$1,761.30 ", N/A ,"$1,417.10 ", N/A ,"$1,696.76 ","$1,696.76 ","$1,696.76 ","$1,696.76 ","$2,420.10 ","$2,016.75 ", N/A ,"$2,366.32 ", N/A ,"$2,016.75 ","$2,016.75 ","$2,285.65 ","$2,285.65 ", N/A ,"$2,285.65 ", N/A ,"$2,124.31 ","$2,124.31 ","$2,124.31 ","$2,420.10 ", N/A ,"$2,420.10 ", N/A ,"$2,689.00 ","$1,761.30 ", N/A ,"$1,167.03 ", N/A , N/A ,"$2,420.10 ", N/A ,"$1,696.76 ","$1,613.40 ","$2,420.10 ", N/A ,"$2,420.10 ","$2,420.10 ", N/A ,"$1,747.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100053,36216,HC PL CATH THOR/BRAC 2ND ORDER 36216,481,1 ,"$2,738.00 ","$1,779.70 ","$1,188.29 ","$2,738.00 ","$2,039.81 ","$1,793.39 ", N/A ,"$1,442.93 ", N/A ,"$1,727.68 ","$1,727.68 ","$1,727.68 ","$1,727.68 ","$2,464.20 ","$2,053.50 ", N/A ,"$2,409.44 ", N/A ,"$2,053.50 ","$2,053.50 ","$2,327.30 ","$2,327.30 ", N/A ,"$2,327.30 ", N/A ,"$2,163.02 ","$2,163.02 ","$2,163.02 ","$2,464.20 ", N/A ,"$2,464.20 ", N/A ,"$2,738.00 ","$1,793.39 ", N/A ,"$1,188.29 ", N/A , N/A ,"$2,464.20 ", N/A ,"$1,727.68 ","$1,642.80 ","$2,464.20 ", N/A ,"$2,464.20 ","$2,464.20 ", N/A ,"$1,779.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100054,36217,HC PL CATH THOR/BRAC 3RD ORDER 36217,481,1 ,"$3,032.00 ","$1,970.80 ","$1,315.89 ","$3,032.00 ","$2,258.84 ","$1,985.96 ", N/A ,"$1,597.86 ", N/A ,"$1,913.19 ","$1,913.19 ","$1,913.19 ","$1,913.19 ","$2,728.80 ","$2,274.00 ", N/A ,"$2,668.16 ", N/A ,"$2,274.00 ","$2,274.00 ","$2,577.20 ","$2,577.20 ", N/A ,"$2,577.20 ", N/A ,"$2,395.28 ","$2,395.28 ","$2,395.28 ","$2,728.80 ", N/A ,"$2,728.80 ", N/A ,"$3,032.00 ","$1,985.96 ", N/A ,"$1,315.89 ", N/A , N/A ,"$2,728.80 ", N/A ,"$1,913.19 ","$1,819.20 ","$2,728.80 ", N/A ,"$2,728.80 ","$2,728.80 ", N/A ,"$1,970.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100055,36218,HC PL CATH THOR/BRAC ADDL 36218,481,1 ,"$1,378.00 ",$895.70 ,$598.05 ,"$1,378.00 ","$1,026.61 ",$902.59 , N/A ,$726.21 , N/A ,$869.52 ,$869.52 ,$869.52 ,$869.52 ,"$1,240.20 ","$1,033.50 ", N/A ,"$1,212.64 ", N/A ,"$1,033.50 ","$1,033.50 ","$1,171.30 ","$1,171.30 ", N/A ,"$1,171.30 ", N/A ,"$1,088.62 ","$1,088.62 ","$1,088.62 ","$1,240.20 ", N/A ,"$1,240.20 ", N/A ,"$1,378.00 ",$902.59 , N/A ,$598.05 , N/A , N/A ,"$1,240.20 ", N/A ,$869.52 ,$826.80 ,"$1,240.20 ", N/A ,"$1,240.20 ","$1,240.20 ", N/A ,$895.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100056,36245,HC ABD 1ST ORDER 36245,481,1 ,"$3,291.00 ","$2,139.15 ","$1,428.29 ","$3,291.00 ","$2,451.80 ","$2,155.61 ", N/A ,"$1,734.36 ", N/A ,"$2,076.62 ","$2,076.62 ","$2,076.62 ","$2,076.62 ","$2,961.90 ","$2,468.25 ", N/A ,"$2,896.08 ", N/A ,"$2,468.25 ","$2,468.25 ","$2,797.35 ","$2,797.35 ", N/A ,"$2,797.35 ", N/A ,"$2,599.89 ","$2,599.89 ","$2,599.89 ","$2,961.90 ", N/A ,"$2,961.90 ", N/A ,"$3,291.00 ","$2,155.61 ", N/A ,"$1,428.29 ", N/A , N/A ,"$2,961.90 ", N/A ,"$2,076.62 ","$1,974.60 ","$2,961.90 ", N/A ,"$2,961.90 ","$2,961.90 ", N/A ,"$2,139.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100057,36246,HC ABD INITIAL 2ND ORDER 36246,481,1 ,"$3,312.00 ","$2,152.80 ","$1,437.41 ","$3,312.00 ","$2,467.44 ","$2,169.36 ", N/A ,"$1,745.42 ", N/A ,"$2,089.87 ","$2,089.87 ","$2,089.87 ","$2,089.87 ","$2,980.80 ","$2,484.00 ", N/A ,"$2,914.56 ", N/A ,"$2,484.00 ","$2,484.00 ","$2,815.20 ","$2,815.20 ", N/A ,"$2,815.20 ", N/A ,"$2,616.48 ","$2,616.48 ","$2,616.48 ","$2,980.80 ", N/A ,"$2,980.80 ", N/A ,"$3,312.00 ","$2,169.36 ", N/A ,"$1,437.41 ", N/A , N/A ,"$2,980.80 ", N/A ,"$2,089.87 ","$1,987.20 ","$2,980.80 ", N/A ,"$2,980.80 ","$2,980.80 ", N/A ,"$2,152.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100057,36246,HC ABD INITIAL 2ND ORDER 36246,481,1 ,"$4,968.00 ","$3,229.20 ","$2,156.11 ","$4,968.00 ","$3,701.16 ","$3,254.04 ", N/A ,"$2,618.14 ", N/A ,"$3,134.81 ","$3,134.81 ","$3,134.81 ","$3,134.81 ","$4,471.20 ","$3,726.00 ", N/A ,"$4,371.84 ", N/A ,"$3,726.00 ","$3,726.00 ","$4,222.80 ","$4,222.80 ", N/A ,"$4,222.80 ", N/A ,"$3,924.72 ","$3,924.72 ","$3,924.72 ","$4,471.20 ", N/A ,"$4,471.20 ", N/A ,"$4,968.00 ","$3,254.04 ", N/A ,"$2,156.11 ", N/A , N/A ,"$4,471.20 ", N/A ,"$3,134.81 ","$2,980.80 ","$4,471.20 ", N/A ,"$4,471.20 ","$4,471.20 ", N/A ,"$3,229.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100058,36247,HC ABD INT 3RD/PLUS ORDER 36247,481,1 ,"$3,741.00 ","$2,431.65 ","$1,623.59 ","$3,741.00 ","$2,787.05 ","$2,450.36 ", N/A ,"$1,971.51 ", N/A ,"$2,360.57 ","$2,360.57 ","$2,360.57 ","$2,360.57 ","$3,366.90 ","$2,805.75 ", N/A ,"$3,292.08 ", N/A ,"$2,805.75 ","$2,805.75 ","$3,179.85 ","$3,179.85 ", N/A ,"$3,179.85 ", N/A ,"$2,955.39 ","$2,955.39 ","$2,955.39 ","$3,366.90 ", N/A ,"$3,366.90 ", N/A ,"$3,741.00 ","$2,450.36 ", N/A ,"$1,623.59 ", N/A , N/A ,"$3,366.90 ", N/A ,"$2,360.57 ","$2,244.60 ","$3,366.90 ", N/A ,"$3,366.90 ","$3,366.90 ", N/A ,"$2,431.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100058,36247,HC ABD INT 3RD/PLUS ORDER 36247,481,1 ,"$5,612.00 ","$3,647.80 ","$2,435.61 ","$5,612.00 ","$4,180.94 ","$3,675.86 ", N/A ,"$2,957.52 ", N/A ,"$3,541.17 ","$3,541.17 ","$3,541.17 ","$3,541.17 ","$5,050.80 ","$4,209.00 ", N/A ,"$4,938.56 ", N/A ,"$4,209.00 ","$4,209.00 ","$4,770.20 ","$4,770.20 ", N/A ,"$4,770.20 ", N/A ,"$4,433.48 ","$4,433.48 ","$4,433.48 ","$5,050.80 ", N/A ,"$5,050.80 ", N/A ,"$5,612.00 ","$3,675.86 ", N/A ,"$2,435.61 ", N/A , N/A ,"$5,050.80 ", N/A ,"$3,541.17 ","$3,367.20 ","$5,050.80 ", N/A ,"$5,050.80 ","$5,050.80 ", N/A ,"$3,647.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100059,36248,HC ABD ADDL 2ND/PLUS ORDER 36248,481,1 ,"$1,537.00 ",$999.05 ,$667.06 ,"$1,537.00 ","$1,145.07 ","$1,006.74 ", N/A ,$810.00 , N/A ,$969.85 ,$969.85 ,$969.85 ,$969.85 ,"$1,383.30 ","$1,152.75 ", N/A ,"$1,352.56 ", N/A ,"$1,152.75 ","$1,152.75 ","$1,306.45 ","$1,306.45 ", N/A ,"$1,306.45 ", N/A ,"$1,214.23 ","$1,214.23 ","$1,214.23 ","$1,383.30 ", N/A ,"$1,383.30 ", N/A ,"$1,537.00 ","$1,006.74 ", N/A ,$667.06 , N/A , N/A ,"$1,383.30 ", N/A ,$969.85 ,$922.20 ,"$1,383.30 ", N/A ,"$1,383.30 ","$1,383.30 ", N/A ,$999.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100069,37241,HC OCCL/EMBOL TRANSCATH PERC 37241,481,1 ,"$26,928.00 ","$17,503.20 ","$10,209.37 ","$26,928.00 ","$20,061.36 ","$17,637.84 ","$10,209.37 ","$14,191.06 ","$10,209.37 ","$16,991.57 ","$16,991.57 ","$16,991.57 ","$16,991.57 ","$24,235.20 ","$20,196.00 ","$10,209.37 ","$23,696.64 ","$10,209.37 ","$20,196.00 ","$20,196.00 ","$22,888.80 ","$22,888.80 ","$10,209.37 ","$22,888.80 ","$10,209.37 ","$21,273.12 ","$21,273.12 ","$21,273.12 ","$24,235.20 ","$24,508.21 ","$24,235.20 ","$10,209.37 ","$26,928.00 ","$17,637.84 ","$10,209.37 ","$11,686.75 ", N/A ,"$10,686.00 ","$24,235.20 ","$22,125.07 ","$16,991.57 ","$16,156.80 ","$24,235.20 ","$10,209.37 ","$24,235.20 ","$24,235.20 ","$10,209.37 ","$17,503.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100077,37220,HC RVC EN PRC ICA W/ANG INT VSL 37220,481,1 ,"$12,465.00 ","$8,102.25 ","$5,038.98 ","$12,465.00 ","$9,286.43 ","$8,164.58 ","$5,038.98 ","$6,569.06 ","$5,038.98 ","$7,865.42 ","$7,865.42 ","$7,865.42 ","$7,865.42 ","$11,218.50 ","$9,348.75 ","$5,038.98 ","$10,969.20 ","$5,038.98 ","$9,348.75 ","$9,348.75 ","$10,595.25 ","$10,595.25 ","$5,038.98 ","$10,595.25 ","$5,038.98 ","$9,847.35 ","$9,847.35 ","$9,847.35 ","$11,218.50 ","$12,096.38 ","$11,218.50 ","$5,038.98 ","$12,465.00 ","$8,164.58 ","$5,038.98 ","$5,409.81 ", N/A ,"$5,274.23 ","$11,218.50 ","$10,920.15 ","$7,865.42 ","$7,479.00 ","$11,218.50 ","$5,038.98 ","$11,218.50 ","$11,218.50 ","$5,038.98 ","$8,102.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100078,37221,HC RVC EN PRC ICA W/TRN SNT INT V 37221,481,1 ,"$16,829.00 ","$10,938.85 ","$7,303.79 ","$22,125.07 ","$12,537.61 ","$11,023.00 ","$10,209.37 ","$8,868.88 ","$10,209.37 ","$10,619.10 ","$10,619.10 ","$10,619.10 ","$10,619.10 ","$15,146.10 ","$12,621.75 ","$10,209.37 ","$14,809.52 ","$10,209.37 ","$12,621.75 ","$12,621.75 ","$14,304.65 ","$14,304.65 ","$10,209.37 ","$14,304.65 ","$10,209.37 ","$13,294.91 ","$13,294.91 ","$13,294.91 ","$15,146.10 ","$16,829.00 ","$15,146.10 ","$10,209.37 ","$16,829.00 ","$11,023.00 ","$10,209.37 ","$7,303.79 ", N/A ,"$10,686.00 ","$15,146.10 ","$22,125.07 ","$10,619.10 ","$10,097.40 ","$15,146.10 ","$10,209.37 ","$15,146.10 ","$15,146.10 ","$10,209.37 ","$10,938.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100079,37222,HC RVC EN PRC ICA W/ANG EA AD VS 37222,481,1 ,"$9,638.00 ","$6,264.70 ","$4,182.89 ","$9,638.00 ","$7,180.31 ","$6,312.89 ", N/A ,"$5,079.23 ", N/A ,"$6,081.58 ","$6,081.58 ","$6,081.58 ","$6,081.58 ","$8,674.20 ","$7,228.50 ", N/A ,"$8,481.44 ", N/A ,"$7,228.50 ","$7,228.50 ","$8,192.30 ","$8,192.30 ", N/A ,"$8,192.30 ", N/A ,"$7,614.02 ","$7,614.02 ","$7,614.02 ","$8,674.20 ", N/A ,"$8,674.20 ", N/A ,"$9,638.00 ","$6,312.89 ", N/A ,"$4,182.89 ", N/A , N/A ,"$8,674.20 ", N/A ,"$6,081.58 ","$5,782.80 ","$8,674.20 ", N/A ,"$8,674.20 ","$8,674.20 ", N/A ,"$6,264.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100080,37223,HC RVC EN PRC ICA W/TRN ST AD VS 37223,481,1 ,"$11,499.00 ","$7,474.35 ","$4,990.57 ","$11,499.00 ","$8,566.76 ","$7,531.85 ", N/A ,"$6,059.97 ", N/A ,"$7,255.87 ","$7,255.87 ","$7,255.87 ","$7,255.87 ","$10,349.10 ","$8,624.25 ", N/A ,"$10,119.12 ", N/A ,"$8,624.25 ","$8,624.25 ","$9,774.15 ","$9,774.15 ", N/A ,"$9,774.15 ", N/A ,"$9,084.21 ","$9,084.21 ","$9,084.21 ","$10,349.10 ", N/A ,"$10,349.10 ", N/A ,"$11,499.00 ","$7,531.85 ", N/A ,"$4,990.57 ", N/A , N/A ,"$10,349.10 ", N/A ,"$7,255.87 ","$6,899.40 ","$10,349.10 ", N/A ,"$10,349.10 ","$10,349.10 ", N/A ,"$7,474.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100081,37224,HC RVC EN PRC R/P W/ANG INT VSL 37224,481,1 ,"$13,362.00 ","$8,685.30 ","$5,038.98 ","$13,362.00 ","$9,954.69 ","$8,752.11 ","$5,038.98 ","$7,041.77 ","$5,038.98 ","$8,431.42 ","$8,431.42 ","$8,431.42 ","$8,431.42 ","$12,025.80 ","$10,021.50 ","$5,038.98 ","$11,758.56 ","$5,038.98 ","$10,021.50 ","$10,021.50 ","$11,357.70 ","$11,357.70 ","$5,038.98 ","$11,357.70 ","$5,038.98 ","$10,555.98 ","$10,555.98 ","$10,555.98 ","$12,025.80 ","$12,096.38 ","$12,025.80 ","$5,038.98 ","$13,362.00 ","$8,752.11 ","$5,038.98 ","$5,799.11 ", N/A ,"$5,274.23 ","$12,025.80 ","$10,920.15 ","$8,431.42 ","$8,017.20 ","$12,025.80 ","$5,038.98 ","$12,025.80 ","$12,025.80 ","$5,038.98 ","$8,685.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100082,37225,HC RVC EN PRC F/P W/ANT INT VSL 37225,481,1 ,"$24,215.00 ","$15,739.75 ","$10,209.37 ","$24,215.00 ","$18,040.18 ","$15,860.83 ","$10,209.37 ","$12,761.31 ","$10,209.37 ","$15,279.67 ","$15,279.67 ","$15,279.67 ","$15,279.67 ","$21,793.50 ","$18,161.25 ","$10,209.37 ","$21,309.20 ","$10,209.37 ","$18,161.25 ","$18,161.25 ","$20,582.75 ","$20,582.75 ","$10,209.37 ","$20,582.75 ","$10,209.37 ","$19,129.85 ","$19,129.85 ","$19,129.85 ","$21,793.50 ","$24,215.00 ","$21,793.50 ","$10,209.37 ","$24,215.00 ","$15,860.83 ","$10,209.37 ","$10,509.31 ", N/A ,"$10,686.00 ","$21,793.50 ","$22,125.07 ","$15,279.67 ","$14,529.00 ","$21,793.50 ","$10,209.37 ","$21,793.50 ","$21,793.50 ","$10,209.37 ","$15,739.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100083,37226,HC RVC EN PRC F/P W/TRN SNT IN VS 37226,481,1 ,"$24,363.00 ","$15,835.95 ","$10,209.37 ","$24,363.00 ","$18,150.44 ","$15,957.77 ","$10,209.37 ","$12,839.30 ","$10,209.37 ","$15,373.05 ","$15,373.05 ","$15,373.05 ","$15,373.05 ","$21,926.70 ","$18,272.25 ","$10,209.37 ","$21,439.44 ","$10,209.37 ","$18,272.25 ","$18,272.25 ","$20,708.55 ","$20,708.55 ","$10,209.37 ","$20,708.55 ","$10,209.37 ","$19,246.77 ","$19,246.77 ","$19,246.77 ","$21,926.70 ","$24,363.00 ","$21,926.70 ","$10,209.37 ","$24,363.00 ","$15,957.77 ","$10,209.37 ","$10,573.54 ", N/A ,"$10,686.00 ","$21,926.70 ","$22,125.07 ","$15,373.05 ","$14,617.80 ","$21,926.70 ","$10,209.37 ","$21,926.70 ","$21,926.70 ","$10,209.37 ","$15,835.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100084,37227,HC RVC EN PRC F/P W/AN/TR ST INT 37227,481,1 ,"$38,196.00 ","$24,827.40 ","$16,330.21 ","$38,196.00 ","$28,456.02 ","$25,018.38 ","$16,330.21 ","$20,129.29 ","$16,330.21 ","$24,101.68 ","$24,101.68 ","$24,101.68 ","$24,101.68 ","$34,376.40 ","$28,647.00 ","$16,330.21 ","$33,612.48 ","$16,330.21 ","$28,647.00 ","$28,647.00 ","$32,466.60 ","$32,466.60 ","$16,330.21 ","$32,466.60 ","$16,330.21 ","$30,174.84 ","$30,174.84 ","$30,174.84 ","$34,376.40 ","$38,196.00 ","$34,376.40 ","$16,330.21 ","$38,196.00 ","$25,018.38 ","$16,330.21 ","$16,577.06 ", N/A ,"$17,092.59 ","$34,376.40 ","$35,389.74 ","$24,101.68 ","$22,917.60 ","$34,376.40 ","$16,330.21 ","$34,376.40 ","$34,376.40 ","$16,330.21 ","$24,827.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100085,37228,HC RVC EN PRC T/P W/ANG INT VSL 37228,481,1 ,"$12,728.00 ","$8,273.20 ","$5,523.95 ","$22,125.07 ","$9,482.36 ","$8,336.84 ","$10,209.37 ","$6,707.66 ","$10,209.37 ","$8,031.37 ","$8,031.37 ","$8,031.37 ","$8,031.37 ","$11,455.20 ","$9,546.00 ","$10,209.37 ","$11,200.64 ","$10,209.37 ","$9,546.00 ","$9,546.00 ","$10,818.80 ","$10,818.80 ","$10,209.37 ","$10,818.80 ","$10,209.37 ","$10,055.12 ","$10,055.12 ","$10,055.12 ","$11,455.20 ","$12,728.00 ","$11,455.20 ","$10,209.37 ","$12,728.00 ","$8,336.84 ","$10,209.37 ","$5,523.95 ", N/A ,"$10,686.00 ","$11,455.20 ","$22,125.07 ","$8,031.37 ","$7,636.80 ","$11,455.20 ","$10,209.37 ","$11,455.20 ","$11,455.20 ","$10,209.37 ","$8,273.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100086,37229,HC RVC EN PRC T/P W/ANT INT VSL 37229,481,1 ,"$22,660.00 ","$14,729.00 ","$9,834.44 ","$35,389.74 ","$16,881.70 ","$14,842.30 ","$16,330.21 ","$11,941.82 ","$16,330.21 ","$14,298.46 ","$14,298.46 ","$14,298.46 ","$14,298.46 ","$20,394.00 ","$16,995.00 ","$16,330.21 ","$19,940.80 ","$16,330.21 ","$16,995.00 ","$16,995.00 ","$19,261.00 ","$19,261.00 ","$16,330.21 ","$19,261.00 ","$16,330.21 ","$17,901.40 ","$17,901.40 ","$17,901.40 ","$20,394.00 ","$22,660.00 ","$20,394.00 ","$16,330.21 ","$22,660.00 ","$14,842.30 ","$16,330.21 ","$9,834.44 ", N/A ,"$17,092.59 ","$20,394.00 ","$35,389.74 ","$14,298.46 ","$13,596.00 ","$20,394.00 ","$16,330.21 ","$20,394.00 ","$20,394.00 ","$16,330.21 ","$14,729.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100088,37231,HC RVC EN PRC T/P W/AN/TR ST IN V 37231,481,1 ,"$34,696.00 ","$22,552.40 ","$15,058.06 ","$35,389.74 ","$25,848.52 ","$22,725.88 ","$16,330.21 ","$18,284.79 ","$16,330.21 ","$21,893.18 ","$21,893.18 ","$21,893.18 ","$21,893.18 ","$31,226.40 ","$26,022.00 ","$16,330.21 ","$30,532.48 ","$16,330.21 ","$26,022.00 ","$26,022.00 ","$29,491.60 ","$29,491.60 ","$16,330.21 ","$29,491.60 ","$16,330.21 ","$27,409.84 ","$27,409.84 ","$27,409.84 ","$31,226.40 ","$34,696.00 ","$31,226.40 ","$16,330.21 ","$34,696.00 ","$22,725.88 ","$16,330.21 ","$15,058.06 ", N/A ,"$17,092.59 ","$31,226.40 ","$35,389.74 ","$21,893.18 ","$20,817.60 ","$31,226.40 ","$16,330.21 ","$31,226.40 ","$31,226.40 ","$16,330.21 ","$22,552.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100089,37232,HC RVC EN PRC T/P W/ANG EA AD VS 37232,481,1 ,"$9,769.00 ","$6,349.85 ","$4,239.75 ","$9,769.00 ","$7,277.91 ","$6,398.70 ", N/A ,"$5,148.26 ", N/A ,"$6,164.24 ","$6,164.24 ","$6,164.24 ","$6,164.24 ","$8,792.10 ","$7,326.75 ", N/A ,"$8,596.72 ", N/A ,"$7,326.75 ","$7,326.75 ","$8,303.65 ","$8,303.65 ", N/A ,"$8,303.65 ", N/A ,"$7,717.51 ","$7,717.51 ","$7,717.51 ","$8,792.10 ", N/A ,"$8,792.10 ", N/A ,"$9,769.00 ","$6,398.70 ", N/A ,"$4,239.75 ", N/A , N/A ,"$8,792.10 ", N/A ,"$6,164.24 ","$5,861.40 ","$8,792.10 ", N/A ,"$8,792.10 ","$8,792.10 ", N/A ,"$6,349.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100090,37233,HC RVC EN PRC T/P W/ANT EA AD VS 37233,481,1 ,"$19,541.00 ","$12,701.65 ","$8,480.79 ","$19,541.00 ","$14,558.05 ","$12,799.36 ", N/A ,"$10,298.11 ", N/A ,"$12,330.37 ","$12,330.37 ","$12,330.37 ","$12,330.37 ","$17,586.90 ","$14,655.75 ", N/A ,"$17,196.08 ", N/A ,"$14,655.75 ","$14,655.75 ","$16,609.85 ","$16,609.85 ", N/A ,"$16,609.85 ", N/A ,"$15,437.39 ","$15,437.39 ","$15,437.39 ","$17,586.90 ", N/A ,"$17,586.90 ", N/A ,"$19,541.00 ","$12,799.36 ", N/A ,"$8,480.79 ", N/A , N/A ,"$17,586.90 ", N/A ,"$12,330.37 ","$11,724.60 ","$17,586.90 ", N/A ,"$17,586.90 ","$17,586.90 ", N/A ,"$12,701.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100092,37235,HC RVC EN PRC T/P W/AN/TR ST AD V 37235,481,1 ,"$20,518.00 ","$13,336.70 ","$8,904.81 ","$20,518.00 ","$15,285.91 ","$13,439.29 ", N/A ,"$10,812.99 ", N/A ,"$12,946.86 ","$12,946.86 ","$12,946.86 ","$12,946.86 ","$18,466.20 ","$15,388.50 ", N/A ,"$18,055.84 ", N/A ,"$15,388.50 ","$15,388.50 ","$17,440.30 ","$17,440.30 ", N/A ,"$17,440.30 ", N/A ,"$16,209.22 ","$16,209.22 ","$16,209.22 ","$18,466.20 ", N/A ,"$18,466.20 ", N/A ,"$20,518.00 ","$13,439.29 ", N/A ,"$8,904.81 ", N/A , N/A ,"$18,466.20 ", N/A ,"$12,946.86 ","$12,310.80 ","$18,466.20 ", N/A ,"$18,466.20 ","$18,466.20 ", N/A ,"$13,336.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100093,37252,HC US VASCULAR NON-CORONARY INIT 37252,481,1 ,"$11,028.00 ","$7,168.20 ","$4,786.15 ","$11,028.00 ","$8,215.86 ","$7,223.34 ", N/A ,"$5,811.76 ", N/A ,"$6,958.67 ","$6,958.67 ","$6,958.67 ","$6,958.67 ","$9,925.20 ","$8,271.00 ", N/A ,"$9,704.64 ", N/A ,"$8,271.00 ","$8,271.00 ","$9,373.80 ","$9,373.80 ", N/A ,"$9,373.80 ", N/A ,"$8,712.12 ","$8,712.12 ","$8,712.12 ","$9,925.20 ", N/A ,"$9,925.20 ", N/A ,"$11,028.00 ","$7,223.34 ", N/A ,"$4,786.15 ", N/A , N/A ,"$9,925.20 ", N/A ,"$6,958.67 ","$6,616.80 ","$9,925.20 ", N/A ,"$9,925.20 ","$9,925.20 ", N/A ,"$7,168.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100094,37253,HC US VASCULAR NON-CORON ADDL EA 37253,481,1 ,"$9,819.00 ","$6,382.35 ","$4,261.45 ","$9,819.00 ","$7,315.16 ","$6,431.45 ", N/A ,"$5,174.61 ", N/A ,"$6,195.79 ","$6,195.79 ","$6,195.79 ","$6,195.79 ","$8,837.10 ","$7,364.25 ", N/A ,"$8,640.72 ", N/A ,"$7,364.25 ","$7,364.25 ","$8,346.15 ","$8,346.15 ", N/A ,"$8,346.15 ", N/A ,"$7,757.01 ","$7,757.01 ","$7,757.01 ","$8,837.10 ", N/A ,"$8,837.10 ", N/A ,"$9,819.00 ","$6,431.45 ", N/A ,"$4,261.45 ", N/A , N/A ,"$8,837.10 ", N/A ,"$6,195.79 ","$5,891.40 ","$8,837.10 ", N/A ,"$8,837.10 ","$8,837.10 ", N/A ,"$6,382.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100095,37191,HC INTERRUPT VENA CAVA INFER,481,1 ,"$8,446.00 ","$5,489.90 ","$3,665.56 ","$10,509.35 ","$6,292.27 ","$5,532.13 ","$4,849.42 ","$4,451.04 ","$4,849.42 ","$5,329.43 ","$5,329.43 ","$5,329.43 ","$5,329.43 ","$7,601.40 ","$6,334.50 ","$4,849.42 ","$7,432.48 ","$4,849.42 ","$6,334.50 ","$6,334.50 ","$7,179.10 ","$7,179.10 ","$4,849.42 ","$7,179.10 ","$4,849.42 ","$6,672.34 ","$6,672.34 ","$6,672.34 ","$7,601.40 ","$8,446.00 ","$7,601.40 ","$4,849.42 ","$8,446.00 ","$5,532.13 ","$4,849.42 ","$3,665.56 ", N/A ,"$5,075.82 ","$7,601.40 ","$10,509.35 ","$5,329.43 ","$5,067.60 ","$7,601.40 ","$4,849.42 ","$7,601.40 ","$7,601.40 ","$4,849.42 ","$5,489.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100107,93451,HC CATH RIGHT HEART 93451,481,1 ,"$8,472.00 ","$5,506.80 ","$2,947.06 ","$8,472.00 ","$6,311.64 ","$5,549.16 ","$2,947.06 ","$4,464.74 ","$2,947.06 ","$5,345.83 ","$5,345.83 ","$5,345.83 ","$5,345.83 ","$7,624.80 ","$6,354.00 ","$2,947.06 ","$7,455.36 ","$2,947.06 ","$6,354.00 ","$6,354.00 ","$7,201.20 ","$7,201.20 ","$2,947.06 ","$7,201.20 ","$2,947.06 ","$6,692.88 ","$6,692.88 ","$6,692.88 ","$7,624.80 ","$7,074.60 ","$7,624.80 ","$2,947.06 ","$8,472.00 ","$5,549.16 ","$2,947.06 ","$3,676.85 ", N/A ,"$3,084.65 ","$7,624.80 ","$6,386.68 ","$5,345.83 ","$5,083.20 ","$7,624.80 ","$2,947.06 ","$7,624.80 ","$7,624.80 ","$2,947.06 ","$5,506.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100108,93452,HC LHC ONLY NO COROS 93452,481,1 ,"$9,379.00 ","$6,096.35 ","$2,947.06 ","$9,379.00 ","$6,987.36 ","$6,143.25 ","$2,947.06 ","$4,942.73 ","$2,947.06 ","$5,918.15 ","$5,918.15 ","$5,918.15 ","$5,918.15 ","$8,441.10 ","$7,034.25 ","$2,947.06 ","$8,253.52 ","$2,947.06 ","$7,034.25 ","$7,034.25 ","$7,972.15 ","$7,972.15 ","$2,947.06 ","$7,972.15 ","$2,947.06 ","$7,409.41 ","$7,409.41 ","$7,409.41 ","$8,441.10 ","$7,074.60 ","$8,441.10 ","$2,947.06 ","$9,379.00 ","$6,143.25 ","$2,947.06 ","$4,070.49 ", N/A ,"$3,084.65 ","$8,441.10 ","$6,386.68 ","$5,918.15 ","$5,627.40 ","$8,441.10 ","$2,947.06 ","$8,441.10 ","$8,441.10 ","$2,947.06 ","$6,096.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100109,93453,HC RHC/LHC ONLY/NO CORS 93453,481,1 ,"$12,729.00 ","$8,273.85 ","$2,947.06 ","$12,729.00 ","$9,483.11 ","$8,337.50 ","$2,947.06 ","$6,708.18 ","$2,947.06 ","$8,032.00 ","$8,032.00 ","$8,032.00 ","$8,032.00 ","$11,456.10 ","$9,546.75 ","$2,947.06 ","$11,201.52 ","$2,947.06 ","$9,546.75 ","$9,546.75 ","$10,819.65 ","$10,819.65 ","$2,947.06 ","$10,819.65 ","$2,947.06 ","$10,055.91 ","$10,055.91 ","$10,055.91 ","$11,456.10 ","$7,074.60 ","$11,456.10 ","$2,947.06 ","$12,729.00 ","$8,337.50 ","$2,947.06 ","$5,524.39 ", N/A ,"$3,084.65 ","$11,456.10 ","$6,386.68 ","$8,032.00 ","$7,637.40 ","$11,456.10 ","$2,947.06 ","$11,456.10 ","$11,456.10 ","$2,947.06 ","$8,273.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100110,93454,HC CORONARY ANGIO ONLY/NO LV 93454,481,1 ,"$10,204.00 ","$6,632.60 ","$2,947.06 ","$10,204.00 ","$7,601.98 ","$6,683.62 ","$2,947.06 ","$5,377.51 ","$2,947.06 ","$6,438.72 ","$6,438.72 ","$6,438.72 ","$6,438.72 ","$9,183.60 ","$7,653.00 ","$2,947.06 ","$8,979.52 ","$2,947.06 ","$7,653.00 ","$7,653.00 ","$8,673.40 ","$8,673.40 ","$2,947.06 ","$8,673.40 ","$2,947.06 ","$8,061.16 ","$8,061.16 ","$8,061.16 ","$9,183.60 ","$7,074.60 ","$9,183.60 ","$2,947.06 ","$10,204.00 ","$6,683.62 ","$2,947.06 ","$4,428.54 ", N/A ,"$3,084.65 ","$9,183.60 ","$6,386.68 ","$6,438.72 ","$6,122.40 ","$9,183.60 ","$2,947.06 ","$9,183.60 ","$9,183.60 ","$2,947.06 ","$6,632.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100111,93455,HC CORO ANGIO AND GRAFTS ONLY NO LV 93455,481,1 ,"$11,555.00 ","$7,510.75 ","$2,947.06 ","$11,555.00 ","$8,608.48 ","$7,568.53 ","$2,947.06 ","$6,089.49 ","$2,947.06 ","$7,291.21 ","$7,291.21 ","$7,291.21 ","$7,291.21 ","$10,399.50 ","$8,666.25 ","$2,947.06 ","$10,168.40 ","$2,947.06 ","$8,666.25 ","$8,666.25 ","$9,821.75 ","$9,821.75 ","$2,947.06 ","$9,821.75 ","$2,947.06 ","$9,128.45 ","$9,128.45 ","$9,128.45 ","$10,399.50 ","$7,074.60 ","$10,399.50 ","$2,947.06 ","$11,555.00 ","$7,568.53 ","$2,947.06 ","$5,014.87 ", N/A ,"$3,084.65 ","$10,399.50 ","$6,386.68 ","$7,291.21 ","$6,933.00 ","$10,399.50 ","$2,947.06 ","$10,399.50 ","$10,399.50 ","$2,947.06 ","$7,510.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100112,93456,HC RHC CORONARY ANGIO/NO LV 93456,481,1 ,"$10,917.00 ","$7,096.05 ","$2,947.06 ","$10,917.00 ","$8,133.17 ","$7,150.64 ","$2,947.06 ","$5,753.26 ","$2,947.06 ","$6,888.63 ","$6,888.63 ","$6,888.63 ","$6,888.63 ","$9,825.30 ","$8,187.75 ","$2,947.06 ","$9,606.96 ","$2,947.06 ","$8,187.75 ","$8,187.75 ","$9,279.45 ","$9,279.45 ","$2,947.06 ","$9,279.45 ","$2,947.06 ","$8,624.43 ","$8,624.43 ","$8,624.43 ","$9,825.30 ","$7,074.60 ","$9,825.30 ","$2,947.06 ","$10,917.00 ","$7,150.64 ","$2,947.06 ","$4,737.98 ", N/A ,"$3,084.65 ","$9,825.30 ","$6,386.68 ","$6,888.63 ","$6,550.20 ","$9,825.30 ","$2,947.06 ","$9,825.30 ","$9,825.30 ","$2,947.06 ","$7,096.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100113,93457,HC RHC CORO ANGIO AND GRAFTS/NO LV 93457,481,1 ,"$12,230.00 ","$7,949.50 ","$2,947.06 ","$12,230.00 ","$9,111.35 ","$8,010.65 ","$2,947.06 ","$6,445.21 ","$2,947.06 ","$7,717.13 ","$7,717.13 ","$7,717.13 ","$7,717.13 ","$11,007.00 ","$9,172.50 ","$2,947.06 ","$10,762.40 ","$2,947.06 ","$9,172.50 ","$9,172.50 ","$10,395.50 ","$10,395.50 ","$2,947.06 ","$10,395.50 ","$2,947.06 ","$9,661.70 ","$9,661.70 ","$9,661.70 ","$11,007.00 ","$7,074.60 ","$11,007.00 ","$2,947.06 ","$12,230.00 ","$8,010.65 ","$2,947.06 ","$5,307.82 ", N/A ,"$3,084.65 ","$11,007.00 ","$6,386.68 ","$7,717.13 ","$7,338.00 ","$11,007.00 ","$2,947.06 ","$11,007.00 ","$11,007.00 ","$2,947.06 ","$7,949.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100114,93458,HC CORONARY ANGIO WITH LV 93458,481,1 ,"$11,675.00 ","$7,588.75 ","$2,947.06 ","$11,675.00 ","$8,697.88 ","$7,647.13 ","$2,947.06 ","$6,152.73 ","$2,947.06 ","$7,366.93 ","$7,366.93 ","$7,366.93 ","$7,366.93 ","$10,507.50 ","$8,756.25 ","$2,947.06 ","$10,274.00 ","$2,947.06 ","$8,756.25 ","$8,756.25 ","$9,923.75 ","$9,923.75 ","$2,947.06 ","$9,923.75 ","$2,947.06 ","$9,223.25 ","$9,223.25 ","$9,223.25 ","$10,507.50 ","$7,074.60 ","$10,507.50 ","$2,947.06 ","$11,675.00 ","$7,647.13 ","$2,947.06 ","$5,066.95 ", N/A ,"$3,084.65 ","$10,507.50 ","$6,386.68 ","$7,366.93 ","$7,005.00 ","$10,507.50 ","$2,947.06 ","$10,507.50 ","$10,507.50 ","$2,947.06 ","$7,588.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100115,93459,HC CORONARY ANGIO W GRAFTS AND LV 93459,481,1 ,"$13,939.00 ","$9,060.35 ","$2,947.06 ","$13,939.00 ","$10,384.56 ","$9,130.05 ","$2,947.06 ","$7,345.85 ","$2,947.06 ","$8,795.51 ","$8,795.51 ","$8,795.51 ","$8,795.51 ","$12,545.10 ","$10,454.25 ","$2,947.06 ","$12,266.32 ","$2,947.06 ","$10,454.25 ","$10,454.25 ","$11,848.15 ","$11,848.15 ","$2,947.06 ","$11,848.15 ","$2,947.06 ","$11,011.81 ","$11,011.81 ","$11,011.81 ","$12,545.10 ","$7,074.60 ","$12,545.10 ","$2,947.06 ","$13,939.00 ","$9,130.05 ","$2,947.06 ","$6,049.53 ", N/A ,"$3,084.65 ","$12,545.10 ","$6,386.68 ","$8,795.51 ","$8,363.40 ","$12,545.10 ","$2,947.06 ","$12,545.10 ","$12,545.10 ","$2,947.06 ","$9,060.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100116,93460,HC RHC/LHC/CORONAY ANGIO AND LV 93460,481,1 ,"$15,061.00 ","$9,789.65 ","$2,947.06 ","$15,061.00 ","$11,220.45 ","$9,864.96 ","$2,947.06 ","$7,937.15 ","$2,947.06 ","$9,503.49 ","$9,503.49 ","$9,503.49 ","$9,503.49 ","$13,554.90 ","$11,295.75 ","$2,947.06 ","$13,253.68 ","$2,947.06 ","$11,295.75 ","$11,295.75 ","$12,801.85 ","$12,801.85 ","$2,947.06 ","$12,801.85 ","$2,947.06 ","$11,898.19 ","$11,898.19 ","$11,898.19 ","$13,554.90 ","$7,074.60 ","$13,554.90 ","$2,947.06 ","$15,061.00 ","$9,864.96 ","$2,947.06 ","$6,536.47 ", N/A ,"$3,084.65 ","$13,554.90 ","$6,386.68 ","$9,503.49 ","$9,036.60 ","$13,554.90 ","$2,947.06 ","$13,554.90 ","$13,554.90 ","$2,947.06 ","$9,789.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100117,93461,HC RHC/LHC/CORON ANGIO GRAFTS AND LV 93461,481,1 ,"$16,210.00 ","$10,536.50 ","$2,947.06 ","$16,210.00 ","$12,076.45 ","$10,617.55 ","$2,947.06 ","$8,542.67 ","$2,947.06 ","$10,228.51 ","$10,228.51 ","$10,228.51 ","$10,228.51 ","$14,589.00 ","$12,157.50 ","$2,947.06 ","$14,264.80 ","$2,947.06 ","$12,157.50 ","$12,157.50 ","$13,778.50 ","$13,778.50 ","$2,947.06 ","$13,778.50 ","$2,947.06 ","$12,805.90 ","$12,805.90 ","$12,805.90 ","$14,589.00 ","$7,074.60 ","$14,589.00 ","$2,947.06 ","$16,210.00 ","$10,617.55 ","$2,947.06 ","$7,035.14 ", N/A ,"$3,084.65 ","$14,589.00 ","$6,386.68 ","$10,228.51 ","$9,726.00 ","$14,589.00 ","$2,947.06 ","$14,589.00 ","$14,589.00 ","$2,947.06 ","$10,536.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100119,93567,HC AORTAGRAM 93567,481,1 ,$636.00 ,$413.40 ,$276.02 ,$636.00 ,$473.82 ,$416.58 , N/A ,$335.17 , N/A ,$401.32 ,$401.32 ,$401.32 ,$401.32 ,$572.40 ,$477.00 , N/A ,$559.68 , N/A ,$477.00 ,$477.00 ,$540.60 ,$540.60 , N/A ,$540.60 , N/A ,$502.44 ,$502.44 ,$502.44 ,$572.40 , N/A ,$572.40 , N/A ,$636.00 ,$416.58 , N/A ,$276.02 , N/A , N/A ,$572.40 , N/A ,$401.32 ,$381.60 ,$572.40 , N/A ,$572.40 ,$572.40 , N/A ,$413.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100150,93503,HC PLACEMENT SWANZ GAN CATH MONIT 93503,481,1 ,"$4,462.00 ","$2,900.30 ","$1,429.44 ","$4,462.00 ","$3,324.19 ","$2,922.61 ","$1,429.44 ","$2,351.47 ","$1,429.44 ","$2,815.52 ","$2,815.52 ","$2,815.52 ","$2,815.52 ","$4,015.80 ","$3,346.50 ","$1,429.44 ","$3,926.56 ","$1,429.44 ","$3,346.50 ","$3,346.50 ","$3,792.70 ","$3,792.70 ","$1,429.44 ","$3,792.70 ","$1,429.44 ","$3,524.98 ","$3,524.98 ","$3,524.98 ","$4,015.80 ","$3,431.46 ","$4,015.80 ","$1,429.44 ","$4,462.00 ","$2,922.61 ","$1,429.44 ","$1,936.51 ", N/A ,"$1,496.18 ","$4,015.80 ","$3,097.79 ","$2,815.52 ","$2,677.20 ","$4,015.80 ","$1,429.44 ","$4,015.80 ","$4,015.80 ","$1,429.44 ","$2,900.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100151,33227,HC REM/REPL PCMKR PUL GEN SGL 33227,481,1 ,"$19,879.00 ","$12,921.35 ","$8,287.68 ","$19,879.00 ","$14,809.86 ","$13,020.75 ","$8,287.68 ","$10,476.23 ","$8,287.68 ","$12,543.65 ","$12,543.65 ","$12,543.65 ","$12,543.65 ","$17,891.10 ","$14,909.25 ","$8,287.68 ","$17,493.52 ","$8,287.68 ","$14,909.25 ","$14,909.25 ","$16,897.15 ","$16,897.15 ","$8,287.68 ","$16,897.15 ","$8,287.68 ","$15,704.41 ","$15,704.41 ","$15,704.41 ","$17,891.10 ","$19,879.00 ","$17,891.10 ","$8,287.68 ","$19,879.00 ","$13,020.75 ","$8,287.68 ","$8,627.49 ", N/A ,"$8,674.60 ","$17,891.10 ","$17,960.52 ","$12,543.65 ","$11,927.40 ","$17,891.10 ","$8,287.68 ","$17,891.10 ","$17,891.10 ","$8,287.68 ","$12,921.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100152,33228,HC REM/REPL PCMKR PUL GEN DUAL 33228,481,1 ,"$27,525.00 ","$17,891.25 ","$10,572.50 ","$27,525.00 ","$20,506.13 ","$18,028.88 ","$10,572.50 ","$14,505.68 ","$10,572.50 ","$17,368.28 ","$17,368.28 ","$17,368.28 ","$17,368.28 ","$24,772.50 ","$20,643.75 ","$10,572.50 ","$24,222.00 ","$10,572.50 ","$20,643.75 ","$20,643.75 ","$23,396.25 ","$23,396.25 ","$10,572.50 ","$23,396.25 ","$10,572.50 ","$21,744.75 ","$21,744.75 ","$21,744.75 ","$24,772.50 ","$25,379.92 ","$24,772.50 ","$10,572.50 ","$27,525.00 ","$18,028.88 ","$10,572.50 ","$11,945.85 ", N/A ,"$11,066.08 ","$24,772.50 ","$22,912.02 ","$17,368.28 ","$16,515.00 ","$24,772.50 ","$10,572.50 ","$24,772.50 ","$24,772.50 ","$10,572.50 ","$17,891.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100153,33229,HC REM/REPL PCMKR PUL GEN MULT 33229,481,1 ,"$50,203.00 ","$32,631.95 ","$18,919.68 ","$50,203.00 ","$37,401.24 ","$32,882.97 ","$18,919.68 ","$26,456.98 ","$18,919.68 ","$31,678.09 ","$31,678.09 ","$31,678.09 ","$31,678.09 ","$45,182.70 ","$37,652.25 ","$18,919.68 ","$44,178.64 ","$18,919.68 ","$37,652.25 ","$37,652.25 ","$42,672.55 ","$42,672.55 ","$18,919.68 ","$42,672.55 ","$18,919.68 ","$39,660.37 ","$39,660.37 ","$39,660.37 ","$45,182.70 ","$45,417.84 ","$45,182.70 ","$18,919.68 ","$50,203.00 ","$32,882.97 ","$18,919.68 ","$21,788.10 ", N/A ,"$19,802.95 ","$45,182.70 ","$41,001.48 ","$31,678.09 ","$30,121.80 ","$45,182.70 ","$18,919.68 ","$45,182.70 ","$45,182.70 ","$18,919.68 ","$32,631.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100155,33263,HC REM/REPL DEFIB PUL GEN DUAL 33263,481,1 ,"$31,028.00 ","$20,168.20 ","$13,466.15 ","$50,758.55 ","$23,115.86 ","$20,323.34 ","$23,421.98 ","$16,351.76 ","$23,421.98 ","$19,578.67 ","$19,578.67 ","$19,578.67 ","$19,578.67 ","$27,925.20 ","$23,271.00 ","$23,421.98 ","$27,304.64 ","$23,421.98 ","$23,271.00 ","$23,271.00 ","$26,373.80 ","$26,373.80 ","$23,421.98 ","$26,373.80 ","$23,421.98 ","$24,512.12 ","$24,512.12 ","$24,512.12 ","$27,925.20 ","$31,028.00 ","$27,925.20 ","$23,421.98 ","$31,028.00 ","$20,323.34 ","$23,421.98 ","$13,466.15 ", N/A ,"$24,515.44 ","$27,925.20 ","$50,758.55 ","$19,578.67 ","$18,616.80 ","$27,925.20 ","$23,421.98 ","$27,925.20 ","$27,925.20 ","$23,421.98 ","$20,168.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100171,36253,HC PLC CATH RENAL ANGIO 1< UNI,481,1 ,"$8,800.00 ","$5,720.00 ","$3,819.20 ","$10,509.35 ","$6,556.00 ","$5,764.00 ","$4,849.42 ","$4,637.60 ","$4,849.42 ","$5,552.80 ","$5,552.80 ","$5,552.80 ","$5,552.80 ","$7,920.00 ","$6,600.00 ","$4,849.42 ","$7,744.00 ","$4,849.42 ","$6,600.00 ","$6,600.00 ","$7,480.00 ","$7,480.00 ","$4,849.42 ","$7,480.00 ","$4,849.42 ","$6,952.00 ","$6,952.00 ","$6,952.00 ","$7,920.00 ","$8,800.00 ","$7,920.00 ","$4,849.42 ","$8,800.00 ","$5,764.00 ","$4,849.42 ","$3,819.20 ", N/A ,"$5,075.82 ","$7,920.00 ","$10,509.35 ","$5,552.80 ","$5,280.00 ","$7,920.00 ","$4,849.42 ","$7,920.00 ","$7,920.00 ","$4,849.42 ","$5,720.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100172,36254,HC PLC CATH RENAL ANGIO 1< BIL,481,1 ,"$3,514.00 ","$2,284.10 ","$1,525.08 ","$6,304.37 ","$2,617.93 ","$2,301.67 ","$2,909.08 ","$1,851.88 ","$2,909.08 ","$2,217.33 ","$2,217.33 ","$2,217.33 ","$2,217.33 ","$3,162.60 ","$2,635.50 ","$2,909.08 ","$3,092.32 ","$2,909.08 ","$2,635.50 ","$2,635.50 ","$2,986.90 ","$2,986.90 ","$2,909.08 ","$2,986.90 ","$2,909.08 ","$2,776.06 ","$2,776.06 ","$2,776.06 ","$3,162.60 ","$3,514.00 ","$3,162.60 ","$2,909.08 ","$3,514.00 ","$2,301.67 ","$2,909.08 ","$1,525.08 ", N/A ,"$3,044.89 ","$3,162.60 ","$6,304.37 ","$2,217.33 ","$2,108.40 ","$3,162.60 ","$2,909.08 ","$3,162.60 ","$3,162.60 ","$2,909.08 ","$2,284.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100173,37193,HC FILTER REMOVAL,481,1 ,"$3,494.00 ","$2,271.10 ","$1,516.40 ","$6,304.37 ","$2,603.03 ","$2,288.57 ","$2,909.08 ","$1,841.34 ","$2,909.08 ","$2,204.71 ","$2,204.71 ","$2,204.71 ","$2,204.71 ","$3,144.60 ","$2,620.50 ","$2,909.08 ","$3,074.72 ","$2,909.08 ","$2,620.50 ","$2,620.50 ","$2,969.90 ","$2,969.90 ","$2,909.08 ","$2,969.90 ","$2,909.08 ","$2,760.26 ","$2,760.26 ","$2,760.26 ","$3,144.60 ","$3,494.00 ","$3,144.60 ","$2,909.08 ","$3,494.00 ","$2,288.57 ","$2,909.08 ","$1,516.40 ", N/A ,"$3,044.89 ","$3,144.60 ","$6,304.37 ","$2,204.71 ","$2,096.40 ","$3,144.60 ","$2,909.08 ","$3,144.60 ","$3,144.60 ","$2,909.08 ","$2,271.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100183,36225,HC CATH PLCMT SEL SUBCL/INOM VERTEB UNI 36225,481,1 ,"$9,645.00 ","$6,269.25 ","$2,909.08 ","$9,645.00 ","$7,185.53 ","$6,317.48 ","$2,909.08 ","$5,082.92 ","$2,909.08 ","$6,086.00 ","$6,086.00 ","$6,086.00 ","$6,086.00 ","$8,680.50 ","$7,233.75 ","$2,909.08 ","$8,487.60 ","$2,909.08 ","$7,233.75 ","$7,233.75 ","$8,198.25 ","$8,198.25 ","$2,909.08 ","$8,198.25 ","$2,909.08 ","$7,619.55 ","$7,619.55 ","$7,619.55 ","$8,680.50 ","$6,983.43 ","$8,680.50 ","$2,909.08 ","$9,645.00 ","$6,317.48 ","$2,909.08 ","$4,185.93 ", N/A ,"$3,044.89 ","$8,680.50 ","$6,304.37 ","$6,086.00 ","$5,787.00 ","$8,680.50 ","$2,909.08 ","$8,680.50 ","$8,680.50 ","$2,909.08 ","$6,269.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100184,36228,HC CATH PLCMT SEL EA INTRACRN BRANCH UNI 36228,481,1 ,"$6,829.00 ","$4,438.85 ","$2,963.79 ","$6,829.00 ","$5,087.61 ","$4,473.00 ", N/A ,"$3,598.88 ", N/A ,"$4,309.10 ","$4,309.10 ","$4,309.10 ","$4,309.10 ","$6,146.10 ","$5,121.75 ", N/A ,"$6,009.52 ", N/A ,"$5,121.75 ","$5,121.75 ","$5,804.65 ","$5,804.65 ", N/A ,"$5,804.65 ", N/A ,"$5,394.91 ","$5,394.91 ","$5,394.91 ","$6,146.10 ", N/A ,"$6,146.10 ", N/A ,"$6,829.00 ","$4,473.00 ", N/A ,"$2,963.79 ", N/A , N/A ,"$6,146.10 ", N/A ,"$4,309.10 ","$4,097.40 ","$6,146.10 ", N/A ,"$6,146.10 ","$6,146.10 ", N/A ,"$4,438.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100187,37197,HC TRANSCATH RETRVAL FOREIGN BODY 37197,481,1 ,"$2,963.00 ","$1,925.95 ","$1,285.94 ","$6,304.37 ","$2,207.44 ","$1,940.77 ","$2,909.08 ","$1,561.50 ","$2,909.08 ","$1,869.65 ","$1,869.65 ","$1,869.65 ","$1,869.65 ","$2,666.70 ","$2,222.25 ","$2,909.08 ","$2,607.44 ","$2,909.08 ","$2,222.25 ","$2,222.25 ","$2,518.55 ","$2,518.55 ","$2,909.08 ","$2,518.55 ","$2,909.08 ","$2,340.77 ","$2,340.77 ","$2,340.77 ","$2,666.70 ","$2,963.00 ","$2,666.70 ","$2,909.08 ","$2,963.00 ","$1,940.77 ","$2,909.08 ","$1,285.94 ", N/A ,"$2,963.00 ","$2,666.70 ","$6,304.37 ","$1,869.65 ","$1,777.80 ","$2,666.70 ","$2,909.08 ","$2,666.70 ","$2,666.70 ","$2,909.08 ","$1,925.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100188,36221,HC CATH PLCMT NON SEL THORAC AORTA 36221,481,1 ,"$8,115.00 ","$5,274.75 ","$2,909.08 ","$8,115.00 ","$6,045.68 ","$5,315.33 ","$2,909.08 ","$4,276.61 ","$2,909.08 ","$5,120.57 ","$5,120.57 ","$5,120.57 ","$5,120.57 ","$7,303.50 ","$6,086.25 ","$2,909.08 ","$7,141.20 ","$2,909.08 ","$6,086.25 ","$6,086.25 ","$6,897.75 ","$6,897.75 ","$2,909.08 ","$6,897.75 ","$2,909.08 ","$6,410.85 ","$6,410.85 ","$6,410.85 ","$7,303.50 ","$6,983.43 ","$7,303.50 ","$2,909.08 ","$8,115.00 ","$5,315.33 ","$2,909.08 ","$3,521.91 ", N/A ,"$3,044.89 ","$7,303.50 ","$6,304.37 ","$5,120.57 ","$4,869.00 ","$7,303.50 ","$2,909.08 ","$7,303.50 ","$7,303.50 ","$2,909.08 ","$5,274.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100189,36222,HC CATH PLCMT SEL COM CAR/INOM EXTRACRN UNI 36222,481,1 ,"$11,161.00 ","$7,254.65 ","$2,909.08 ","$11,161.00 ","$8,314.95 ","$7,310.46 ","$2,909.08 ","$5,881.85 ","$2,909.08 ","$7,042.59 ","$7,042.59 ","$7,042.59 ","$7,042.59 ","$10,044.90 ","$8,370.75 ","$2,909.08 ","$9,821.68 ","$2,909.08 ","$8,370.75 ","$8,370.75 ","$9,486.85 ","$9,486.85 ","$2,909.08 ","$9,486.85 ","$2,909.08 ","$8,817.19 ","$8,817.19 ","$8,817.19 ","$10,044.90 ","$6,983.43 ","$10,044.90 ","$2,909.08 ","$11,161.00 ","$7,310.46 ","$2,909.08 ","$4,843.87 ", N/A ,"$3,044.89 ","$10,044.90 ","$6,304.37 ","$7,042.59 ","$6,696.60 ","$10,044.90 ","$2,909.08 ","$10,044.90 ","$10,044.90 ","$2,909.08 ","$7,254.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100190,36223,HC CATH PLCMT SEL COM CAR/INOM INTRACRN UNI 36223,481,1 ,"$12,482.00 ","$8,113.30 ","$4,849.42 ","$12,482.00 ","$9,299.09 ","$8,175.71 ","$4,849.42 ","$6,578.01 ","$4,849.42 ","$7,876.14 ","$7,876.14 ","$7,876.14 ","$7,876.14 ","$11,233.80 ","$9,361.50 ","$4,849.42 ","$10,984.16 ","$4,849.42 ","$9,361.50 ","$9,361.50 ","$10,609.70 ","$10,609.70 ","$4,849.42 ","$10,609.70 ","$4,849.42 ","$9,860.78 ","$9,860.78 ","$9,860.78 ","$11,233.80 ","$11,641.33 ","$11,233.80 ","$4,849.42 ","$12,482.00 ","$8,175.71 ","$4,849.42 ","$5,417.19 ", N/A ,"$5,075.82 ","$11,233.80 ","$10,509.35 ","$7,876.14 ","$7,489.20 ","$11,233.80 ","$4,849.42 ","$11,233.80 ","$11,233.80 ","$4,849.42 ","$8,113.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100191,36224,HC CATH PLCMT SEL INTERNAL CAR UNI 36224,481,1 ,"$15,952.00 ","$10,368.80 ","$4,849.42 ","$15,952.00 ","$11,884.24 ","$10,448.56 ","$4,849.42 ","$8,406.70 ","$4,849.42 ","$10,065.71 ","$10,065.71 ","$10,065.71 ","$10,065.71 ","$14,356.80 ","$11,964.00 ","$4,849.42 ","$14,037.76 ","$4,849.42 ","$11,964.00 ","$11,964.00 ","$13,559.20 ","$13,559.20 ","$4,849.42 ","$13,559.20 ","$4,849.42 ","$12,602.08 ","$12,602.08 ","$12,602.08 ","$14,356.80 ","$11,641.33 ","$14,356.80 ","$4,849.42 ","$15,952.00 ","$10,448.56 ","$4,849.42 ","$6,923.17 ", N/A ,"$5,075.82 ","$14,356.80 ","$10,509.35 ","$10,065.71 ","$9,571.20 ","$14,356.80 ","$4,849.42 ","$14,356.80 ","$14,356.80 ","$4,849.42 ","$10,368.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100192,36226,HC CATH PLCMT SEL VERTEBRAL UNI 36226,481,1 ,"$13,139.00 ","$8,540.35 ","$4,849.42 ","$13,139.00 ","$9,788.56 ","$8,606.05 ","$4,849.42 ","$6,924.25 ","$4,849.42 ","$8,290.71 ","$8,290.71 ","$8,290.71 ","$8,290.71 ","$11,825.10 ","$9,854.25 ","$4,849.42 ","$11,562.32 ","$4,849.42 ","$9,854.25 ","$9,854.25 ","$11,168.15 ","$11,168.15 ","$4,849.42 ","$11,168.15 ","$4,849.42 ","$10,379.81 ","$10,379.81 ","$10,379.81 ","$11,825.10 ","$11,641.33 ","$11,825.10 ","$4,849.42 ","$13,139.00 ","$8,606.05 ","$4,849.42 ","$5,702.33 ", N/A ,"$5,075.82 ","$11,825.10 ","$10,509.35 ","$8,290.71 ","$7,883.40 ","$11,825.10 ","$4,849.42 ","$11,825.10 ","$11,825.10 ","$4,849.42 ","$8,540.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100193,36227,HC CATH PLCMT SEL EXTERNAL CAR UNI 36227,481,1 ,"$7,751.00 ","$5,038.15 ","$3,363.93 ","$7,751.00 ","$5,774.50 ","$5,076.91 ", N/A ,"$4,084.78 ", N/A ,"$4,890.88 ","$4,890.88 ","$4,890.88 ","$4,890.88 ","$6,975.90 ","$5,813.25 ", N/A ,"$6,820.88 ", N/A ,"$5,813.25 ","$5,813.25 ","$6,588.35 ","$6,588.35 ", N/A ,"$6,588.35 ", N/A ,"$6,123.29 ","$6,123.29 ","$6,123.29 ","$6,975.90 ", N/A ,"$6,975.90 ", N/A ,"$7,751.00 ","$5,076.91 ", N/A ,"$3,363.93 ", N/A , N/A ,"$6,975.90 ", N/A ,"$4,890.88 ","$4,650.60 ","$6,975.90 ", N/A ,"$6,975.90 ","$6,975.90 ", N/A ,"$5,038.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100263,36902,HC INTRO CATH/CIRCUIT W/ANGIO 36902,481,1 ,"$15,485.00 ","$10,065.25 ","$5,038.98 ","$15,485.00 ","$11,536.33 ","$10,142.68 ","$5,038.98 ","$8,160.60 ","$5,038.98 ","$9,771.04 ","$9,771.04 ","$9,771.04 ","$9,771.04 ","$13,936.50 ","$11,613.75 ","$5,038.98 ","$13,626.80 ","$5,038.98 ","$11,613.75 ","$11,613.75 ","$13,162.25 ","$13,162.25 ","$5,038.98 ","$13,162.25 ","$5,038.98 ","$12,233.15 ","$12,233.15 ","$12,233.15 ","$13,936.50 ","$12,096.38 ","$13,936.50 ","$5,038.98 ","$15,485.00 ","$10,142.68 ","$5,038.98 ","$6,720.49 ", N/A ,"$5,274.23 ","$13,936.50 ","$10,920.15 ","$9,771.04 ","$9,291.00 ","$13,936.50 ","$5,038.98 ","$13,936.50 ","$13,936.50 ","$5,038.98 ","$10,065.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100265,36907,HC ANGIOPLASTY CTR DIALYSIS SEGMENT 36907,481,1 ,"$2,521.00 ","$1,638.65 ","$1,094.11 ","$2,521.00 ","$1,878.15 ","$1,651.26 ", N/A ,"$1,328.57 ", N/A ,"$1,590.75 ","$1,590.75 ","$1,590.75 ","$1,590.75 ","$2,268.90 ","$1,890.75 ", N/A ,"$2,218.48 ", N/A ,"$1,890.75 ","$1,890.75 ","$2,142.85 ","$2,142.85 ", N/A ,"$2,142.85 ", N/A ,"$1,991.59 ","$1,991.59 ","$1,991.59 ","$2,268.90 ", N/A ,"$2,268.90 ", N/A ,"$2,521.00 ","$1,651.26 ", N/A ,"$1,094.11 ", N/A , N/A ,"$2,268.90 ", N/A ,"$1,590.75 ","$1,512.60 ","$2,268.90 ", N/A ,"$2,268.90 ","$2,268.90 ", N/A ,"$1,638.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100270,36908,HC PLACE STENT CENTRAL DIAL SEGMENT 36908,481,1 ,"$1,901.00 ","$1,235.65 ",$825.03 ,"$1,901.00 ","$1,416.25 ","$1,245.16 ", N/A ,"$1,001.83 ", N/A ,"$1,199.53 ","$1,199.53 ","$1,199.53 ","$1,199.53 ","$1,710.90 ","$1,425.75 ", N/A ,"$1,672.88 ", N/A ,"$1,425.75 ","$1,425.75 ","$1,615.85 ","$1,615.85 ", N/A ,"$1,615.85 ", N/A ,"$1,501.79 ","$1,501.79 ","$1,501.79 ","$1,710.90 ", N/A ,"$1,710.90 ", N/A ,"$1,901.00 ","$1,245.16 ", N/A ,$825.03 , N/A , N/A ,"$1,710.90 ", N/A ,"$1,199.53 ","$1,140.60 ","$1,710.90 ", N/A ,"$1,710.90 ","$1,710.90 ", N/A ,"$1,235.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100271,36909,HC DIAL CIRCUIT VASC EMBOL/OCCUL 36909,481,1 ,"$2,521.00 ","$1,638.65 ","$1,094.11 ","$2,521.00 ","$1,878.15 ","$1,651.26 ", N/A ,"$1,328.57 ", N/A ,"$1,590.75 ","$1,590.75 ","$1,590.75 ","$1,590.75 ","$2,268.90 ","$1,890.75 ", N/A ,"$2,218.48 ", N/A ,"$1,890.75 ","$1,890.75 ","$2,142.85 ","$2,142.85 ", N/A ,"$2,142.85 ", N/A ,"$1,991.59 ","$1,991.59 ","$1,991.59 ","$2,268.90 ", N/A ,"$2,268.90 ", N/A ,"$2,521.00 ","$1,651.26 ", N/A ,"$1,094.11 ", N/A , N/A ,"$2,268.90 ", N/A ,"$1,590.75 ","$1,512.60 ","$2,268.90 ", N/A ,"$2,268.90 ","$2,268.90 ", N/A ,"$1,638.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100272,36901,HC INTRO CATH DIALYSIS CIRCUIT 36901,481,1 ,"$2,521.00 ","$1,638.65 ","$1,094.11 ","$3,097.79 ","$1,878.15 ","$1,651.26 ","$1,429.44 ","$1,328.57 ","$1,429.44 ","$1,590.75 ","$1,590.75 ","$1,590.75 ","$1,590.75 ","$2,268.90 ","$1,890.75 ","$1,429.44 ","$2,218.48 ","$1,429.44 ","$1,890.75 ","$1,890.75 ","$2,142.85 ","$2,142.85 ","$1,429.44 ","$2,142.85 ","$1,429.44 ","$1,991.59 ","$1,991.59 ","$1,991.59 ","$2,268.90 ","$2,521.00 ","$2,268.90 ","$1,429.44 ","$2,521.00 ","$1,651.26 ","$1,429.44 ","$1,094.11 ", N/A ,"$1,496.18 ","$2,268.90 ","$3,097.79 ","$1,590.75 ","$1,512.60 ","$2,268.90 ","$1,429.44 ","$2,268.90 ","$2,268.90 ","$1,429.44 ","$1,638.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100323,36245,HC PLACE CATH ABD/PEL 1ST ORDER-BI,360,1 ,"$4,937.00 ","$3,209.05 ","$2,142.66 ","$4,937.00 ","$3,678.07 ","$3,233.74 ", N/A ,"$2,601.80 ", N/A ,"$3,115.25 ","$3,115.25 ","$3,115.25 ","$3,115.25 ","$4,443.30 ","$3,702.75 ", N/A ,"$4,344.56 ", N/A ,"$3,702.75 ","$3,702.75 ","$4,196.45 ","$4,196.45 ", N/A ,"$4,196.45 ", N/A ,"$3,900.23 ","$3,900.23 ","$3,900.23 ","$4,443.30 ", N/A ,"$4,443.30 ", N/A ,"$4,937.00 ","$3,233.74 ", N/A ,"$2,142.66 ", N/A , N/A ,"$4,443.30 ", N/A ,"$3,115.25 ","$2,962.20 ","$4,443.30 ", N/A ,"$4,443.30 ","$4,443.30 ", N/A ,"$3,209.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100324,36245,HC PLACE CATH ABD/PEL 1ST ORDER-LT,360,1 ,"$3,291.00 ","$2,139.15 ","$1,428.29 ","$3,291.00 ","$2,451.80 ","$2,155.61 ", N/A ,"$1,734.36 ", N/A ,"$2,076.62 ","$2,076.62 ","$2,076.62 ","$2,076.62 ","$2,961.90 ","$2,468.25 ", N/A ,"$2,896.08 ", N/A ,"$2,468.25 ","$2,468.25 ","$2,797.35 ","$2,797.35 ", N/A ,"$2,797.35 ", N/A ,"$2,599.89 ","$2,599.89 ","$2,599.89 ","$2,961.90 ", N/A ,"$2,961.90 ", N/A ,"$3,291.00 ","$2,155.61 ", N/A ,"$1,428.29 ", N/A , N/A ,"$2,961.90 ", N/A ,"$2,076.62 ","$1,974.60 ","$2,961.90 ", N/A ,"$2,961.90 ","$2,961.90 ", N/A ,"$2,139.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100325,36245,HC PLACE CATH ABD/PEL 1ST ORDER-RT,360,1 ,"$3,291.00 ","$2,139.15 ","$1,428.29 ","$3,291.00 ","$2,451.80 ","$2,155.61 ", N/A ,"$1,734.36 ", N/A ,"$2,076.62 ","$2,076.62 ","$2,076.62 ","$2,076.62 ","$2,961.90 ","$2,468.25 ", N/A ,"$2,896.08 ", N/A ,"$2,468.25 ","$2,468.25 ","$2,797.35 ","$2,797.35 ", N/A ,"$2,797.35 ", N/A ,"$2,599.89 ","$2,599.89 ","$2,599.89 ","$2,961.90 ", N/A ,"$2,961.90 ", N/A ,"$3,291.00 ","$2,155.61 ", N/A ,"$1,428.29 ", N/A , N/A ,"$2,961.90 ", N/A ,"$2,076.62 ","$1,974.60 ","$2,961.90 ", N/A ,"$2,961.90 ","$2,961.90 ", N/A ,"$2,139.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100421,33211,HC INS/REPL TEMP ELECTRODE DUAL CHAMBER-33211,481,1 ,"$2,048.00 ","$1,331.20 ",$888.83 ,"$17,960.52 ","$1,525.76 ","$1,341.44 ","$2,048.00 ","$1,079.30 ","$2,048.00 ","$1,292.29 ","$1,292.29 ","$1,292.29 ","$1,292.29 ","$1,843.20 ","$1,536.00 ","$2,048.00 ","$1,802.24 ","$2,048.00 ","$1,536.00 ","$1,536.00 ","$1,740.80 ","$1,740.80 ","$2,048.00 ","$1,740.80 ","$2,048.00 ","$1,617.92 ","$1,617.92 ","$1,617.92 ","$1,843.20 ","$2,048.00 ","$1,843.20 ","$2,048.00 ","$2,048.00 ","$1,341.44 ","$2,048.00 ",$888.83 , N/A ,"$2,048.00 ","$1,843.20 ","$17,960.52 ","$1,292.29 ","$1,228.80 ","$1,843.20 ","$2,048.00 ","$1,843.20 ","$1,843.20 ","$2,048.00 ","$1,331.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100456,75600,HC AORTOGRAM THORACIC W/O SERIALOGRAPHY,481,1 ,"$4,641.00 ","$3,016.65 ","$2,014.19 ","$6,304.37 ","$3,457.55 ","$3,039.86 ","$2,909.08 ","$2,445.81 ","$2,909.08 ","$2,928.47 ","$2,928.47 ","$2,928.47 ","$2,928.47 ","$4,176.90 ","$3,480.75 ","$2,909.08 ","$4,084.08 ","$2,909.08 ","$3,480.75 ","$3,480.75 ","$3,944.85 ","$3,944.85 ","$2,909.08 ","$3,944.85 ","$2,909.08 ","$3,666.39 ","$3,666.39 ","$3,666.39 ","$4,176.90 ","$4,641.00 ","$4,176.90 ","$2,909.08 ","$4,641.00 ","$3,039.86 ","$2,909.08 ","$2,014.19 ", N/A ,"$3,044.89 ","$4,176.90 ","$6,304.37 ","$2,928.47 ","$2,784.60 ","$4,176.90 ","$2,909.08 ","$4,176.90 ","$4,176.90 ","$2,909.08 ","$3,016.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48100469,93454,HC CORONARY ARTERY ANGIOGRAPHY,481,1 ,"$10,204.00 ","$6,632.60 ","$2,947.06 ","$10,204.00 ","$7,601.98 ","$6,683.62 ","$2,947.06 ","$5,377.51 ","$2,947.06 ","$6,438.72 ","$6,438.72 ","$6,438.72 ","$6,438.72 ","$9,183.60 ","$7,653.00 ","$2,947.06 ","$8,979.52 ","$2,947.06 ","$7,653.00 ","$7,653.00 ","$8,673.40 ","$8,673.40 ","$2,947.06 ","$8,673.40 ","$2,947.06 ","$8,061.16 ","$8,061.16 ","$8,061.16 ","$9,183.60 ","$7,074.60 ","$9,183.60 ","$2,947.06 ","$10,204.00 ","$6,683.62 ","$2,947.06 ","$4,428.54 ", N/A ,"$3,084.65 ","$9,183.60 ","$6,386.68 ","$6,438.72 ","$6,122.40 ","$9,183.60 ","$2,947.06 ","$9,183.60 ","$9,183.60 ","$2,947.06 ","$6,632.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48200000,93017,HC STRESS TEST TRACING ONLY,482,1 ,"$1,521.00 ",$988.65 ,$268.83 ,"$1,521.00 ","$1,133.15 ",$996.26 ,$268.83 ,$801.57 ,$268.83 ,$959.75 ,$959.75 ,$959.75 ,$959.75 ,"$1,368.90 ","$1,140.75 ",$268.83 ,"$1,338.48 ",$268.83 ,"$1,140.75 ","$1,140.75 ","$1,292.85 ","$1,292.85 ",$268.83 ,"$1,292.85 ",$268.83 ,"$1,201.59 ","$1,201.59 ","$1,201.59 ","$1,368.90 ",$645.35 ,"$1,368.90 ",$268.83 ,"$1,521.00 ",$996.26 ,$268.83 ,$660.11 , N/A ,$281.38 ,"$1,368.90 ",$582.60 ,$959.75 ,$912.60 ,"$1,368.90 ",$268.83 ,"$1,368.90 ","$1,368.90 ",$268.83 ,$988.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48300000,93306,HC ECHO/CARDIAC DOP/COLOR FLOW,483,1 ,"$2,099.00 ","$1,364.35 ",$490.89 ,"$2,099.00 ","$1,563.76 ","$1,374.85 ",$490.89 ,"$1,106.17 ",$490.89 ,"$1,324.47 ","$1,324.47 ","$1,324.47 ","$1,324.47 ","$1,889.10 ","$1,574.25 ",$490.89 ,"$1,847.12 ",$490.89 ,"$1,574.25 ","$1,574.25 ","$1,784.15 ","$1,784.15 ",$490.89 ,"$1,784.15 ",$490.89 ,"$1,658.21 ","$1,658.21 ","$1,658.21 ","$1,889.10 ","$1,178.42 ","$1,889.10 ",$490.89 ,"$2,099.00 ","$1,374.85 ",$490.89 ,$910.97 , N/A ,$513.81 ,"$1,889.10 ","$1,063.83 ","$1,324.47 ","$1,259.40 ","$1,889.10 ",$490.89 ,"$1,889.10 ","$1,889.10 ",$490.89 ,"$1,364.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48300002,93308,HC ECHO 2D W/W/O M-MODE LTD,483,1 ,$882.00 ,$573.30 ,$233.94 ,$882.00 ,$657.09 ,$577.71 ,$233.94 ,$464.81 ,$233.94 ,$556.54 ,$556.54 ,$556.54 ,$556.54 ,$793.80 ,$661.50 ,$233.94 ,$776.16 ,$233.94 ,$661.50 ,$661.50 ,$749.70 ,$749.70 ,$233.94 ,$749.70 ,$233.94 ,$696.78 ,$696.78 ,$696.78 ,$793.80 ,$561.60 ,$793.80 ,$233.94 ,$882.00 ,$577.71 ,$233.94 ,$382.79 , N/A ,$244.87 ,$793.80 ,$506.99 ,$556.54 ,$529.20 ,$793.80 ,$233.94 ,$793.80 ,$793.80 ,$233.94 ,$573.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48300003,93312,HC ECHO TEE CMPL W/PF,483,1 ,"$3,051.00 ","$1,983.15 ",$490.89 ,"$3,051.00 ","$2,273.00 ","$1,998.41 ",$490.89 ,"$1,607.88 ",$490.89 ,"$1,925.18 ","$1,925.18 ","$1,925.18 ","$1,925.18 ","$2,745.90 ","$2,288.25 ",$490.89 ,"$2,684.88 ",$490.89 ,"$2,288.25 ","$2,288.25 ","$2,593.35 ","$2,593.35 ",$490.89 ,"$2,593.35 ",$490.89 ,"$2,410.29 ","$2,410.29 ","$2,410.29 ","$2,745.90 ","$1,178.42 ","$2,745.90 ",$490.89 ,"$3,051.00 ","$1,998.41 ",$490.89 ,"$1,324.13 ", N/A ,$513.81 ,"$2,745.90 ","$1,063.83 ","$1,925.18 ","$1,830.60 ","$2,745.90 ",$490.89 ,"$2,745.90 ","$2,745.90 ",$490.89 ,"$1,983.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48300005,93320,HC ECHO DOPPLER,483,1 ,$408.00 ,$265.20 ,$177.07 ,$408.00 ,$303.96 ,$267.24 , N/A ,$215.02 , N/A ,$257.45 ,$257.45 ,$257.45 ,$257.45 ,$367.20 ,$306.00 , N/A ,$359.04 , N/A ,$306.00 ,$306.00 ,$346.80 ,$346.80 , N/A ,$346.80 , N/A ,$322.32 ,$322.32 ,$322.32 ,$367.20 , N/A ,$367.20 , N/A ,$408.00 ,$267.24 , N/A ,$177.07 , N/A , N/A ,$367.20 , N/A ,$257.45 ,$244.80 ,$367.20 , N/A ,$367.20 ,$367.20 , N/A ,$265.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48300006,93325,HC ECHO COLOR FLOW MAPPING,483,1 ,$648.00 ,$421.20 ,$281.23 ,$648.00 ,$482.76 ,$424.44 , N/A ,$341.50 , N/A ,$408.89 ,$408.89 ,$408.89 ,$408.89 ,$583.20 ,$486.00 , N/A ,$570.24 , N/A ,$486.00 ,$486.00 ,$550.80 ,$550.80 , N/A ,$550.80 , N/A ,$511.92 ,$511.92 ,$511.92 ,$583.20 , N/A ,$583.20 , N/A ,$648.00 ,$424.44 , N/A ,$281.23 , N/A , N/A ,$583.20 , N/A ,$408.89 ,$388.80 ,$583.20 , N/A ,$583.20 ,$583.20 , N/A ,$421.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48300007,93350,HC ECHO REST AND STRESS W/PF,483,1 ,"$3,724.00 ","$2,420.60 ",$490.89 ,"$3,724.00 ","$2,774.38 ","$2,439.22 ",$490.89 ,"$1,962.55 ",$490.89 ,"$2,349.84 ","$2,349.84 ","$2,349.84 ","$2,349.84 ","$3,351.60 ","$2,793.00 ",$490.89 ,"$3,277.12 ",$490.89 ,"$2,793.00 ","$2,793.00 ","$3,165.40 ","$3,165.40 ",$490.89 ,"$3,165.40 ",$490.89 ,"$2,941.96 ","$2,941.96 ","$2,941.96 ","$3,351.60 ","$1,178.42 ","$3,351.60 ",$490.89 ,"$3,724.00 ","$2,439.22 ",$490.89 ,"$1,616.22 ", N/A ,$513.81 ,"$3,351.60 ","$1,063.83 ","$2,349.84 ","$2,234.40 ","$3,351.60 ",$490.89 ,"$3,351.60 ","$3,351.60 ",$490.89 ,"$2,420.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48300008,93303,HC ECHO PEDS CONGENITAL,483,1 ,"$2,414.00 ","$1,569.10 ",$490.89 ,"$2,414.00 ","$1,798.43 ","$1,581.17 ",$490.89 ,"$1,272.18 ",$490.89 ,"$1,523.23 ","$1,523.23 ","$1,523.23 ","$1,523.23 ","$2,172.60 ","$1,810.50 ",$490.89 ,"$2,124.32 ",$490.89 ,"$1,810.50 ","$1,810.50 ","$2,051.90 ","$2,051.90 ",$490.89 ,"$2,051.90 ",$490.89 ,"$1,907.06 ","$1,907.06 ","$1,907.06 ","$2,172.60 ","$1,178.42 ","$2,172.60 ",$490.89 ,"$2,414.00 ","$1,581.17 ",$490.89 ,"$1,047.68 ", N/A ,$513.81 ,"$2,172.60 ","$1,063.83 ","$1,523.23 ","$1,448.40 ","$2,172.60 ",$490.89 ,"$2,172.60 ","$2,172.60 ",$490.89 ,"$1,569.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48300009,93304,HC ECHO PEDS CONGENITAL LMTD,483,1 ,$969.00 ,$629.85 ,$420.55 ,"$1,063.83 ",$721.91 ,$634.70 ,$490.89 ,$510.66 ,$490.89 ,$611.44 ,$611.44 ,$611.44 ,$611.44 ,$872.10 ,$726.75 ,$490.89 ,$852.72 ,$490.89 ,$726.75 ,$726.75 ,$823.65 ,$823.65 ,$490.89 ,$823.65 ,$490.89 ,$765.51 ,$765.51 ,$765.51 ,$872.10 ,$969.00 ,$872.10 ,$490.89 ,$969.00 ,$634.70 ,$490.89 ,$420.55 , N/A ,$513.81 ,$872.10 ,"$1,063.83 ",$611.44 ,$581.40 ,$872.10 ,$490.89 ,$872.10 ,$872.10 ,$490.89 ,$629.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48300010,93321,HC ECHO DOPPLER LMTD,483,1 ,$418.00 ,$271.70 ,$181.41 ,$418.00 ,$311.41 ,$273.79 , N/A ,$220.29 , N/A ,$263.76 ,$263.76 ,$263.76 ,$263.76 ,$376.20 ,$313.50 , N/A ,$367.84 , N/A ,$313.50 ,$313.50 ,$355.30 ,$355.30 , N/A ,$355.30 , N/A ,$330.22 ,$330.22 ,$330.22 ,$376.20 , N/A ,$376.20 , N/A ,$418.00 ,$273.79 , N/A ,$181.41 , N/A , N/A ,$376.20 , N/A ,$263.76 ,$250.80 ,$376.20 , N/A ,$376.20 ,$376.20 , N/A ,$271.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48300018,C8928,HC ECHO TTE 2D STRESS W/W/O CONT AND W/CONT W/PF,483,1 ,"$2,386.00 ","$1,550.90 ",$727.03 ,"$2,386.00 ","$1,777.57 ","$1,562.83 ",$727.03 ,"$1,257.42 ",$727.03 ,"$1,505.57 ","$1,505.57 ","$1,505.57 ","$1,505.57 ","$2,147.40 ","$1,789.50 ",$727.03 ,"$2,099.68 ",$727.03 ,"$1,789.50 ","$1,789.50 ","$2,028.10 ","$2,028.10 ",$727.03 ,"$2,028.10 ",$727.03 ,"$1,884.94 ","$1,884.94 ","$1,884.94 ","$2,147.40 ","$1,745.28 ","$2,147.40 ",$727.03 ,"$2,386.00 ","$1,562.83 ",$727.03 ,"$1,035.52 ", N/A ,$760.97 ,"$2,147.40 ","$1,575.58 ","$1,505.57 ","$1,431.60 ","$2,147.40 ",$727.03 ,"$2,147.40 ","$2,147.40 ",$727.03 ,"$1,550.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),48300019,C8929,HC ECHO TTE 2D W/DOPPLER W/W/O CONT AND W/CONT,483,1 ,"$2,260.00 ","$1,469.00 ",$727.03 ,"$2,260.00 ","$1,683.70 ","$1,480.30 ",$727.03 ,"$1,191.02 ",$727.03 ,"$1,426.06 ","$1,426.06 ","$1,426.06 ","$1,426.06 ","$2,034.00 ","$1,695.00 ",$727.03 ,"$1,988.80 ",$727.03 ,"$1,695.00 ","$1,695.00 ","$1,921.00 ","$1,921.00 ",$727.03 ,"$1,921.00 ",$727.03 ,"$1,785.40 ","$1,785.40 ","$1,785.40 ","$2,034.00 ","$1,745.28 ","$2,034.00 ",$727.03 ,"$2,260.00 ","$1,480.30 ",$727.03 ,$980.84 , N/A ,$760.97 ,"$2,034.00 ","$1,575.58 ","$1,426.06 ","$1,356.00 ","$2,034.00 ",$727.03 ,"$2,034.00 ","$2,034.00 ",$727.03 ,"$1,469.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000005,11042,HC DEBR SKIN/SUBQ TISS INIT 20CM FAC,510,1 ,"$1,011.00 ",$657.15 ,$351.57 ,"$1,011.00 ",$753.20 ,$662.21 ,$351.57 ,$532.80 ,$351.57 ,$637.94 ,$637.94 ,$637.94 ,$637.94 ,$909.90 ,$758.25 ,$351.57 ,$889.68 ,$351.57 ,$758.25 ,$758.25 ,$859.35 ,$859.35 ,$351.57 ,$859.35 ,$351.57 ,$798.69 ,$798.69 ,$798.69 ,$909.90 ,$843.97 ,$909.90 ,$351.57 ,"$1,011.00 ",$662.21 ,$351.57 ,$438.77 , N/A ,$367.98 ,$909.90 ,$761.90 ,$637.94 ,$606.60 ,$909.90 ,$351.57 ,$909.90 ,$909.90 ,$351.57 ,$657.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000006,11043,HC DEBR SKIN/SUBQ TISSUE/MUSCLE FAC,510,1 ,"$1,193.00 ",$775.45 ,$517.76 ,"$1,193.00 ",$888.79 ,$781.42 ,$532.86 ,$628.71 ,$532.86 ,$752.78 ,$752.78 ,$752.78 ,$752.78 ,"$1,073.70 ",$894.75 ,$532.86 ,"$1,049.84 ",$532.86 ,$894.75 ,$894.75 ,"$1,014.05 ","$1,014.05 ",$532.86 ,"$1,014.05 ",$532.86 ,$942.47 ,$942.47 ,$942.47 ,"$1,073.70 ","$1,193.00 ","$1,073.70 ",$532.86 ,"$1,193.00 ",$781.42 ,$532.86 ,$517.76 , N/A ,$557.73 ,"$1,073.70 ","$1,154.77 ",$752.78 ,$715.80 ,"$1,073.70 ",$532.86 ,"$1,073.70 ","$1,073.70 ",$532.86 ,$775.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000007,11044,HC DEBR SKIN/SUB TIS/MUS/BONE INT 20 FAC,510,1 ,"$3,144.00 ","$2,043.60 ","$1,364.50 ","$3,144.00 ","$2,342.28 ","$2,059.32 ","$1,430.32 ","$1,656.89 ","$1,430.32 ","$1,983.86 ","$1,983.86 ","$1,983.86 ","$1,983.86 ","$2,829.60 ","$2,358.00 ","$1,430.32 ","$2,766.72 ","$1,430.32 ","$2,358.00 ","$2,358.00 ","$2,672.40 ","$2,672.40 ","$1,430.32 ","$2,672.40 ","$1,430.32 ","$2,483.76 ","$2,483.76 ","$2,483.76 ","$2,829.60 ","$3,144.00 ","$2,829.60 ","$1,430.32 ","$3,144.00 ","$2,059.32 ","$1,430.32 ","$1,364.50 ", N/A ,"$1,497.09 ","$2,829.60 ","$3,099.69 ","$1,983.86 ","$1,886.40 ","$2,829.60 ","$1,430.32 ","$2,829.60 ","$2,829.60 ","$1,430.32 ","$2,043.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000009,11045,HC DEBR SKIN/SUBQ TIS EA ADL 20CM FAC,510,1 ,"$1,011.00 ",$657.15 ,$438.77 ,"$1,011.00 ",$753.20 ,$662.21 , N/A ,$532.80 , N/A ,$637.94 ,$637.94 ,$637.94 ,$637.94 ,$909.90 ,$758.25 , N/A ,$889.68 , N/A ,$758.25 ,$758.25 ,$859.35 ,$859.35 , N/A ,$859.35 , N/A ,$798.69 ,$798.69 ,$798.69 ,$909.90 , N/A ,$909.90 , N/A ,"$1,011.00 ",$662.21 , N/A ,$438.77 , N/A , N/A ,$909.90 , N/A ,$637.94 ,$606.60 ,$909.90 , N/A ,$909.90 ,$909.90 , N/A ,$657.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000010,11046,HC DEBR SKIN/SUBQ MUS/FAS ADL 20C FAC,510,1 ,$997.00 ,$648.05 ,$432.70 ,$997.00 ,$742.77 ,$653.04 , N/A ,$525.42 , N/A ,$629.11 ,$629.11 ,$629.11 ,$629.11 ,$897.30 ,$747.75 , N/A ,$877.36 , N/A ,$747.75 ,$747.75 ,$847.45 ,$847.45 , N/A ,$847.45 , N/A ,$787.63 ,$787.63 ,$787.63 ,$897.30 , N/A ,$897.30 , N/A ,$997.00 ,$653.04 , N/A ,$432.70 , N/A , N/A ,$897.30 , N/A ,$629.11 ,$598.20 ,$897.30 , N/A ,$897.30 ,$897.30 , N/A ,$648.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000011,11047,HC DEBR SKIN/SUB TIS/MUS/BN ADL 20C FAC,510,1 ,"$3,285.00 ","$2,135.25 ","$1,425.69 ","$3,285.00 ","$2,447.33 ","$2,151.68 ", N/A ,"$1,731.20 ", N/A ,"$2,072.84 ","$2,072.84 ","$2,072.84 ","$2,072.84 ","$2,956.50 ","$2,463.75 ", N/A ,"$2,890.80 ", N/A ,"$2,463.75 ","$2,463.75 ","$2,792.25 ","$2,792.25 ", N/A ,"$2,792.25 ", N/A ,"$2,595.15 ","$2,595.15 ","$2,595.15 ","$2,956.50 ", N/A ,"$2,956.50 ", N/A ,"$3,285.00 ","$2,151.68 ", N/A ,"$1,425.69 ", N/A , N/A ,"$2,956.50 ", N/A ,"$2,072.84 ","$1,971.00 ","$2,956.50 ", N/A ,"$2,956.50 ","$2,956.50 ", N/A ,"$2,135.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000012,11055,HC PARING LESN BENIGN 1 FAC,510,1 ,$334.00 ,$217.10 ,$144.96 ,$395.56 ,$248.83 ,$218.77 ,$182.53 ,$176.02 ,$182.53 ,$210.75 ,$210.75 ,$210.75 ,$210.75 ,$300.60 ,$250.50 ,$182.53 ,$293.92 ,$182.53 ,$250.50 ,$250.50 ,$283.90 ,$283.90 ,$182.53 ,$283.90 ,$182.53 ,$263.86 ,$263.86 ,$263.86 ,$300.60 ,$334.00 ,$300.60 ,$182.53 ,$334.00 ,$218.77 ,$182.53 ,$144.96 , N/A ,$191.05 ,$300.60 ,$395.56 ,$210.75 ,$200.40 ,$300.60 ,$182.53 ,$300.60 ,$300.60 ,$182.53 ,$217.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000014,11056,HC PARING LESN BENIGN 2-4 FAC,510,1 ,$334.00 ,$217.10 ,$144.96 ,$395.56 ,$248.83 ,$218.77 ,$182.53 ,$176.02 ,$182.53 ,$210.75 ,$210.75 ,$210.75 ,$210.75 ,$300.60 ,$250.50 ,$182.53 ,$293.92 ,$182.53 ,$250.50 ,$250.50 ,$283.90 ,$283.90 ,$182.53 ,$283.90 ,$182.53 ,$263.86 ,$263.86 ,$263.86 ,$300.60 ,$334.00 ,$300.60 ,$182.53 ,$334.00 ,$218.77 ,$182.53 ,$144.96 , N/A ,$191.05 ,$300.60 ,$395.56 ,$210.75 ,$200.40 ,$300.60 ,$182.53 ,$300.60 ,$300.60 ,$182.53 ,$217.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000021,11719,HC TRIM NAILS NONDYSTROPHIC FAC,510,1 ,$168.00 ,$109.20 ,$56.58 ,$168.00 ,$125.16 ,$110.04 ,$56.58 ,$88.54 ,$56.58 ,$106.01 ,$106.01 ,$106.01 ,$106.01 ,$151.20 ,$126.00 ,$56.58 ,$147.84 ,$56.58 ,$126.00 ,$126.00 ,$142.80 ,$142.80 ,$56.58 ,$142.80 ,$56.58 ,$132.72 ,$132.72 ,$132.72 ,$151.20 ,$135.83 ,$151.20 ,$56.58 ,$168.00 ,$110.04 ,$56.58 ,$72.91 , N/A ,$59.22 ,$151.20 ,$122.62 ,$106.01 ,$100.80 ,$151.20 ,$56.58 ,$151.20 ,$151.20 ,$56.58 ,$109.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000023,11720,HC DEBR NAIL(S) UP TO 5,510,1 ,$334.00 ,$217.10 ,$56.58 ,$334.00 ,$248.83 ,$218.77 ,$56.58 ,$176.02 ,$56.58 ,$210.75 ,$210.75 ,$210.75 ,$210.75 ,$300.60 ,$250.50 ,$56.58 ,$293.92 ,$56.58 ,$250.50 ,$250.50 ,$283.90 ,$283.90 ,$56.58 ,$283.90 ,$56.58 ,$263.86 ,$263.86 ,$263.86 ,$300.60 ,$135.83 ,$300.60 ,$56.58 ,$334.00 ,$218.77 ,$56.58 ,$144.96 , N/A ,$59.22 ,$300.60 ,$122.62 ,$210.75 ,$200.40 ,$300.60 ,$56.58 ,$300.60 ,$300.60 ,$56.58 ,$217.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000024,11721,HC DEBR NAIL(S) 6 OR MORE,510,1 ,$334.00 ,$217.10 ,$56.58 ,$334.00 ,$248.83 ,$218.77 ,$56.58 ,$176.02 ,$56.58 ,$210.75 ,$210.75 ,$210.75 ,$210.75 ,$300.60 ,$250.50 ,$56.58 ,$293.92 ,$56.58 ,$250.50 ,$250.50 ,$283.90 ,$283.90 ,$56.58 ,$283.90 ,$56.58 ,$263.86 ,$263.86 ,$263.86 ,$300.60 ,$135.83 ,$300.60 ,$56.58 ,$334.00 ,$218.77 ,$56.58 ,$144.96 , N/A ,$59.22 ,$300.60 ,$122.62 ,$210.75 ,$200.40 ,$300.60 ,$56.58 ,$300.60 ,$300.60 ,$56.58 ,$217.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000025,11750,HC REMOVE NAIL BED FACIL,510,1 ,"$1,594.00 ","$1,036.10 ",$351.57 ,"$1,594.00 ","$1,187.53 ","$1,044.07 ",$351.57 ,$840.04 ,$351.57 ,"$1,005.81 ","$1,005.81 ","$1,005.81 ","$1,005.81 ","$1,434.60 ","$1,195.50 ",$351.57 ,"$1,402.72 ",$351.57 ,"$1,195.50 ","$1,195.50 ","$1,354.90 ","$1,354.90 ",$351.57 ,"$1,354.90 ",$351.57 ,"$1,259.26 ","$1,259.26 ","$1,259.26 ","$1,434.60 ",$843.97 ,"$1,434.60 ",$351.57 ,"$1,594.00 ","$1,044.07 ",$351.57 ,$691.80 , N/A ,$367.98 ,"$1,434.60 ",$761.90 ,"$1,005.81 ",$956.40 ,"$1,434.60 ",$351.57 ,"$1,434.60 ","$1,434.60 ",$351.57 ,"$1,036.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000045,36593,HC DECLOTTING/ACCESS DEVICE/CATH,510,1 ,$883.00 ,$573.95 ,$315.90 ,$883.00 ,$657.84 ,$578.37 ,$315.90 ,$465.34 ,$315.90 ,$557.17 ,$557.17 ,$557.17 ,$557.17 ,$794.70 ,$662.25 ,$315.90 ,$777.04 ,$315.90 ,$662.25 ,$662.25 ,$750.55 ,$750.55 ,$315.90 ,$750.55 ,$315.90 ,$697.57 ,$697.57 ,$697.57 ,$794.70 ,$758.34 ,$794.70 ,$315.90 ,$883.00 ,$578.37 ,$315.90 ,$383.22 , N/A ,$330.65 ,$794.70 ,$684.60 ,$557.17 ,$529.80 ,$794.70 ,$315.90 ,$794.70 ,$794.70 ,$315.90 ,$573.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000063,96372,HC INJECTION IM/SUBQ,260,1 ,$233.00 ,$151.45 ,$63.00 ,$233.00 ,$173.59 ,$152.62 ,$63.00 ,$122.79 ,$63.00 ,$147.02 ,$147.02 ,$147.02 ,$147.02 ,$209.70 ,$174.75 ,$63.00 ,$205.04 ,$63.00 ,$174.75 ,$174.75 ,$198.05 ,$198.05 ,$63.00 ,$198.05 ,$63.00 ,$184.07 ,$184.07 ,$184.07 ,$209.70 ,$151.23 ,$209.70 ,$63.00 ,$233.00 ,$152.62 ,$63.00 ,$101.12 , N/A ,$65.94 ,$209.70 ,$136.52 ,$147.02 ,$139.80 ,$209.70 ,$63.00 ,$209.70 ,$209.70 ,$63.00 ,$151.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000065,96374,HC INJ IV PUSH SINGL/INITIAL,260,1 ,$175.00 ,$113.75 ,$75.95 ,$448.32 ,$130.38 ,$114.63 ,$175.00 ,$92.23 ,$175.00 ,$110.43 ,$110.43 ,$110.43 ,$110.43 ,$157.50 ,$131.25 ,$175.00 ,$154.00 ,$175.00 ,$131.25 ,$131.25 ,$148.75 ,$148.75 ,$175.00 ,$148.75 ,$175.00 ,$138.25 ,$138.25 ,$138.25 ,$157.50 ,$175.00 ,$157.50 ,$175.00 ,$175.00 ,$114.63 ,$175.00 ,$75.95 , N/A ,$175.00 ,$157.50 ,$448.32 ,$110.43 ,$105.00 ,$157.50 ,$175.00 ,$157.50 ,$157.50 ,$175.00 ,$113.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000066,96375,HC INJ IV PUSH ADDL NEW DRUG,260,1 ,$150.00 ,$97.50 ,$40.66 ,$150.00 ,$111.75 ,$98.25 ,$40.66 ,$79.05 ,$40.66 ,$94.65 ,$94.65 ,$94.65 ,$94.65 ,$135.00 ,$112.50 ,$40.66 ,$132.00 ,$40.66 ,$112.50 ,$112.50 ,$127.50 ,$127.50 ,$40.66 ,$127.50 ,$40.66 ,$118.50 ,$118.50 ,$118.50 ,$135.00 ,$97.61 ,$135.00 ,$40.66 ,$150.00 ,$98.25 ,$40.66 ,$65.10 , N/A ,$42.56 ,$135.00 ,$88.12 ,$94.65 ,$90.00 ,$135.00 ,$40.66 ,$135.00 ,$135.00 ,$40.66 ,$97.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000067,96376,HC INJ IV PUSH SAME DRUG >30MIN,260,1 ,$175.00 ,$113.75 ,$75.95 ,$175.00 ,$130.38 ,$114.63 , N/A ,$92.23 , N/A ,$110.43 ,$110.43 ,$110.43 ,$110.43 ,$157.50 ,$131.25 , N/A ,$154.00 , N/A ,$131.25 ,$131.25 ,$148.75 ,$148.75 , N/A ,$148.75 , N/A ,$138.25 ,$138.25 ,$138.25 ,$157.50 , N/A ,$157.50 , N/A ,$175.00 ,$114.63 , N/A ,$75.95 , N/A , N/A ,$157.50 , N/A ,$110.43 ,$105.00 ,$157.50 , N/A ,$157.50 ,$157.50 , N/A ,$113.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000068,96523,HC IRRIGAT IMPLANT VEN ACCESS DEV,510,1 ,$214.00 ,$139.10 ,$56.58 ,$214.00 ,$159.43 ,$140.17 ,$56.58 ,$112.78 ,$56.58 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$56.58 ,$188.32 ,$56.58 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$56.58 ,$181.90 ,$56.58 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$135.83 ,$192.60 ,$56.58 ,$214.00 ,$140.17 ,$56.58 ,$92.88 , N/A ,$59.22 ,$192.60 ,$122.62 ,$135.03 ,$128.40 ,$192.60 ,$56.58 ,$192.60 ,$192.60 ,$56.58 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000072,97597,HC DEBR SKIN PART THICKNESS <20CM FAC,510,1 ,$554.00 ,$360.10 ,$182.53 ,$554.00 ,$412.73 ,$362.87 ,$182.53 ,$291.96 ,$182.53 ,$349.57 ,$349.57 ,$349.57 ,$349.57 ,$498.60 ,$415.50 ,$182.53 ,$487.52 ,$182.53 ,$415.50 ,$415.50 ,$470.90 ,$470.90 ,$182.53 ,$470.90 ,$182.53 ,$437.66 ,$437.66 ,$437.66 ,$498.60 ,$438.16 ,$498.60 ,$182.53 ,$554.00 ,$362.87 ,$182.53 ,$240.44 , N/A ,$191.05 ,$498.60 ,$395.56 ,$349.57 ,$332.40 ,$498.60 ,$182.53 ,$498.60 ,$498.60 ,$182.53 ,$360.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000099,99201,HC CLINIC VISIT BRIEF NEW,510,1 ,$261.00 ,$169.65 ,$113.27 ,$261.00 ,$194.45 ,$170.96 , N/A ,$137.55 , N/A ,$164.69 ,$164.69 ,$164.69 ,$164.69 ,$234.90 ,$195.75 , N/A ,$229.68 , N/A ,$195.75 ,$195.75 ,$221.85 ,$221.85 , N/A ,$221.85 , N/A ,$206.19 ,$206.19 ,$206.19 ,$234.90 , N/A ,$234.90 , N/A ,$261.00 ,$170.96 , N/A ,$113.27 , N/A , N/A ,$234.90 , N/A ,$164.69 ,$156.60 ,$234.90 , N/A ,$234.90 ,$234.90 , N/A ,$169.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000101,99202,HC CLINIC VISIT LIMITED NEW,510,1 ,$330.00 ,$214.50 ,$78.75 ,$330.00 ,$245.85 ,$216.15 , N/A ,$173.91 , N/A ,$208.23 ,$208.23 ,$208.23 ,$208.23 ,$297.00 ,$247.50 , N/A ,$290.40 , N/A ,$247.50 ,$247.50 ,$280.50 ,$280.50 , N/A ,$280.50 , N/A ,$260.70 ,$260.70 ,$260.70 ,$297.00 , N/A ,$297.00 , N/A ,$78.75 ,$216.15 , N/A ,$143.22 , N/A , N/A ,$297.00 , N/A ,$208.23 ,$198.00 ,$297.00 , N/A ,$297.00 ,$297.00 , N/A ,$214.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000104,99203,HC CLINIC VISIT INTERM NEW,510,1 ,$429.00 ,$278.85 ,$121.24 ,$429.00 ,$319.61 ,$281.00 , N/A ,$226.08 , N/A ,$270.70 ,$270.70 ,$270.70 ,$270.70 ,$386.10 ,$321.75 , N/A ,$377.52 , N/A ,$321.75 ,$321.75 ,$364.65 ,$364.65 , N/A ,$364.65 , N/A ,$338.91 ,$338.91 ,$338.91 ,$386.10 , N/A ,$386.10 , N/A ,$121.24 ,$281.00 , N/A ,$186.19 , N/A , N/A ,$386.10 , N/A ,$270.70 ,$257.40 ,$386.10 , N/A ,$386.10 ,$386.10 , N/A ,$278.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000109,99204,HC CLINIC VISIT COMPLEX NEW,510,1 ,$543.00 ,$352.95 ,$181.05 ,$543.00 ,$404.54 ,$355.67 , N/A ,$286.16 , N/A ,$342.63 ,$342.63 ,$342.63 ,$342.63 ,$488.70 ,$407.25 , N/A ,$477.84 , N/A ,$407.25 ,$407.25 ,$461.55 ,$461.55 , N/A ,$461.55 , N/A ,$428.97 ,$428.97 ,$428.97 ,$488.70 , N/A ,$488.70 , N/A ,$181.05 ,$355.67 , N/A ,$235.66 , N/A , N/A ,$488.70 , N/A ,$342.63 ,$325.80 ,$488.70 , N/A ,$488.70 ,$488.70 , N/A ,$352.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000113,99205,HC CLINIC VISIT COMPREH NEW,510,1 ,$773.00 ,$502.45 ,$239.15 ,$773.00 ,$575.89 ,$506.32 , N/A ,$407.37 , N/A ,$487.76 ,$487.76 ,$487.76 ,$487.76 ,$695.70 ,$579.75 , N/A ,$680.24 , N/A ,$579.75 ,$579.75 ,$657.05 ,$657.05 , N/A ,$657.05 , N/A ,$610.67 ,$610.67 ,$610.67 ,$695.70 , N/A ,$695.70 , N/A ,$239.15 ,$506.32 , N/A ,$335.48 , N/A , N/A ,$695.70 , N/A ,$487.76 ,$463.80 ,$695.70 , N/A ,$695.70 ,$695.70 , N/A ,$502.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000114,99211,HC CLINIC VISIT BRIEF EST,510,1 ,$158.00 ,$102.70 ,$68.57 ,$158.00 ,$117.71 ,$103.49 , N/A ,$83.27 , N/A ,$99.70 ,$99.70 ,$99.70 ,$99.70 ,$142.20 ,$118.50 , N/A ,$139.04 , N/A ,$118.50 ,$118.50 ,$134.30 ,$134.30 , N/A ,$134.30 , N/A ,$124.82 ,$124.82 ,$124.82 ,$142.20 , N/A ,$142.20 , N/A ,$158.00 ,$103.49 , N/A ,$68.57 , N/A , N/A ,$142.20 , N/A ,$99.70 ,$94.80 ,$142.20 , N/A ,$142.20 ,$142.20 , N/A ,$102.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000120,99212,HC CLINIC VISIT LIMIT EST,510,1 ,$277.00 ,$180.05 ,$60.02 ,$277.00 ,$206.37 ,$181.44 , N/A ,$145.98 , N/A ,$174.79 ,$174.79 ,$174.79 ,$174.79 ,$249.30 ,$207.75 , N/A ,$243.76 , N/A ,$207.75 ,$207.75 ,$235.45 ,$235.45 , N/A ,$235.45 , N/A ,$218.83 ,$218.83 ,$218.83 ,$249.30 , N/A ,$249.30 , N/A ,$60.02 ,$181.44 , N/A ,$120.22 , N/A , N/A ,$249.30 , N/A ,$174.79 ,$166.20 ,$249.30 , N/A ,$249.30 ,$249.30 , N/A ,$180.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000131,99213,HC CLINIC VISIT INTERM EST,510,1 ,$341.00 ,$221.65 ,$97.92 ,$341.00 ,$254.05 ,$223.36 , N/A ,$179.71 , N/A ,$215.17 ,$215.17 ,$215.17 ,$215.17 ,$306.90 ,$255.75 , N/A ,$300.08 , N/A ,$255.75 ,$255.75 ,$289.85 ,$289.85 , N/A ,$289.85 , N/A ,$269.39 ,$269.39 ,$269.39 ,$306.90 , N/A ,$306.90 , N/A ,$97.92 ,$223.36 , N/A ,$147.99 , N/A , N/A ,$306.90 , N/A ,$215.17 ,$204.60 ,$306.90 , N/A ,$306.90 ,$306.90 , N/A ,$221.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000136,99214,HC CLINIC VISIT COMPLX EST,510,1 ,$429.00 ,$278.85 ,$186.19 ,$429.00 ,$319.61 ,$281.00 , N/A ,$226.08 , N/A ,$270.70 ,$270.70 ,$270.70 ,$270.70 ,$386.10 ,$321.75 , N/A ,$377.52 , N/A ,$321.75 ,$321.75 ,$364.65 ,$364.65 , N/A ,$364.65 , N/A ,$338.91 ,$338.91 ,$338.91 ,$386.10 , N/A ,$386.10 , N/A ,$429.00 ,$281.00 , N/A ,$186.19 , N/A , N/A ,$386.10 , N/A ,$270.70 ,$257.40 ,$386.10 , N/A ,$386.10 ,$386.10 , N/A ,$278.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000139,99215,HC CLINIC VISIT COMPRH EST,510,1 ,$543.00 ,$352.95 ,$235.66 ,$543.00 ,$404.54 ,$355.67 , N/A ,$286.16 , N/A ,$342.63 ,$342.63 ,$342.63 ,$342.63 ,$488.70 ,$407.25 , N/A ,$477.84 , N/A ,$407.25 ,$407.25 ,$461.55 ,$461.55 , N/A ,$461.55 , N/A ,$428.97 ,$428.97 ,$428.97 ,$488.70 , N/A ,$488.70 , N/A ,$543.00 ,$355.67 , N/A ,$235.66 , N/A , N/A ,$488.70 , N/A ,$342.63 ,$325.80 ,$488.70 , N/A ,$488.70 ,$488.70 , N/A ,$352.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000171,51701,HC CATH BLADDER NON-INDWELLING,510,1 ,$466.00 ,$302.90 ,$113.81 ,$466.00 ,$347.17 ,$305.23 ,$113.81 ,$245.58 ,$113.81 ,$294.05 ,$294.05 ,$294.05 ,$294.05 ,$419.40 ,$349.50 ,$113.81 ,$410.08 ,$113.81 ,$349.50 ,$349.50 ,$396.10 ,$396.10 ,$113.81 ,$396.10 ,$113.81 ,$368.14 ,$368.14 ,$368.14 ,$419.40 ,$273.20 ,$419.40 ,$113.81 ,$466.00 ,$305.23 ,$113.81 ,$202.24 , N/A ,$119.12 ,$419.40 ,$246.63 ,$294.05 ,$279.60 ,$419.40 ,$113.81 ,$419.40 ,$419.40 ,$113.81 ,$302.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000172,51702,HC CATH BLADDER SMP,510,1 ,$466.00 ,$302.90 ,$113.81 ,$466.00 ,$347.17 ,$305.23 ,$113.81 ,$245.58 ,$113.81 ,$294.05 ,$294.05 ,$294.05 ,$294.05 ,$419.40 ,$349.50 ,$113.81 ,$410.08 ,$113.81 ,$349.50 ,$349.50 ,$396.10 ,$396.10 ,$113.81 ,$396.10 ,$113.81 ,$368.14 ,$368.14 ,$368.14 ,$419.40 ,$273.20 ,$419.40 ,$113.81 ,$466.00 ,$305.23 ,$113.81 ,$202.24 , N/A ,$119.12 ,$419.40 ,$246.63 ,$294.05 ,$279.60 ,$419.40 ,$113.81 ,$419.40 ,$419.40 ,$113.81 ,$302.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000173,51703,HC CATH BLADDER CPLX,510,1 ,$396.63 ,$257.81 ,$141.86 ,$396.63 ,$295.49 ,$259.79 ,$141.86 ,$209.02 ,$141.86 ,$250.27 ,$250.27 ,$250.27 ,$250.27 ,$356.97 ,$297.47 ,$141.86 ,$349.03 ,$141.86 ,$297.47 ,$297.47 ,$337.14 ,$337.14 ,$141.86 ,$337.14 ,$141.86 ,$313.34 ,$313.34 ,$313.34 ,$356.97 ,$340.55 ,$356.97 ,$141.86 ,$396.63 ,$259.79 ,$141.86 ,$172.14 , N/A ,$148.49 ,$356.97 ,$307.44 ,$250.27 ,$237.98 ,$356.97 ,$141.86 ,$356.97 ,$356.97 ,$141.86 ,$257.81 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000325,15271,HC APL SKIN SUB TAL<100 INT 25CM,761,1 ,$994.00 ,$646.10 ,$431.40 ,"$3,779.02 ",$740.53 ,$651.07 ,$994.00 ,$523.84 ,$994.00 ,$627.21 ,$627.21 ,$627.21 ,$627.21 ,$894.60 ,$745.50 ,$994.00 ,$874.72 ,$994.00 ,$745.50 ,$745.50 ,$844.90 ,$844.90 ,$994.00 ,$844.90 ,$994.00 ,$785.26 ,$785.26 ,$785.26 ,$894.60 ,$994.00 ,$894.60 ,$994.00 ,$994.00 ,$651.07 ,$994.00 ,$431.40 , N/A ,$994.00 ,$894.60 ,"$3,779.02 ",$627.21 ,$596.40 ,$894.60 ,$994.00 ,$894.60 ,$894.60 ,$994.00 ,$646.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000326,15272,HC APL SKIN SUB TAL<100 ADL 25CM,761,1 ,$366.00 ,$237.90 ,$158.84 ,$366.00 ,$272.67 ,$239.73 , N/A ,$192.88 , N/A ,$230.95 ,$230.95 ,$230.95 ,$230.95 ,$329.40 ,$274.50 , N/A ,$322.08 , N/A ,$274.50 ,$274.50 ,$311.10 ,$311.10 , N/A ,$311.10 , N/A ,$289.14 ,$289.14 ,$289.14 ,$329.40 , N/A ,$329.40 , N/A ,$366.00 ,$239.73 , N/A ,$158.84 , N/A , N/A ,$329.40 , N/A ,$230.95 ,$219.60 ,$329.40 , N/A ,$329.40 ,$329.40 , N/A ,$237.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000327,15273,HC APL SKIN SUB TAL>100 INT 100CM,761,1 ,"$1,514.00 ",$984.10 ,$657.08 ,"$7,759.46 ","$1,127.93 ",$991.67 ,"$1,514.00 ",$797.88 ,"$1,514.00 ",$955.33 ,$955.33 ,$955.33 ,$955.33 ,"$1,362.60 ","$1,135.50 ","$1,514.00 ","$1,332.32 ","$1,514.00 ","$1,135.50 ","$1,135.50 ","$1,286.90 ","$1,286.90 ","$1,514.00 ","$1,286.90 ","$1,514.00 ","$1,196.06 ","$1,196.06 ","$1,196.06 ","$1,362.60 ","$1,514.00 ","$1,362.60 ","$1,514.00 ","$1,514.00 ",$991.67 ,"$1,514.00 ",$657.08 , N/A ,"$1,514.00 ","$1,362.60 ","$7,759.46 ",$955.33 ,$908.40 ,"$1,362.60 ","$1,514.00 ","$1,362.60 ","$1,362.60 ","$1,514.00 ",$984.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000328,15274,HC APL SKIN SUB TAL>100 ADL 100CM,761,1 ,$994.00 ,$646.10 ,$431.40 ,$994.00 ,$740.53 ,$651.07 , N/A ,$523.84 , N/A ,$627.21 ,$627.21 ,$627.21 ,$627.21 ,$894.60 ,$745.50 , N/A ,$874.72 , N/A ,$745.50 ,$745.50 ,$844.90 ,$844.90 , N/A ,$844.90 , N/A ,$785.26 ,$785.26 ,$785.26 ,$894.60 , N/A ,$894.60 , N/A ,$994.00 ,$651.07 , N/A ,$431.40 , N/A , N/A ,$894.60 , N/A ,$627.21 ,$596.40 ,$894.60 , N/A ,$894.60 ,$894.60 , N/A ,$646.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000329,15275,HC APL SKIN SUB OTH<100 INT 25CM,761,1 ,$994.00 ,$646.10 ,$431.40 ,"$3,779.02 ",$740.53 ,$651.07 ,$994.00 ,$523.84 ,$994.00 ,$627.21 ,$627.21 ,$627.21 ,$627.21 ,$894.60 ,$745.50 ,$994.00 ,$874.72 ,$994.00 ,$745.50 ,$745.50 ,$844.90 ,$844.90 ,$994.00 ,$844.90 ,$994.00 ,$785.26 ,$785.26 ,$785.26 ,$894.60 ,$994.00 ,$894.60 ,$994.00 ,$994.00 ,$651.07 ,$994.00 ,$431.40 , N/A ,$994.00 ,$894.60 ,"$3,779.02 ",$627.21 ,$596.40 ,$894.60 ,$994.00 ,$894.60 ,$894.60 ,$994.00 ,$646.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000330,15276,HC APL SKIN SUB OTH<100 ADL 25CM,761,1 ,$366.00 ,$237.90 ,$158.84 ,$366.00 ,$272.67 ,$239.73 , N/A ,$192.88 , N/A ,$230.95 ,$230.95 ,$230.95 ,$230.95 ,$329.40 ,$274.50 , N/A ,$322.08 , N/A ,$274.50 ,$274.50 ,$311.10 ,$311.10 , N/A ,$311.10 , N/A ,$289.14 ,$289.14 ,$289.14 ,$329.40 , N/A ,$329.40 , N/A ,$366.00 ,$239.73 , N/A ,$158.84 , N/A , N/A ,$329.40 , N/A ,$230.95 ,$219.60 ,$329.40 , N/A ,$329.40 ,$329.40 , N/A ,$237.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000331,15277,HC APL SKIN SUB OTH>100 INT 100CM,761,1 ,"$1,514.00 ",$984.10 ,$657.08 ,"$3,779.02 ","$1,127.93 ",$991.67 ,"$1,514.00 ",$797.88 ,"$1,514.00 ",$955.33 ,$955.33 ,$955.33 ,$955.33 ,"$1,362.60 ","$1,135.50 ","$1,514.00 ","$1,332.32 ","$1,514.00 ","$1,135.50 ","$1,135.50 ","$1,286.90 ","$1,286.90 ","$1,514.00 ","$1,286.90 ","$1,514.00 ","$1,196.06 ","$1,196.06 ","$1,196.06 ","$1,362.60 ","$1,514.00 ","$1,362.60 ","$1,514.00 ","$1,514.00 ",$991.67 ,"$1,514.00 ",$657.08 , N/A ,"$1,514.00 ","$1,362.60 ","$3,779.02 ",$955.33 ,$908.40 ,"$1,362.60 ","$1,514.00 ","$1,362.60 ","$1,362.60 ","$1,514.00 ",$984.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000332,15278,HC APL SKIN SUB OTH>100 ADL 100CM,761,1 ,$994.00 ,$646.10 ,$431.40 ,$994.00 ,$740.53 ,$651.07 , N/A ,$523.84 , N/A ,$627.21 ,$627.21 ,$627.21 ,$627.21 ,$894.60 ,$745.50 , N/A ,$874.72 , N/A ,$745.50 ,$745.50 ,$844.90 ,$844.90 , N/A ,$844.90 , N/A ,$785.26 ,$785.26 ,$785.26 ,$894.60 , N/A ,$894.60 , N/A ,$994.00 ,$651.07 , N/A ,$431.40 , N/A , N/A ,$894.60 , N/A ,$627.21 ,$596.40 ,$894.60 , N/A ,$894.60 ,$894.60 , N/A ,$646.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000352,11057,HC PARING LESN BENIGN >4 FAC,510,1 ,$334.00 ,$217.10 ,$144.96 ,$395.56 ,$248.83 ,$218.77 ,$182.53 ,$176.02 ,$182.53 ,$210.75 ,$210.75 ,$210.75 ,$210.75 ,$300.60 ,$250.50 ,$182.53 ,$293.92 ,$182.53 ,$250.50 ,$250.50 ,$283.90 ,$283.90 ,$182.53 ,$283.90 ,$182.53 ,$263.86 ,$263.86 ,$263.86 ,$300.60 ,$334.00 ,$300.60 ,$182.53 ,$334.00 ,$218.77 ,$182.53 ,$144.96 , N/A ,$191.05 ,$300.60 ,$395.56 ,$210.75 ,$200.40 ,$300.60 ,$182.53 ,$300.60 ,$300.60 ,$182.53 ,$217.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000400,29580,HC APPLY UNNA BOOT BILAT FAC,510,1 ,$605.00 ,$393.25 ,$143.52 ,$605.00 ,$450.73 ,$396.28 ,$143.52 ,$318.84 ,$143.52 ,$381.76 ,$381.76 ,$381.76 ,$381.76 ,$544.50 ,$453.75 ,$143.52 ,$532.40 ,$143.52 ,$453.75 ,$453.75 ,$514.25 ,$514.25 ,$143.52 ,$514.25 ,$143.52 ,$477.95 ,$477.95 ,$477.95 ,$544.50 ,$344.53 ,$544.50 ,$143.52 ,$605.00 ,$396.28 ,$143.52 ,$262.57 , N/A ,$150.22 ,$544.50 ,$311.03 ,$381.76 ,$363.00 ,$544.50 ,$143.52 ,$544.50 ,$544.50 ,$143.52 ,$393.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000401,29581,HC APPLY MULTI COMP LWR LEG BIL FAC,510,1 ,$565.00 ,$367.25 ,$143.52 ,$565.00 ,$420.93 ,$370.08 ,$143.52 ,$297.76 ,$143.52 ,$356.52 ,$356.52 ,$356.52 ,$356.52 ,$508.50 ,$423.75 ,$143.52 ,$497.20 ,$143.52 ,$423.75 ,$423.75 ,$480.25 ,$480.25 ,$143.52 ,$480.25 ,$143.52 ,$446.35 ,$446.35 ,$446.35 ,$508.50 ,$344.53 ,$508.50 ,$143.52 ,$565.00 ,$370.08 ,$143.52 ,$245.21 , N/A ,$150.22 ,$508.50 ,$311.03 ,$356.52 ,$339.00 ,$508.50 ,$143.52 ,$508.50 ,$508.50 ,$143.52 ,$367.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000407,11200,HC REMOVAL SKIN TAG LESIONS <=15 FAC,510,1 ,$500.91 ,$325.59 ,$182.53 ,$500.91 ,$373.18 ,$328.10 ,$182.53 ,$263.98 ,$182.53 ,$316.07 ,$316.07 ,$316.07 ,$316.07 ,$450.82 ,$375.68 ,$182.53 ,$440.80 ,$182.53 ,$375.68 ,$375.68 ,$425.77 ,$425.77 ,$182.53 ,$425.77 ,$182.53 ,$395.72 ,$395.72 ,$395.72 ,$450.82 ,$438.16 ,$450.82 ,$182.53 ,$500.91 ,$328.10 ,$182.53 ,$217.39 , N/A ,$191.05 ,$450.82 ,$395.56 ,$316.07 ,$300.55 ,$450.82 ,$182.53 ,$450.82 ,$450.82 ,$182.53 ,$325.59 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000463,99201,HC CLINIC VISIT BRIEF NEW -25,510,1 ,$261.00 ,$169.65 ,$113.27 ,$261.00 ,$194.45 ,$170.96 , N/A ,$137.55 , N/A ,$164.69 ,$164.69 ,$164.69 ,$164.69 ,$234.90 ,$195.75 , N/A ,$229.68 , N/A ,$195.75 ,$195.75 ,$221.85 ,$221.85 , N/A ,$221.85 , N/A ,$206.19 ,$206.19 ,$206.19 ,$234.90 , N/A ,$234.90 , N/A ,$261.00 ,$170.96 , N/A ,$113.27 , N/A , N/A ,$234.90 , N/A ,$164.69 ,$156.60 ,$234.90 , N/A ,$234.90 ,$234.90 , N/A ,$169.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000464,99202,HC CLINIC VISIT LIMITED NEW -25,510,1 ,$330.00 ,$214.50 ,$78.75 ,$330.00 ,$245.85 ,$216.15 , N/A ,$173.91 , N/A ,$208.23 ,$208.23 ,$208.23 ,$208.23 ,$297.00 ,$247.50 , N/A ,$290.40 , N/A ,$247.50 ,$247.50 ,$280.50 ,$280.50 , N/A ,$280.50 , N/A ,$260.70 ,$260.70 ,$260.70 ,$297.00 , N/A ,$297.00 , N/A ,$78.75 ,$216.15 , N/A ,$143.22 , N/A , N/A ,$297.00 , N/A ,$208.23 ,$198.00 ,$297.00 , N/A ,$297.00 ,$297.00 , N/A ,$214.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000465,99203,HC CLINIC VISIT INTERM NEW -25,510,1 ,$429.00 ,$278.85 ,$121.24 ,$429.00 ,$319.61 ,$281.00 , N/A ,$226.08 , N/A ,$270.70 ,$270.70 ,$270.70 ,$270.70 ,$386.10 ,$321.75 , N/A ,$377.52 , N/A ,$321.75 ,$321.75 ,$364.65 ,$364.65 , N/A ,$364.65 , N/A ,$338.91 ,$338.91 ,$338.91 ,$386.10 , N/A ,$386.10 , N/A ,$121.24 ,$281.00 , N/A ,$186.19 , N/A , N/A ,$386.10 , N/A ,$270.70 ,$257.40 ,$386.10 , N/A ,$386.10 ,$386.10 , N/A ,$278.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000466,99204,HC CLINIC VISIT COMPLEX NEW -25,510,1 ,$543.00 ,$352.95 ,$181.05 ,$543.00 ,$404.54 ,$355.67 , N/A ,$286.16 , N/A ,$342.63 ,$342.63 ,$342.63 ,$342.63 ,$488.70 ,$407.25 , N/A ,$477.84 , N/A ,$407.25 ,$407.25 ,$461.55 ,$461.55 , N/A ,$461.55 , N/A ,$428.97 ,$428.97 ,$428.97 ,$488.70 , N/A ,$488.70 , N/A ,$181.05 ,$355.67 , N/A ,$235.66 , N/A , N/A ,$488.70 , N/A ,$342.63 ,$325.80 ,$488.70 , N/A ,$488.70 ,$488.70 , N/A ,$352.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000467,99205,HC CLINIC VISIT COMPREH NEW -25,510,1 ,$773.00 ,$502.45 ,$239.15 ,$773.00 ,$575.89 ,$506.32 , N/A ,$407.37 , N/A ,$487.76 ,$487.76 ,$487.76 ,$487.76 ,$695.70 ,$579.75 , N/A ,$680.24 , N/A ,$579.75 ,$579.75 ,$657.05 ,$657.05 , N/A ,$657.05 , N/A ,$610.67 ,$610.67 ,$610.67 ,$695.70 , N/A ,$695.70 , N/A ,$239.15 ,$506.32 , N/A ,$335.48 , N/A , N/A ,$695.70 , N/A ,$487.76 ,$463.80 ,$695.70 , N/A ,$695.70 ,$695.70 , N/A ,$502.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000468,99211,HC CLINIC VISIT BRIEF ESTAB -25,510,1 ,$158.00 ,$102.70 ,$68.57 ,$158.00 ,$117.71 ,$103.49 , N/A ,$83.27 , N/A ,$99.70 ,$99.70 ,$99.70 ,$99.70 ,$142.20 ,$118.50 , N/A ,$139.04 , N/A ,$118.50 ,$118.50 ,$134.30 ,$134.30 , N/A ,$134.30 , N/A ,$124.82 ,$124.82 ,$124.82 ,$142.20 , N/A ,$142.20 , N/A ,$158.00 ,$103.49 , N/A ,$68.57 , N/A , N/A ,$142.20 , N/A ,$99.70 ,$94.80 ,$142.20 , N/A ,$142.20 ,$142.20 , N/A ,$102.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000469,99212,HC CLINIC VISIT LIMITED ESTAB -25,510,1 ,$277.00 ,$180.05 ,$60.02 ,$277.00 ,$206.37 ,$181.44 , N/A ,$145.98 , N/A ,$174.79 ,$174.79 ,$174.79 ,$174.79 ,$249.30 ,$207.75 , N/A ,$243.76 , N/A ,$207.75 ,$207.75 ,$235.45 ,$235.45 , N/A ,$235.45 , N/A ,$218.83 ,$218.83 ,$218.83 ,$249.30 , N/A ,$249.30 , N/A ,$60.02 ,$181.44 , N/A ,$120.22 , N/A , N/A ,$249.30 , N/A ,$174.79 ,$166.20 ,$249.30 , N/A ,$249.30 ,$249.30 , N/A ,$180.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000470,99213,HC CLINIC VISIT INTERM EST -25,510,1 ,$341.00 ,$221.65 ,$97.92 ,$341.00 ,$254.05 ,$223.36 , N/A ,$179.71 , N/A ,$215.17 ,$215.17 ,$215.17 ,$215.17 ,$306.90 ,$255.75 , N/A ,$300.08 , N/A ,$255.75 ,$255.75 ,$289.85 ,$289.85 , N/A ,$289.85 , N/A ,$269.39 ,$269.39 ,$269.39 ,$306.90 , N/A ,$306.90 , N/A ,$97.92 ,$223.36 , N/A ,$147.99 , N/A , N/A ,$306.90 , N/A ,$215.17 ,$204.60 ,$306.90 , N/A ,$306.90 ,$306.90 , N/A ,$221.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000471,99214,HC CLINIC VISIT COMPLEX EST -25,510,1 ,$429.00 ,$278.85 ,$186.19 ,$429.00 ,$319.61 ,$281.00 , N/A ,$226.08 , N/A ,$270.70 ,$270.70 ,$270.70 ,$270.70 ,$386.10 ,$321.75 , N/A ,$377.52 , N/A ,$321.75 ,$321.75 ,$364.65 ,$364.65 , N/A ,$364.65 , N/A ,$338.91 ,$338.91 ,$338.91 ,$386.10 , N/A ,$386.10 , N/A ,$429.00 ,$281.00 , N/A ,$186.19 , N/A , N/A ,$386.10 , N/A ,$270.70 ,$257.40 ,$386.10 , N/A ,$386.10 ,$386.10 , N/A ,$278.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51000472,99215,HC CLINIC VISIT COMPREH EST -25,510,1 ,$543.00 ,$352.95 ,$235.66 ,$543.00 ,$404.54 ,$355.67 , N/A ,$286.16 , N/A ,$342.63 ,$342.63 ,$342.63 ,$342.63 ,$488.70 ,$407.25 , N/A ,$477.84 , N/A ,$407.25 ,$407.25 ,$461.55 ,$461.55 , N/A ,$461.55 , N/A ,$428.97 ,$428.97 ,$428.97 ,$488.70 , N/A ,$488.70 , N/A ,$543.00 ,$355.67 , N/A ,$235.66 , N/A , N/A ,$488.70 , N/A ,$342.63 ,$325.80 ,$488.70 , N/A ,$488.70 ,$488.70 , N/A ,$352.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51070001,98960,HC EDUCATION SELF MGNT NON PHY HLTCARE PROF,510,1 ,$115.00 ,$74.75 ,$49.91 ,$115.00 ,$85.68 ,$75.33 , N/A ,$60.61 , N/A ,$72.57 ,$72.57 ,$72.57 ,$72.57 ,$103.50 ,$86.25 , N/A ,$101.20 , N/A ,$86.25 ,$86.25 ,$97.75 ,$97.75 , N/A ,$97.75 , N/A ,$90.85 ,$90.85 ,$90.85 ,$103.50 , N/A ,$103.50 , N/A ,$115.00 ,$75.33 , N/A ,$49.91 , N/A , N/A ,$103.50 , N/A ,$72.57 ,$69.00 ,$103.50 , N/A ,$103.50 ,$103.50 , N/A ,$74.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),51100000,62370,HC ELEC ANLYS REPRGRMING/REFILL SPINAL INF PUMP PHYSICIAN,511,1 ,$776.64 ,$504.82 ,$276.99 ,$776.64 ,$578.60 ,$508.70 ,$276.99 ,$409.29 ,$276.99 ,$490.06 ,$490.06 ,$490.06 ,$490.06 ,$698.98 ,$582.48 ,$276.99 ,$683.44 ,$276.99 ,$582.48 ,$582.48 ,$660.14 ,$660.14 ,$276.99 ,$660.14 ,$276.99 ,$613.55 ,$613.55 ,$613.55 ,$698.98 ,$664.92 ,$698.98 ,$276.99 ,$776.64 ,$508.70 ,$276.99 ,$337.06 , N/A ,$289.92 ,$698.98 ,$600.26 ,$490.06 ,$465.98 ,$698.98 ,$276.99 ,$698.98 ,$698.98 ,$276.99 ,$504.82 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),54200001,N/A,HC MEDICAL TRANSPORT/AMBULANCE PER HR,542,1 ,$180.00 ,$117.00 ,$78.12 ,$180.00 ,$134.10 ,$117.90 , N/A ,$94.86 , N/A ,$113.58 ,$113.58 ,$113.58 ,$113.58 ,$162.00 ,$135.00 , N/A ,$158.40 , N/A ,$135.00 ,$135.00 ,$153.00 ,$153.00 , N/A ,$153.00 , N/A ,$142.20 ,$142.20 ,$142.20 ,$162.00 , N/A ,$162.00 , N/A ,$180.00 ,$117.90 , N/A ,$78.12 , N/A , N/A ,$162.00 , N/A ,$113.58 ,$108.00 ,$162.00 , N/A ,$162.00 ,$162.00 , N/A ,$117.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000000,70543,HC MRI ORBIT/FACE/NECK W AND W/O CON,610,1 ,"$4,074.00 ","$2,648.10 ",$374.22 ,"$4,074.00 ","$3,035.13 ","$2,668.47 ",$374.22 ,"$2,147.00 ",$374.22 ,"$2,570.69 ","$2,570.69 ","$2,570.69 ","$2,570.69 ","$3,666.60 ","$3,055.50 ",$374.22 ,"$3,585.12 ",$374.22 ,"$3,055.50 ","$3,055.50 ","$3,462.90 ","$3,462.90 ",$374.22 ,"$3,462.90 ",$374.22 ,"$3,218.46 ","$3,218.46 ","$3,218.46 ","$3,666.60 ",$898.34 ,"$3,666.60 ",$374.22 ,"$4,074.00 ","$2,668.47 ",$374.22 ,"$1,768.12 ", N/A ,$391.69 ,"$3,666.60 ",$810.99 ,"$2,570.69 ","$1,304.00 ","$3,666.60 ",$374.22 ,"$3,666.60 ","$3,666.60 ",$374.22 ,"$2,648.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000001,70544,HC MRA HEAD W/O CONTRAST,610,1 ,"$2,894.00 ","$1,881.10 ",$233.94 ,"$2,894.00 ","$2,156.03 ","$1,895.57 ",$233.94 ,"$1,525.14 ",$233.94 ,"$1,826.11 ","$1,826.11 ","$1,826.11 ","$1,826.11 ","$2,604.60 ","$2,170.50 ",$233.94 ,"$2,546.72 ",$233.94 ,"$2,170.50 ","$2,170.50 ","$2,459.90 ","$2,459.90 ",$233.94 ,"$2,459.90 ",$233.94 ,"$2,286.26 ","$2,286.26 ","$2,286.26 ","$2,604.60 ",$561.60 ,"$2,604.60 ",$233.94 ,"$2,894.00 ","$1,895.57 ",$233.94 ,"$1,256.00 ", N/A ,$244.87 ,"$2,604.60 ",$506.99 ,"$1,826.11 ","$1,304.00 ","$2,604.60 ",$233.94 ,"$2,604.60 ","$2,604.60 ",$233.94 ,"$1,881.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000002,70545,HC MRA HEAD W/CONTRAST,610,1 ,"$3,473.00 ","$2,257.45 ",$374.22 ,"$3,473.00 ","$2,587.39 ","$2,274.82 ",$374.22 ,"$1,830.27 ",$374.22 ,"$2,191.46 ","$2,191.46 ","$2,191.46 ","$2,191.46 ","$3,125.70 ","$2,604.75 ",$374.22 ,"$3,056.24 ",$374.22 ,"$2,604.75 ","$2,604.75 ","$2,952.05 ","$2,952.05 ",$374.22 ,"$2,952.05 ",$374.22 ,"$2,743.67 ","$2,743.67 ","$2,743.67 ","$3,125.70 ",$898.34 ,"$3,125.70 ",$374.22 ,"$3,473.00 ","$2,274.82 ",$374.22 ,"$1,507.28 ", N/A ,$391.69 ,"$3,125.70 ",$810.99 ,"$2,191.46 ","$1,304.00 ","$3,125.70 ",$374.22 ,"$3,125.70 ","$3,125.70 ",$374.22 ,"$2,257.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000003,70546,HC MRA HEAD W AND W/O CONTRAST,610,1 ,"$4,051.00 ","$2,633.15 ",$374.22 ,"$4,051.00 ","$3,018.00 ","$2,653.41 ",$374.22 ,"$2,134.88 ",$374.22 ,"$2,556.18 ","$2,556.18 ","$2,556.18 ","$2,556.18 ","$3,645.90 ","$3,038.25 ",$374.22 ,"$3,564.88 ",$374.22 ,"$3,038.25 ","$3,038.25 ","$3,443.35 ","$3,443.35 ",$374.22 ,"$3,443.35 ",$374.22 ,"$3,200.29 ","$3,200.29 ","$3,200.29 ","$3,645.90 ",$898.34 ,"$3,645.90 ",$374.22 ,"$4,051.00 ","$2,653.41 ",$374.22 ,"$1,758.13 ", N/A ,$391.69 ,"$3,645.90 ",$810.99 ,"$2,556.18 ","$1,304.00 ","$3,645.90 ",$374.22 ,"$3,645.90 ","$3,645.90 ",$374.22 ,"$2,633.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000005,70547,HC MRA NECK W/O CONTRAST,610,1 ,"$2,517.00 ","$1,636.05 ",$233.94 ,"$2,517.00 ","$1,875.17 ","$1,648.64 ",$233.94 ,"$1,326.46 ",$233.94 ,"$1,588.23 ","$1,588.23 ","$1,588.23 ","$1,588.23 ","$2,265.30 ","$1,887.75 ",$233.94 ,"$2,214.96 ",$233.94 ,"$1,887.75 ","$1,887.75 ","$2,139.45 ","$2,139.45 ",$233.94 ,"$2,139.45 ",$233.94 ,"$1,988.43 ","$1,988.43 ","$1,988.43 ","$2,265.30 ",$561.60 ,"$2,265.30 ",$233.94 ,"$2,517.00 ","$1,648.64 ",$233.94 ,"$1,092.38 ", N/A ,$244.87 ,"$2,265.30 ",$506.99 ,"$1,588.23 ","$1,304.00 ","$2,265.30 ",$233.94 ,"$2,265.30 ","$2,265.30 ",$233.94 ,"$1,636.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000006,70548,HC MRA NECK W/CONTRAST,610,1 ,"$3,021.00 ","$1,963.65 ",$374.22 ,"$3,021.00 ","$2,250.65 ","$1,978.76 ",$374.22 ,"$1,592.07 ",$374.22 ,"$1,906.25 ","$1,906.25 ","$1,906.25 ","$1,906.25 ","$2,718.90 ","$2,265.75 ",$374.22 ,"$2,658.48 ",$374.22 ,"$2,265.75 ","$2,265.75 ","$2,567.85 ","$2,567.85 ",$374.22 ,"$2,567.85 ",$374.22 ,"$2,386.59 ","$2,386.59 ","$2,386.59 ","$2,718.90 ",$898.34 ,"$2,718.90 ",$374.22 ,"$3,021.00 ","$1,978.76 ",$374.22 ,"$1,311.11 ", N/A ,$391.69 ,"$2,718.90 ",$810.99 ,"$1,906.25 ","$1,304.00 ","$2,718.90 ",$374.22 ,"$2,718.90 ","$2,718.90 ",$374.22 ,"$1,963.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000007,70549,HC MRA NECK W AND W/O CONTRAST,610,1 ,"$4,081.00 ","$2,652.65 ",$374.22 ,"$4,081.00 ","$3,040.35 ","$2,673.06 ",$374.22 ,"$2,150.69 ",$374.22 ,"$2,575.11 ","$2,575.11 ","$2,575.11 ","$2,575.11 ","$3,672.90 ","$3,060.75 ",$374.22 ,"$3,591.28 ",$374.22 ,"$3,060.75 ","$3,060.75 ","$3,468.85 ","$3,468.85 ",$374.22 ,"$3,468.85 ",$374.22 ,"$3,223.99 ","$3,223.99 ","$3,223.99 ","$3,672.90 ",$898.34 ,"$3,672.90 ",$374.22 ,"$4,081.00 ","$2,673.06 ",$374.22 ,"$1,771.15 ", N/A ,$391.69 ,"$3,672.90 ",$810.99 ,"$2,575.11 ","$1,304.00 ","$3,672.90 ",$374.22 ,"$3,672.90 ","$3,672.90 ",$374.22 ,"$2,652.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000008,70551,HC MRI BRAIN W/O CONTRAST,610,1 ,"$3,322.00 ","$2,159.30 ",$233.94 ,"$3,322.00 ","$2,474.89 ","$2,175.91 ",$233.94 ,"$1,750.69 ",$233.94 ,"$2,096.18 ","$2,096.18 ","$2,096.18 ","$2,096.18 ","$2,989.80 ","$2,491.50 ",$233.94 ,"$2,923.36 ",$233.94 ,"$2,491.50 ","$2,491.50 ","$2,823.70 ","$2,823.70 ",$233.94 ,"$2,823.70 ",$233.94 ,"$2,624.38 ","$2,624.38 ","$2,624.38 ","$2,989.80 ",$561.60 ,"$2,989.80 ",$233.94 ,"$3,322.00 ","$2,175.91 ",$233.94 ,"$1,441.75 ", N/A ,$244.87 ,"$2,989.80 ",$506.99 ,"$2,096.18 ","$1,304.00 ","$2,989.80 ",$233.94 ,"$2,989.80 ","$2,989.80 ",$233.94 ,"$2,159.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000009,70552,HC MRI BRAIN W/CON,610,1 ,"$3,811.00 ","$2,477.15 ",$374.22 ,"$3,811.00 ","$2,839.20 ","$2,496.21 ",$374.22 ,"$2,008.40 ",$374.22 ,"$2,404.74 ","$2,404.74 ","$2,404.74 ","$2,404.74 ","$3,429.90 ","$2,858.25 ",$374.22 ,"$3,353.68 ",$374.22 ,"$2,858.25 ","$2,858.25 ","$3,239.35 ","$3,239.35 ",$374.22 ,"$3,239.35 ",$374.22 ,"$3,010.69 ","$3,010.69 ","$3,010.69 ","$3,429.90 ",$898.34 ,"$3,429.90 ",$374.22 ,"$3,811.00 ","$2,496.21 ",$374.22 ,"$1,653.97 ", N/A ,$391.69 ,"$3,429.90 ",$810.99 ,"$2,404.74 ","$1,304.00 ","$3,429.90 ",$374.22 ,"$3,429.90 ","$3,429.90 ",$374.22 ,"$2,477.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000010,70553,HC MRI BRAIN W AND W/O CONTRAST,610,1 ,"$4,702.00 ","$3,056.30 ",$374.22 ,"$4,702.00 ","$3,502.99 ","$3,079.81 ",$374.22 ,"$2,477.95 ",$374.22 ,"$2,966.96 ","$2,966.96 ","$2,966.96 ","$2,966.96 ","$4,231.80 ","$3,526.50 ",$374.22 ,"$4,137.76 ",$374.22 ,"$3,526.50 ","$3,526.50 ","$3,996.70 ","$3,996.70 ",$374.22 ,"$3,996.70 ",$374.22 ,"$3,714.58 ","$3,714.58 ","$3,714.58 ","$4,231.80 ",$898.34 ,"$4,231.80 ",$374.22 ,"$4,702.00 ","$3,079.81 ",$374.22 ,"$2,040.67 ", N/A ,$391.69 ,"$4,231.80 ",$810.99 ,"$2,966.96 ","$1,304.00 ","$4,231.80 ",$374.22 ,"$4,231.80 ","$4,231.80 ",$374.22 ,"$3,056.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000011,72141,HC MRI C-SPINE W/O CONTRAST,610,1 ,"$4,756.00 ","$3,091.40 ",$233.94 ,"$4,756.00 ","$3,543.22 ","$3,115.18 ",$233.94 ,"$2,506.41 ",$233.94 ,"$3,001.04 ","$3,001.04 ","$3,001.04 ","$3,001.04 ","$4,280.40 ","$3,567.00 ",$233.94 ,"$4,185.28 ",$233.94 ,"$3,567.00 ","$3,567.00 ","$4,042.60 ","$4,042.60 ",$233.94 ,"$4,042.60 ",$233.94 ,"$3,757.24 ","$3,757.24 ","$3,757.24 ","$4,280.40 ",$561.60 ,"$4,280.40 ",$233.94 ,"$4,756.00 ","$3,115.18 ",$233.94 ,"$2,064.10 ", N/A ,$244.87 ,"$4,280.40 ",$506.99 ,"$3,001.04 ","$1,304.00 ","$4,280.40 ",$233.94 ,"$4,280.40 ","$4,280.40 ",$233.94 ,"$3,091.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000012,72142,HC MRI C-SPINE W/CON,610,1 ,"$5,795.00 ","$3,766.75 ",$374.22 ,"$5,795.00 ","$4,317.28 ","$3,795.73 ",$374.22 ,"$3,053.97 ",$374.22 ,"$3,656.65 ","$3,656.65 ","$3,656.65 ","$3,656.65 ","$5,215.50 ","$4,346.25 ",$374.22 ,"$5,099.60 ",$374.22 ,"$4,346.25 ","$4,346.25 ","$4,925.75 ","$4,925.75 ",$374.22 ,"$4,925.75 ",$374.22 ,"$4,578.05 ","$4,578.05 ","$4,578.05 ","$5,215.50 ",$898.34 ,"$5,215.50 ",$374.22 ,"$5,795.00 ","$3,795.73 ",$374.22 ,"$2,515.03 ", N/A ,$391.69 ,"$5,215.50 ",$810.99 ,"$3,656.65 ","$1,304.00 ","$5,215.50 ",$374.22 ,"$5,215.50 ","$5,215.50 ",$374.22 ,"$3,766.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000013,72146,HC MRI T-SPINE W/O CONTRAST,610,1 ,"$2,925.00 ","$1,901.25 ",$233.94 ,"$2,925.00 ","$2,179.13 ","$1,915.88 ",$233.94 ,"$1,541.48 ",$233.94 ,"$1,845.68 ","$1,845.68 ","$1,845.68 ","$1,845.68 ","$2,632.50 ","$2,193.75 ",$233.94 ,"$2,574.00 ",$233.94 ,"$2,193.75 ","$2,193.75 ","$2,486.25 ","$2,486.25 ",$233.94 ,"$2,486.25 ",$233.94 ,"$2,310.75 ","$2,310.75 ","$2,310.75 ","$2,632.50 ",$561.60 ,"$2,632.50 ",$233.94 ,"$2,925.00 ","$1,915.88 ",$233.94 ,"$1,269.45 ", N/A ,$244.87 ,"$2,632.50 ",$506.99 ,"$1,845.68 ","$1,304.00 ","$2,632.50 ",$233.94 ,"$2,632.50 ","$2,632.50 ",$233.94 ,"$1,901.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000014,72147,HC MRI T-SPINE W/CON,610,1 ,"$3,640.00 ","$2,366.00 ",$374.22 ,"$3,640.00 ","$2,711.80 ","$2,384.20 ",$374.22 ,"$1,918.28 ",$374.22 ,"$2,296.84 ","$2,296.84 ","$2,296.84 ","$2,296.84 ","$3,276.00 ","$2,730.00 ",$374.22 ,"$3,203.20 ",$374.22 ,"$2,730.00 ","$2,730.00 ","$3,094.00 ","$3,094.00 ",$374.22 ,"$3,094.00 ",$374.22 ,"$2,875.60 ","$2,875.60 ","$2,875.60 ","$3,276.00 ",$898.34 ,"$3,276.00 ",$374.22 ,"$3,640.00 ","$2,384.20 ",$374.22 ,"$1,579.76 ", N/A ,$391.69 ,"$3,276.00 ",$810.99 ,"$2,296.84 ","$1,304.00 ","$3,276.00 ",$374.22 ,"$3,276.00 ","$3,276.00 ",$374.22 ,"$2,366.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000016,72148,HC MRI L-SPINE W/O CONTRAST,610,1 ,"$3,137.00 ","$2,039.05 ",$233.94 ,"$3,137.00 ","$2,337.07 ","$2,054.74 ",$233.94 ,"$1,653.20 ",$233.94 ,"$1,979.45 ","$1,979.45 ","$1,979.45 ","$1,979.45 ","$2,823.30 ","$2,352.75 ",$233.94 ,"$2,760.56 ",$233.94 ,"$2,352.75 ","$2,352.75 ","$2,666.45 ","$2,666.45 ",$233.94 ,"$2,666.45 ",$233.94 ,"$2,478.23 ","$2,478.23 ","$2,478.23 ","$2,823.30 ",$561.60 ,"$2,823.30 ",$233.94 ,"$3,137.00 ","$2,054.74 ",$233.94 ,"$1,361.46 ", N/A ,$244.87 ,"$2,823.30 ",$506.99 ,"$1,979.45 ","$1,304.00 ","$2,823.30 ",$233.94 ,"$2,823.30 ","$2,823.30 ",$233.94 ,"$2,039.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000017,72149,HC MRI L-SPINE W/CON,610,1 ,"$3,822.00 ","$2,484.30 ",$374.22 ,"$3,822.00 ","$2,847.39 ","$2,503.41 ",$374.22 ,"$2,014.19 ",$374.22 ,"$2,411.68 ","$2,411.68 ","$2,411.68 ","$2,411.68 ","$3,439.80 ","$2,866.50 ",$374.22 ,"$3,363.36 ",$374.22 ,"$2,866.50 ","$2,866.50 ","$3,248.70 ","$3,248.70 ",$374.22 ,"$3,248.70 ",$374.22 ,"$3,019.38 ","$3,019.38 ","$3,019.38 ","$3,439.80 ",$898.34 ,"$3,439.80 ",$374.22 ,"$3,822.00 ","$2,503.41 ",$374.22 ,"$1,658.75 ", N/A ,$391.69 ,"$3,439.80 ",$810.99 ,"$2,411.68 ","$1,304.00 ","$3,439.80 ",$374.22 ,"$3,439.80 ","$3,439.80 ",$374.22 ,"$2,484.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000018,72156,HC MRI C-SPINE W AND W/O CON,610,1 ,"$5,992.00 ","$3,894.80 ",$374.22 ,"$5,992.00 ","$4,464.04 ","$3,924.76 ",$374.22 ,"$3,157.78 ",$374.22 ,"$3,780.95 ","$3,780.95 ","$3,780.95 ","$3,780.95 ","$5,392.80 ","$4,494.00 ",$374.22 ,"$5,272.96 ",$374.22 ,"$4,494.00 ","$4,494.00 ","$5,093.20 ","$5,093.20 ",$374.22 ,"$5,093.20 ",$374.22 ,"$4,733.68 ","$4,733.68 ","$4,733.68 ","$5,392.80 ",$898.34 ,"$5,392.80 ",$374.22 ,"$5,992.00 ","$3,924.76 ",$374.22 ,"$2,600.53 ", N/A ,$391.69 ,"$5,392.80 ",$810.99 ,"$3,780.95 ","$1,304.00 ","$5,392.80 ",$374.22 ,"$5,392.80 ","$5,392.80 ",$374.22 ,"$3,894.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000019,72157,HC MRI T-SPINE W AND W/O CON,610,1 ,"$4,208.00 ","$2,735.20 ",$374.22 ,"$4,208.00 ","$3,134.96 ","$2,756.24 ",$374.22 ,"$2,217.62 ",$374.22 ,"$2,655.25 ","$2,655.25 ","$2,655.25 ","$2,655.25 ","$3,787.20 ","$3,156.00 ",$374.22 ,"$3,703.04 ",$374.22 ,"$3,156.00 ","$3,156.00 ","$3,576.80 ","$3,576.80 ",$374.22 ,"$3,576.80 ",$374.22 ,"$3,324.32 ","$3,324.32 ","$3,324.32 ","$3,787.20 ",$898.34 ,"$3,787.20 ",$374.22 ,"$4,208.00 ","$2,756.24 ",$374.22 ,"$1,826.27 ", N/A ,$391.69 ,"$3,787.20 ",$810.99 ,"$2,655.25 ","$1,304.00 ","$3,787.20 ",$374.22 ,"$3,787.20 ","$3,787.20 ",$374.22 ,"$2,735.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000020,72158,HC MRI L-SPINE W AND W/O CON,610,1 ,"$4,391.00 ","$2,854.15 ",$374.22 ,"$4,391.00 ","$3,271.30 ","$2,876.11 ",$374.22 ,"$2,314.06 ",$374.22 ,"$2,770.72 ","$2,770.72 ","$2,770.72 ","$2,770.72 ","$3,951.90 ","$3,293.25 ",$374.22 ,"$3,864.08 ",$374.22 ,"$3,293.25 ","$3,293.25 ","$3,732.35 ","$3,732.35 ",$374.22 ,"$3,732.35 ",$374.22 ,"$3,468.89 ","$3,468.89 ","$3,468.89 ","$3,951.90 ",$898.34 ,"$3,951.90 ",$374.22 ,"$4,391.00 ","$2,876.11 ",$374.22 ,"$1,905.69 ", N/A ,$391.69 ,"$3,951.90 ",$810.99 ,"$2,770.72 ","$1,304.00 ","$3,951.90 ",$374.22 ,"$3,951.90 ","$3,951.90 ",$374.22 ,"$2,854.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000021,72195,HC MRI PELVIS W/O CON,610,1 ,"$3,715.00 ","$2,414.75 ",$233.94 ,"$3,715.00 ","$2,767.68 ","$2,433.33 ",$233.94 ,"$1,957.81 ",$233.94 ,"$2,344.17 ","$2,344.17 ","$2,344.17 ","$2,344.17 ","$3,343.50 ","$2,786.25 ",$233.94 ,"$3,269.20 ",$233.94 ,"$2,786.25 ","$2,786.25 ","$3,157.75 ","$3,157.75 ",$233.94 ,"$3,157.75 ",$233.94 ,"$2,934.85 ","$2,934.85 ","$2,934.85 ","$3,343.50 ",$561.60 ,"$3,343.50 ",$233.94 ,"$3,715.00 ","$2,433.33 ",$233.94 ,"$1,612.31 ", N/A ,$244.87 ,"$3,343.50 ",$506.99 ,"$2,344.17 ","$1,304.00 ","$3,343.50 ",$233.94 ,"$3,343.50 ","$3,343.50 ",$233.94 ,"$2,414.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000022,72196,HC MRI PELVIS W/CON,610,1 ,"$4,332.00 ","$2,815.80 ",$374.22 ,"$4,332.00 ","$3,227.34 ","$2,837.46 ",$374.22 ,"$2,282.96 ",$374.22 ,"$2,733.49 ","$2,733.49 ","$2,733.49 ","$2,733.49 ","$3,898.80 ","$3,249.00 ",$374.22 ,"$3,812.16 ",$374.22 ,"$3,249.00 ","$3,249.00 ","$3,682.20 ","$3,682.20 ",$374.22 ,"$3,682.20 ",$374.22 ,"$3,422.28 ","$3,422.28 ","$3,422.28 ","$3,898.80 ",$898.34 ,"$3,898.80 ",$374.22 ,"$4,332.00 ","$2,837.46 ",$374.22 ,"$1,880.09 ", N/A ,$391.69 ,"$3,898.80 ",$810.99 ,"$2,733.49 ","$1,304.00 ","$3,898.80 ",$374.22 ,"$3,898.80 ","$3,898.80 ",$374.22 ,"$2,815.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000023,72197,HC MRI PELVIS W AND W/O CON,610,1 ,"$4,681.00 ","$3,042.65 ",$374.22 ,"$4,681.00 ","$3,487.35 ","$3,066.06 ",$374.22 ,"$2,466.89 ",$374.22 ,"$2,953.71 ","$2,953.71 ","$2,953.71 ","$2,953.71 ","$4,212.90 ","$3,510.75 ",$374.22 ,"$4,119.28 ",$374.22 ,"$3,510.75 ","$3,510.75 ","$3,978.85 ","$3,978.85 ",$374.22 ,"$3,978.85 ",$374.22 ,"$3,697.99 ","$3,697.99 ","$3,697.99 ","$4,212.90 ",$898.34 ,"$4,212.90 ",$374.22 ,"$4,681.00 ","$3,066.06 ",$374.22 ,"$2,031.55 ", N/A ,$391.69 ,"$4,212.90 ",$810.99 ,"$2,953.71 ","$1,304.00 ","$4,212.90 ",$374.22 ,"$4,212.90 ","$4,212.90 ",$374.22 ,"$3,042.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000024,73218,HC MRI UPPR EXT NONJOINT W/O CONTRAST,610,1 ,"$3,602.00 ","$2,341.30 ",$233.94 ,"$3,602.00 ","$2,683.49 ","$2,359.31 ",$233.94 ,"$1,898.25 ",$233.94 ,"$2,272.86 ","$2,272.86 ","$2,272.86 ","$2,272.86 ","$3,241.80 ","$2,701.50 ",$233.94 ,"$3,169.76 ",$233.94 ,"$2,701.50 ","$2,701.50 ","$3,061.70 ","$3,061.70 ",$233.94 ,"$3,061.70 ",$233.94 ,"$2,845.58 ","$2,845.58 ","$2,845.58 ","$3,241.80 ",$561.60 ,"$3,241.80 ",$233.94 ,"$3,602.00 ","$2,359.31 ",$233.94 ,"$1,563.27 ", N/A ,$244.87 ,"$3,241.80 ",$506.99 ,"$2,272.86 ","$1,304.00 ","$3,241.80 ",$233.94 ,"$3,241.80 ","$3,241.80 ",$233.94 ,"$2,341.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000025,73219,HC MRI UPPR EXT NONJOINT W/CONTRAST,610,1 ,"$3,962.00 ","$2,575.30 ",$374.22 ,"$3,962.00 ","$2,951.69 ","$2,595.11 ",$374.22 ,"$2,087.97 ",$374.22 ,"$2,500.02 ","$2,500.02 ","$2,500.02 ","$2,500.02 ","$3,565.80 ","$2,971.50 ",$374.22 ,"$3,486.56 ",$374.22 ,"$2,971.50 ","$2,971.50 ","$3,367.70 ","$3,367.70 ",$374.22 ,"$3,367.70 ",$374.22 ,"$3,129.98 ","$3,129.98 ","$3,129.98 ","$3,565.80 ",$898.34 ,"$3,565.80 ",$374.22 ,"$3,962.00 ","$2,595.11 ",$374.22 ,"$1,719.51 ", N/A ,$391.69 ,"$3,565.80 ",$810.99 ,"$2,500.02 ","$1,304.00 ","$3,565.80 ",$374.22 ,"$3,565.80 ","$3,565.80 ",$374.22 ,"$2,575.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000026,73220,HC MRI UPPR EXT NONJOINT W AND W/O CONTRAST,610,1 ,"$5,043.00 ","$3,277.95 ",$374.22 ,"$5,043.00 ","$3,757.04 ","$3,303.17 ",$374.22 ,"$2,657.66 ",$374.22 ,"$3,182.13 ","$3,182.13 ","$3,182.13 ","$3,182.13 ","$4,538.70 ","$3,782.25 ",$374.22 ,"$4,437.84 ",$374.22 ,"$3,782.25 ","$3,782.25 ","$4,286.55 ","$4,286.55 ",$374.22 ,"$4,286.55 ",$374.22 ,"$3,983.97 ","$3,983.97 ","$3,983.97 ","$4,538.70 ",$898.34 ,"$4,538.70 ",$374.22 ,"$5,043.00 ","$3,303.17 ",$374.22 ,"$2,188.66 ", N/A ,$391.69 ,"$4,538.70 ",$810.99 ,"$3,182.13 ","$1,304.00 ","$4,538.70 ",$374.22 ,"$4,538.70 ","$4,538.70 ",$374.22 ,"$3,277.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000027,73221,HC MRI UPPR EXT JOINT W/O CONTRAST,610,1 ,"$2,866.00 ","$1,862.90 ",$233.94 ,"$2,866.00 ","$2,135.17 ","$1,877.23 ",$233.94 ,"$1,510.38 ",$233.94 ,"$1,808.45 ","$1,808.45 ","$1,808.45 ","$1,808.45 ","$2,579.40 ","$2,149.50 ",$233.94 ,"$2,522.08 ",$233.94 ,"$2,149.50 ","$2,149.50 ","$2,436.10 ","$2,436.10 ",$233.94 ,"$2,436.10 ",$233.94 ,"$2,264.14 ","$2,264.14 ","$2,264.14 ","$2,579.40 ",$561.60 ,"$2,579.40 ",$233.94 ,"$2,866.00 ","$1,877.23 ",$233.94 ,"$1,243.84 ", N/A ,$244.87 ,"$2,579.40 ",$506.99 ,"$1,808.45 ","$1,304.00 ","$2,579.40 ",$233.94 ,"$2,579.40 ","$2,579.40 ",$233.94 ,"$1,862.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000028,73222,HC MRI UPPR EXT JOINT W/CONTRAST,610,1 ,"$3,962.00 ","$2,575.30 ",$727.03 ,"$3,962.00 ","$2,951.69 ","$2,595.11 ",$727.03 ,"$2,087.97 ",$727.03 ,"$2,500.02 ","$2,500.02 ","$2,500.02 ","$2,500.02 ","$3,565.80 ","$2,971.50 ",$727.03 ,"$3,486.56 ",$727.03 ,"$2,971.50 ","$2,971.50 ","$3,367.70 ","$3,367.70 ",$727.03 ,"$3,367.70 ",$727.03 ,"$3,129.98 ","$3,129.98 ","$3,129.98 ","$3,565.80 ","$1,745.28 ","$3,565.80 ",$727.03 ,"$3,962.00 ","$2,595.11 ",$727.03 ,"$1,719.51 ", N/A ,$760.97 ,"$3,565.80 ","$1,575.58 ","$2,500.02 ","$1,304.00 ","$3,565.80 ",$727.03 ,"$3,565.80 ","$3,565.80 ",$727.03 ,"$2,575.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000029,73223,HC MRI UPPR EXT JOINT W AND W/O CONTRAST,610,1 ,"$4,539.00 ","$2,950.35 ",$374.22 ,"$4,539.00 ","$3,381.56 ","$2,973.05 ",$374.22 ,"$2,392.05 ",$374.22 ,"$2,864.11 ","$2,864.11 ","$2,864.11 ","$2,864.11 ","$4,085.10 ","$3,404.25 ",$374.22 ,"$3,994.32 ",$374.22 ,"$3,404.25 ","$3,404.25 ","$3,858.15 ","$3,858.15 ",$374.22 ,"$3,858.15 ",$374.22 ,"$3,585.81 ","$3,585.81 ","$3,585.81 ","$4,085.10 ",$898.34 ,"$4,085.10 ",$374.22 ,"$4,539.00 ","$2,973.05 ",$374.22 ,"$1,969.93 ", N/A ,$391.69 ,"$4,085.10 ",$810.99 ,"$2,864.11 ","$1,304.00 ","$4,085.10 ",$374.22 ,"$4,085.10 ","$4,085.10 ",$374.22 ,"$2,950.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000030,73718,HC MRI LE NONJOINT WO CONTRAST,610,1 ,"$3,602.00 ","$2,341.30 ",$233.94 ,"$3,602.00 ","$2,683.49 ","$2,359.31 ",$233.94 ,"$1,898.25 ",$233.94 ,"$2,272.86 ","$2,272.86 ","$2,272.86 ","$2,272.86 ","$3,241.80 ","$2,701.50 ",$233.94 ,"$3,169.76 ",$233.94 ,"$2,701.50 ","$2,701.50 ","$3,061.70 ","$3,061.70 ",$233.94 ,"$3,061.70 ",$233.94 ,"$2,845.58 ","$2,845.58 ","$2,845.58 ","$3,241.80 ",$561.60 ,"$3,241.80 ",$233.94 ,"$3,602.00 ","$2,359.31 ",$233.94 ,"$1,563.27 ", N/A ,$244.87 ,"$3,241.80 ",$506.99 ,"$2,272.86 ","$1,304.00 ","$3,241.80 ",$233.94 ,"$3,241.80 ","$3,241.80 ",$233.94 ,"$2,341.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000032,73719,HC MRI LE NONJOINT W/ CONTRAST,610,1 ,"$3,962.00 ","$2,575.30 ",$374.22 ,"$3,962.00 ","$2,951.69 ","$2,595.11 ",$374.22 ,"$2,087.97 ",$374.22 ,"$2,500.02 ","$2,500.02 ","$2,500.02 ","$2,500.02 ","$3,565.80 ","$2,971.50 ",$374.22 ,"$3,486.56 ",$374.22 ,"$2,971.50 ","$2,971.50 ","$3,367.70 ","$3,367.70 ",$374.22 ,"$3,367.70 ",$374.22 ,"$3,129.98 ","$3,129.98 ","$3,129.98 ","$3,565.80 ",$898.34 ,"$3,565.80 ",$374.22 ,"$3,962.00 ","$2,595.11 ",$374.22 ,"$1,719.51 ", N/A ,$391.69 ,"$3,565.80 ",$810.99 ,"$2,500.02 ","$1,304.00 ","$3,565.80 ",$374.22 ,"$3,565.80 ","$3,565.80 ",$374.22 ,"$2,575.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000033,73720,HC MRI LE NONJOINT W/WO CONTRAST,610,1 ,"$4,540.00 ","$2,951.00 ",$374.22 ,"$4,540.00 ","$3,382.30 ","$2,973.70 ",$374.22 ,"$2,392.58 ",$374.22 ,"$2,864.74 ","$2,864.74 ","$2,864.74 ","$2,864.74 ","$4,086.00 ","$3,405.00 ",$374.22 ,"$3,995.20 ",$374.22 ,"$3,405.00 ","$3,405.00 ","$3,859.00 ","$3,859.00 ",$374.22 ,"$3,859.00 ",$374.22 ,"$3,586.60 ","$3,586.60 ","$3,586.60 ","$4,086.00 ",$898.34 ,"$4,086.00 ",$374.22 ,"$4,540.00 ","$2,973.70 ",$374.22 ,"$1,970.36 ", N/A ,$391.69 ,"$4,086.00 ",$810.99 ,"$2,864.74 ","$1,304.00 ","$4,086.00 ",$374.22 ,"$4,086.00 ","$4,086.00 ",$374.22 ,"$2,951.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000034,73721,HC MRI LWR EXT JOINT W/O CONTRAST,610,1 ,"$2,866.00 ","$1,862.90 ",$233.94 ,"$2,866.00 ","$2,135.17 ","$1,877.23 ",$233.94 ,"$1,510.38 ",$233.94 ,"$1,808.45 ","$1,808.45 ","$1,808.45 ","$1,808.45 ","$2,579.40 ","$2,149.50 ",$233.94 ,"$2,522.08 ",$233.94 ,"$2,149.50 ","$2,149.50 ","$2,436.10 ","$2,436.10 ",$233.94 ,"$2,436.10 ",$233.94 ,"$2,264.14 ","$2,264.14 ","$2,264.14 ","$2,579.40 ",$561.60 ,"$2,579.40 ",$233.94 ,"$2,866.00 ","$1,877.23 ",$233.94 ,"$1,243.84 ", N/A ,$244.87 ,"$2,579.40 ",$506.99 ,"$1,808.45 ","$1,304.00 ","$2,579.40 ",$233.94 ,"$2,579.40 ","$2,579.40 ",$233.94 ,"$1,862.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000035,73722,HC MRI LWR EXT JOINT W/CONTRAST,610,1 ,"$3,962.00 ","$2,575.30 ",$727.03 ,"$3,962.00 ","$2,951.69 ","$2,595.11 ",$727.03 ,"$2,087.97 ",$727.03 ,"$2,500.02 ","$2,500.02 ","$2,500.02 ","$2,500.02 ","$3,565.80 ","$2,971.50 ",$727.03 ,"$3,486.56 ",$727.03 ,"$2,971.50 ","$2,971.50 ","$3,367.70 ","$3,367.70 ",$727.03 ,"$3,367.70 ",$727.03 ,"$3,129.98 ","$3,129.98 ","$3,129.98 ","$3,565.80 ","$1,745.28 ","$3,565.80 ",$727.03 ,"$3,962.00 ","$2,595.11 ",$727.03 ,"$1,719.51 ", N/A ,$760.97 ,"$3,565.80 ","$1,575.58 ","$2,500.02 ","$1,304.00 ","$3,565.80 ",$727.03 ,"$3,565.80 ","$3,565.80 ",$727.03 ,"$2,575.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000036,73723,HC MRI LWR EXT JOINT W AND W/O CONTRAST,610,1 ,"$5,043.00 ","$3,277.95 ",$374.22 ,"$5,043.00 ","$3,757.04 ","$3,303.17 ",$374.22 ,"$2,657.66 ",$374.22 ,"$3,182.13 ","$3,182.13 ","$3,182.13 ","$3,182.13 ","$4,538.70 ","$3,782.25 ",$374.22 ,"$4,437.84 ",$374.22 ,"$3,782.25 ","$3,782.25 ","$4,286.55 ","$4,286.55 ",$374.22 ,"$4,286.55 ",$374.22 ,"$3,983.97 ","$3,983.97 ","$3,983.97 ","$4,538.70 ",$898.34 ,"$4,538.70 ",$374.22 ,"$5,043.00 ","$3,303.17 ",$374.22 ,"$2,188.66 ", N/A ,$391.69 ,"$4,538.70 ",$810.99 ,"$3,182.13 ","$1,304.00 ","$4,538.70 ",$374.22 ,"$4,538.70 ","$4,538.70 ",$374.22 ,"$3,277.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000038,74181,HC MRI ABDOMEN W/O CON,610,1 ,"$2,512.00 ","$1,632.80 ",$233.94 ,"$2,512.00 ","$1,871.44 ","$1,645.36 ",$233.94 ,"$1,323.82 ",$233.94 ,"$1,585.07 ","$1,585.07 ","$1,585.07 ","$1,585.07 ","$2,260.80 ","$1,884.00 ",$233.94 ,"$2,210.56 ",$233.94 ,"$1,884.00 ","$1,884.00 ","$2,135.20 ","$2,135.20 ",$233.94 ,"$2,135.20 ",$233.94 ,"$1,984.48 ","$1,984.48 ","$1,984.48 ","$2,260.80 ",$561.60 ,"$2,260.80 ",$233.94 ,"$2,512.00 ","$1,645.36 ",$233.94 ,"$1,090.21 ", N/A ,$244.87 ,"$2,260.80 ",$506.99 ,"$1,585.07 ","$1,304.00 ","$2,260.80 ",$233.94 ,"$2,260.80 ","$2,260.80 ",$233.94 ,"$1,632.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000040,74183,HC MRI ABDOMEN W AND W/O CON,610,1 ,"$4,002.00 ","$2,601.30 ",$374.22 ,"$4,002.00 ","$2,981.49 ","$2,621.31 ",$374.22 ,"$2,109.05 ",$374.22 ,"$2,525.26 ","$2,525.26 ","$2,525.26 ","$2,525.26 ","$3,601.80 ","$3,001.50 ",$374.22 ,"$3,521.76 ",$374.22 ,"$3,001.50 ","$3,001.50 ","$3,401.70 ","$3,401.70 ",$374.22 ,"$3,401.70 ",$374.22 ,"$3,161.58 ","$3,161.58 ","$3,161.58 ","$3,601.80 ",$898.34 ,"$3,601.80 ",$374.22 ,"$4,002.00 ","$2,621.31 ",$374.22 ,"$1,736.87 ", N/A ,$391.69 ,"$3,601.80 ",$810.99 ,"$2,525.26 ","$1,304.00 ","$3,601.80 ",$374.22 ,"$3,601.80 ","$3,601.80 ",$374.22 ,"$2,601.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000050,C8937,HC MRI BREAST CAD,610,1 ,"$1,256.00 ",$816.40 ,$545.10 ,"$1,256.00 ",$935.72 ,$822.68 , N/A ,$661.91 , N/A ,$792.54 ,$792.54 ,$792.54 ,$792.54 ,"$1,130.40 ",$942.00 , N/A ,"$1,105.28 ", N/A ,$942.00 ,$942.00 ,"$1,067.60 ","$1,067.60 ", N/A ,"$1,067.60 ", N/A ,$992.24 ,$992.24 ,$992.24 ,"$1,130.40 ", N/A ,"$1,130.40 ", N/A ,"$1,256.00 ",$822.68 , N/A ,$545.10 , N/A , N/A ,"$1,130.40 ", N/A ,$792.54 ,"$1,256.00 ","$1,130.40 ", N/A ,"$1,130.40 ","$1,130.40 ", N/A ,$816.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000051,C8900,HC MRA ABDOMEN W/CONTRAST,610,1 ,"$1,776.00 ","$1,154.40 ",$374.22 ,"$1,776.00 ","$1,323.12 ","$1,163.28 ",$374.22 ,$935.95 ,$374.22 ,"$1,120.66 ","$1,120.66 ","$1,120.66 ","$1,120.66 ","$1,598.40 ","$1,332.00 ",$374.22 ,"$1,562.88 ",$374.22 ,"$1,332.00 ","$1,332.00 ","$1,509.60 ","$1,509.60 ",$374.22 ,"$1,509.60 ",$374.22 ,"$1,403.04 ","$1,403.04 ","$1,403.04 ","$1,598.40 ",$898.34 ,"$1,598.40 ",$374.22 ,"$1,776.00 ","$1,163.28 ",$374.22 ,$770.78 , N/A ,$391.69 ,"$1,598.40 ",$810.99 ,"$1,120.66 ","$1,304.00 ","$1,598.40 ",$374.22 ,"$1,598.40 ","$1,598.40 ",$374.22 ,"$1,154.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000052,C8901,HC MRA ABDOMEN W/O CONTRAST,610,1 ,"$1,522.00 ",$989.30 ,$233.94 ,"$1,522.00 ","$1,133.89 ",$996.91 ,$233.94 ,$802.09 ,$233.94 ,$960.38 ,$960.38 ,$960.38 ,$960.38 ,"$1,369.80 ","$1,141.50 ",$233.94 ,"$1,339.36 ",$233.94 ,"$1,141.50 ","$1,141.50 ","$1,293.70 ","$1,293.70 ",$233.94 ,"$1,293.70 ",$233.94 ,"$1,202.38 ","$1,202.38 ","$1,202.38 ","$1,369.80 ",$561.60 ,"$1,369.80 ",$233.94 ,"$1,522.00 ",$996.91 ,$233.94 ,$660.55 , N/A ,$244.87 ,"$1,369.80 ",$506.99 ,$960.38 ,"$1,304.00 ","$1,369.80 ",$233.94 ,"$1,369.80 ","$1,369.80 ",$233.94 ,$989.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000053,C8902,HC MRA ABDOMEN W AND W/O CON,610,1 ,"$2,592.00 ","$1,684.80 ",$374.22 ,"$2,592.00 ","$1,931.04 ","$1,697.76 ",$374.22 ,"$1,365.98 ",$374.22 ,"$1,635.55 ","$1,635.55 ","$1,635.55 ","$1,635.55 ","$2,332.80 ","$1,944.00 ",$374.22 ,"$2,280.96 ",$374.22 ,"$1,944.00 ","$1,944.00 ","$2,203.20 ","$2,203.20 ",$374.22 ,"$2,203.20 ",$374.22 ,"$2,047.68 ","$2,047.68 ","$2,047.68 ","$2,332.80 ",$898.34 ,"$2,332.80 ",$374.22 ,"$2,592.00 ","$1,697.76 ",$374.22 ,"$1,124.93 ", N/A ,$391.69 ,"$2,332.80 ",$810.99 ,"$1,635.55 ","$1,304.00 ","$2,332.80 ",$374.22 ,"$2,332.80 ","$2,332.80 ",$374.22 ,"$1,684.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000056,C8905,HC MRI BREAST UNI W AND W/O CONTRAST,610,1 ,"$1,110.00 ",$721.50 ,$374.22 ,"$1,110.00 ",$826.95 ,$727.05 ,$374.22 ,$584.97 ,$374.22 ,$700.41 ,$700.41 ,$700.41 ,$700.41 ,$999.00 ,$832.50 ,$374.22 ,$976.80 ,$374.22 ,$832.50 ,$832.50 ,$943.50 ,$943.50 ,$374.22 ,$943.50 ,$374.22 ,$876.90 ,$876.90 ,$876.90 ,$999.00 ,$898.34 ,$999.00 ,$374.22 ,"$1,110.00 ",$727.05 ,$374.22 ,$481.74 , N/A ,$391.69 ,$999.00 ,$810.99 ,$700.41 ,"$1,110.00 ",$999.00 ,$374.22 ,$999.00 ,$999.00 ,$374.22 ,$721.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000057,C8906,HC MRI BREAST BIL W/CONTRAST,610,1 ,"$2,199.00 ","$1,429.35 ",$374.22 ,"$2,199.00 ","$1,638.26 ","$1,440.35 ",$374.22 ,"$1,158.87 ",$374.22 ,"$1,387.57 ","$1,387.57 ","$1,387.57 ","$1,387.57 ","$1,979.10 ","$1,649.25 ",$374.22 ,"$1,935.12 ",$374.22 ,"$1,649.25 ","$1,649.25 ","$1,869.15 ","$1,869.15 ",$374.22 ,"$1,869.15 ",$374.22 ,"$1,737.21 ","$1,737.21 ","$1,737.21 ","$1,979.10 ",$898.34 ,"$1,979.10 ",$374.22 ,"$2,199.00 ","$1,440.35 ",$374.22 ,$954.37 , N/A ,$391.69 ,"$1,979.10 ",$810.99 ,"$1,387.57 ","$1,304.00 ","$1,979.10 ",$374.22 ,"$1,979.10 ","$1,979.10 ",$374.22 ,"$1,429.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000058,77047,HC MRI BREAST BI W/O CON,610,1 ,"$2,112.00 ","$1,372.80 ",$179.80 ,"$2,112.00 ","$1,573.44 ","$1,383.36 ",$233.94 ,"$1,113.02 ",$233.94 ,"$1,332.67 ","$1,332.67 ","$1,332.67 ","$1,332.67 ","$1,900.80 ","$1,584.00 ",$233.94 ,"$1,858.56 ",$233.94 ,"$1,584.00 ","$1,584.00 ","$1,795.20 ","$1,795.20 ",$233.94 ,"$1,795.20 ",$233.94 ,"$1,668.48 ","$1,668.48 ","$1,668.48 ","$1,900.80 ",$561.60 ,"$1,900.80 ",$233.94 ,$179.80 ,"$1,383.36 ",$233.94 ,$916.61 , N/A ,$244.87 ,"$1,900.80 ",$506.99 ,"$1,332.67 ","$1,304.00 ","$1,900.80 ",$233.94 ,"$1,900.80 ","$1,900.80 ",$233.94 ,"$1,372.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000059,C8908,HC MRI BREAST BI W AND W/O CON,610,1 ,"$3,247.00 ","$2,110.55 ",$374.22 ,"$3,247.00 ","$2,419.02 ","$2,126.79 ",$374.22 ,"$1,711.17 ",$374.22 ,"$2,048.86 ","$2,048.86 ","$2,048.86 ","$2,048.86 ","$2,922.30 ","$2,435.25 ",$374.22 ,"$2,857.36 ",$374.22 ,"$2,435.25 ","$2,435.25 ","$2,759.95 ","$2,759.95 ",$374.22 ,"$2,759.95 ",$374.22 ,"$2,565.13 ","$2,565.13 ","$2,565.13 ","$2,922.30 ",$898.34 ,"$2,922.30 ",$374.22 ,"$3,247.00 ","$2,126.79 ",$374.22 ,"$1,409.20 ", N/A ,$391.69 ,"$2,922.30 ",$810.99 ,"$2,048.86 ","$1,304.00 ","$2,922.30 ",$374.22 ,"$2,922.30 ","$2,922.30 ",$374.22 ,"$2,110.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000060,C8909,HC MRA CHEST W/CONTRAST,610,1 ,"$2,243.00 ","$1,457.95 ",$374.22 ,"$2,243.00 ","$1,671.04 ","$1,469.17 ",$374.22 ,"$1,182.06 ",$374.22 ,"$1,415.33 ","$1,415.33 ","$1,415.33 ","$1,415.33 ","$2,018.70 ","$1,682.25 ",$374.22 ,"$1,973.84 ",$374.22 ,"$1,682.25 ","$1,682.25 ","$1,906.55 ","$1,906.55 ",$374.22 ,"$1,906.55 ",$374.22 ,"$1,771.97 ","$1,771.97 ","$1,771.97 ","$2,018.70 ",$898.34 ,"$2,018.70 ",$374.22 ,"$2,243.00 ","$1,469.17 ",$374.22 ,$973.46 , N/A ,$391.69 ,"$2,018.70 ",$810.99 ,"$1,415.33 ","$1,304.00 ","$2,018.70 ",$374.22 ,"$2,018.70 ","$2,018.70 ",$374.22 ,"$1,457.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000061,C8910,HC MRA CHEST W/O CONTRAST,610,1 ,"$2,222.00 ","$1,444.30 ",$233.94 ,"$2,222.00 ","$1,655.39 ","$1,455.41 ",$233.94 ,"$1,170.99 ",$233.94 ,"$1,402.08 ","$1,402.08 ","$1,402.08 ","$1,402.08 ","$1,999.80 ","$1,666.50 ",$233.94 ,"$1,955.36 ",$233.94 ,"$1,666.50 ","$1,666.50 ","$1,888.70 ","$1,888.70 ",$233.94 ,"$1,888.70 ",$233.94 ,"$1,755.38 ","$1,755.38 ","$1,755.38 ","$1,999.80 ",$561.60 ,"$1,999.80 ",$233.94 ,"$2,222.00 ","$1,455.41 ",$233.94 ,$964.35 , N/A ,$244.87 ,"$1,999.80 ",$506.99 ,"$1,402.08 ","$1,304.00 ","$1,999.80 ",$233.94 ,"$1,999.80 ","$1,999.80 ",$233.94 ,"$1,444.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000062,C8911,HC MRA CHEST W AND W/O CONTRAST,610,1 ,"$3,258.00 ","$2,117.70 ",$374.22 ,"$3,258.00 ","$2,427.21 ","$2,133.99 ",$374.22 ,"$1,716.97 ",$374.22 ,"$2,055.80 ","$2,055.80 ","$2,055.80 ","$2,055.80 ","$2,932.20 ","$2,443.50 ",$374.22 ,"$2,867.04 ",$374.22 ,"$2,443.50 ","$2,443.50 ","$2,769.30 ","$2,769.30 ",$374.22 ,"$2,769.30 ",$374.22 ,"$2,573.82 ","$2,573.82 ","$2,573.82 ","$2,932.20 ",$898.34 ,"$2,932.20 ",$374.22 ,"$3,258.00 ","$2,133.99 ",$374.22 ,"$1,413.97 ", N/A ,$391.69 ,"$2,932.20 ",$810.99 ,"$2,055.80 ","$1,304.00 ","$2,932.20 ",$374.22 ,"$2,932.20 ","$2,932.20 ",$374.22 ,"$2,117.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000063,C8912,HC MRA LWR EXT W/CON,610,1 ,"$1,854.00 ","$1,205.10 ",$374.22 ,"$1,854.00 ","$1,381.23 ","$1,214.37 ",$374.22 ,$977.06 ,$374.22 ,"$1,169.87 ","$1,169.87 ","$1,169.87 ","$1,169.87 ","$1,668.60 ","$1,390.50 ",$374.22 ,"$1,631.52 ",$374.22 ,"$1,390.50 ","$1,390.50 ","$1,575.90 ","$1,575.90 ",$374.22 ,"$1,575.90 ",$374.22 ,"$1,464.66 ","$1,464.66 ","$1,464.66 ","$1,668.60 ",$898.34 ,"$1,668.60 ",$374.22 ,"$1,854.00 ","$1,214.37 ",$374.22 ,$804.64 , N/A ,$391.69 ,"$1,668.60 ",$810.99 ,"$1,169.87 ","$1,304.00 ","$1,668.60 ",$374.22 ,"$1,668.60 ","$1,668.60 ",$374.22 ,"$1,205.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000063,C8912,HC MRA LWR EXT W/CON,610,1 ,"$2,782.00 ","$1,808.30 ",$374.22 ,"$2,782.00 ","$2,072.59 ","$1,822.21 ",$374.22 ,"$1,466.11 ",$374.22 ,"$1,755.44 ","$1,755.44 ","$1,755.44 ","$1,755.44 ","$2,503.80 ","$2,086.50 ",$374.22 ,"$2,448.16 ",$374.22 ,"$2,086.50 ","$2,086.50 ","$2,364.70 ","$2,364.70 ",$374.22 ,"$2,364.70 ",$374.22 ,"$2,197.78 ","$2,197.78 ","$2,197.78 ","$2,503.80 ",$898.34 ,"$2,503.80 ",$374.22 ,"$2,782.00 ","$1,822.21 ",$374.22 ,"$1,207.39 ", N/A ,$391.69 ,"$2,503.80 ",$810.99 ,"$1,755.44 ","$1,304.00 ","$2,503.80 ",$374.22 ,"$2,503.80 ","$2,503.80 ",$374.22 ,"$1,808.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000064,C8913,HC MRA LWR EXT W/O CON,610,1 ,"$1,686.00 ","$1,095.90 ",$233.94 ,"$1,686.00 ","$1,256.07 ","$1,104.33 ",$233.94 ,$888.52 ,$233.94 ,"$1,063.87 ","$1,063.87 ","$1,063.87 ","$1,063.87 ","$1,517.40 ","$1,264.50 ",$233.94 ,"$1,483.68 ",$233.94 ,"$1,264.50 ","$1,264.50 ","$1,433.10 ","$1,433.10 ",$233.94 ,"$1,433.10 ",$233.94 ,"$1,331.94 ","$1,331.94 ","$1,331.94 ","$1,517.40 ",$561.60 ,"$1,517.40 ",$233.94 ,"$1,686.00 ","$1,104.33 ",$233.94 ,$731.72 , N/A ,$244.87 ,"$1,517.40 ",$506.99 ,"$1,063.87 ","$1,304.00 ","$1,517.40 ",$233.94 ,"$1,517.40 ","$1,517.40 ",$233.94 ,"$1,095.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000064,C8913,HC MRA LWR EXT W/O CON,610,1 ,"$2,529.00 ","$1,643.85 ",$233.94 ,"$2,529.00 ","$1,884.11 ","$1,656.50 ",$233.94 ,"$1,332.78 ",$233.94 ,"$1,595.80 ","$1,595.80 ","$1,595.80 ","$1,595.80 ","$2,276.10 ","$1,896.75 ",$233.94 ,"$2,225.52 ",$233.94 ,"$1,896.75 ","$1,896.75 ","$2,149.65 ","$2,149.65 ",$233.94 ,"$2,149.65 ",$233.94 ,"$1,997.91 ","$1,997.91 ","$1,997.91 ","$2,276.10 ",$561.60 ,"$2,276.10 ",$233.94 ,"$2,529.00 ","$1,656.50 ",$233.94 ,"$1,097.59 ", N/A ,$244.87 ,"$2,276.10 ",$506.99 ,"$1,595.80 ","$1,304.00 ","$2,276.10 ",$233.94 ,"$2,276.10 ","$2,276.10 ",$233.94 ,"$1,643.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000067,C8914,HC MRA LWR EXT W AND W/O CONTRAST,610,1 ,"$2,258.00 ","$1,467.70 ",$374.22 ,"$2,258.00 ","$1,682.21 ","$1,478.99 ",$374.22 ,"$1,189.97 ",$374.22 ,"$1,424.80 ","$1,424.80 ","$1,424.80 ","$1,424.80 ","$2,032.20 ","$1,693.50 ",$374.22 ,"$1,987.04 ",$374.22 ,"$1,693.50 ","$1,693.50 ","$1,919.30 ","$1,919.30 ",$374.22 ,"$1,919.30 ",$374.22 ,"$1,783.82 ","$1,783.82 ","$1,783.82 ","$2,032.20 ",$898.34 ,"$2,032.20 ",$374.22 ,"$2,258.00 ","$1,478.99 ",$374.22 ,$979.97 , N/A ,$391.69 ,"$2,032.20 ",$810.99 ,"$1,424.80 ","$1,304.00 ","$2,032.20 ",$374.22 ,"$2,032.20 ","$2,032.20 ",$374.22 ,"$1,467.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000067,C8914,HC MRA LWR EXT W AND W/O CONTRAST,610,1 ,"$3,388.00 ","$2,202.20 ",$374.22 ,"$3,388.00 ","$2,524.06 ","$2,219.14 ",$374.22 ,"$1,785.48 ",$374.22 ,"$2,137.83 ","$2,137.83 ","$2,137.83 ","$2,137.83 ","$3,049.20 ","$2,541.00 ",$374.22 ,"$2,981.44 ",$374.22 ,"$2,541.00 ","$2,541.00 ","$2,879.80 ","$2,879.80 ",$374.22 ,"$2,879.80 ",$374.22 ,"$2,676.52 ","$2,676.52 ","$2,676.52 ","$3,049.20 ",$898.34 ,"$3,049.20 ",$374.22 ,"$3,388.00 ","$2,219.14 ",$374.22 ,"$1,470.39 ", N/A ,$391.69 ,"$3,049.20 ",$810.99 ,"$2,137.83 ","$1,304.00 ","$3,049.20 ",$374.22 ,"$3,049.20 ","$3,049.20 ",$374.22 ,"$2,202.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000068,C8918,HC MRA PELVIS W/CON,610,1 ,"$3,697.00 ","$2,403.05 ",$374.22 ,"$3,697.00 ","$2,754.27 ","$2,421.54 ",$374.22 ,"$1,948.32 ",$374.22 ,"$2,332.81 ","$2,332.81 ","$2,332.81 ","$2,332.81 ","$3,327.30 ","$2,772.75 ",$374.22 ,"$3,253.36 ",$374.22 ,"$2,772.75 ","$2,772.75 ","$3,142.45 ","$3,142.45 ",$374.22 ,"$3,142.45 ",$374.22 ,"$2,920.63 ","$2,920.63 ","$2,920.63 ","$3,327.30 ",$898.34 ,"$3,327.30 ",$374.22 ,"$3,697.00 ","$2,421.54 ",$374.22 ,"$1,604.50 ", N/A ,$391.69 ,"$3,327.30 ",$810.99 ,"$2,332.81 ","$1,304.00 ","$3,327.30 ",$374.22 ,"$3,327.30 ","$3,327.30 ",$374.22 ,"$2,403.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000070,C8920,HC MRA PELVIS W AND W/O CONTRAST,610,1 ,"$1,686.00 ","$1,095.90 ",$374.22 ,"$1,686.00 ","$1,256.07 ","$1,104.33 ",$374.22 ,$888.52 ,$374.22 ,"$1,063.87 ","$1,063.87 ","$1,063.87 ","$1,063.87 ","$1,517.40 ","$1,264.50 ",$374.22 ,"$1,483.68 ",$374.22 ,"$1,264.50 ","$1,264.50 ","$1,433.10 ","$1,433.10 ",$374.22 ,"$1,433.10 ",$374.22 ,"$1,331.94 ","$1,331.94 ","$1,331.94 ","$1,517.40 ",$898.34 ,"$1,517.40 ",$374.22 ,"$1,686.00 ","$1,104.33 ",$374.22 ,$731.72 , N/A ,$391.69 ,"$1,517.40 ",$810.99 ,"$1,063.87 ","$1,304.00 ","$1,517.40 ",$374.22 ,"$1,517.40 ","$1,517.40 ",$374.22 ,"$1,095.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000071,C8934,HC MRA UPPR EXT W/CONTRAST,610,1 ,"$1,686.00 ","$1,095.90 ",$374.22 ,"$1,686.00 ","$1,256.07 ","$1,104.33 ",$374.22 ,$888.52 ,$374.22 ,"$1,063.87 ","$1,063.87 ","$1,063.87 ","$1,063.87 ","$1,517.40 ","$1,264.50 ",$374.22 ,"$1,483.68 ",$374.22 ,"$1,264.50 ","$1,264.50 ","$1,433.10 ","$1,433.10 ",$374.22 ,"$1,433.10 ",$374.22 ,"$1,331.94 ","$1,331.94 ","$1,331.94 ","$1,517.40 ",$898.34 ,"$1,517.40 ",$374.22 ,"$1,686.00 ","$1,104.33 ",$374.22 ,$731.72 , N/A ,$391.69 ,"$1,517.40 ",$810.99 ,"$1,063.87 ","$1,304.00 ","$1,517.40 ",$374.22 ,"$1,517.40 ","$1,517.40 ",$374.22 ,"$1,095.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000073,70553,HC MRI BRAIN W AND W/O CONTRAST PITUITARY,610,1 ,"$4,702.00 ","$3,056.30 ",$374.22 ,"$4,702.00 ","$3,502.99 ","$3,079.81 ",$374.22 ,"$2,477.95 ",$374.22 ,"$2,966.96 ","$2,966.96 ","$2,966.96 ","$2,966.96 ","$4,231.80 ","$3,526.50 ",$374.22 ,"$4,137.76 ",$374.22 ,"$3,526.50 ","$3,526.50 ","$3,996.70 ","$3,996.70 ",$374.22 ,"$3,996.70 ",$374.22 ,"$3,714.58 ","$3,714.58 ","$3,714.58 ","$4,231.80 ",$898.34 ,"$4,231.80 ",$374.22 ,"$4,702.00 ","$3,079.81 ",$374.22 ,"$2,040.67 ", N/A ,$391.69 ,"$4,231.80 ",$810.99 ,"$2,966.96 ","$1,304.00 ","$4,231.80 ",$374.22 ,"$4,231.80 ","$4,231.80 ",$374.22 ,"$3,056.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),61000076,70542,HC MRI ORBIT/FACE/NECK W/CONTRAST,610,1 ,"$3,176.00 ","$2,064.40 ",$374.22 ,"$3,176.00 ","$2,366.12 ","$2,080.28 ",$374.22 ,"$1,673.75 ",$374.22 ,"$2,004.06 ","$2,004.06 ","$2,004.06 ","$2,004.06 ","$2,858.40 ","$2,382.00 ",$374.22 ,"$2,794.88 ",$374.22 ,"$2,382.00 ","$2,382.00 ","$2,699.60 ","$2,699.60 ",$374.22 ,"$2,699.60 ",$374.22 ,"$2,509.04 ","$2,509.04 ","$2,509.04 ","$2,858.40 ",$898.34 ,"$2,858.40 ",$374.22 ,"$3,176.00 ","$2,080.28 ",$374.22 ,"$1,378.38 ", N/A ,$391.69 ,"$2,858.40 ",$810.99 ,"$2,004.06 ","$1,304.00 ","$2,858.40 ",$374.22 ,"$2,858.40 ","$2,858.40 ",$374.22 ,"$2,064.40 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),62300009,A6022,HC DRESSING COLLAGEN >16 = <48 SQ IN,623,1 ,$79.77 ,$51.85 ,$34.62 ,$79.77 ,$59.43 ,$52.25 , N/A ,$42.04 , N/A ,$50.33 ,$50.33 ,$50.33 ,$50.33 ,$71.79 ,$59.83 , N/A ,$70.20 , N/A ,$59.83 ,$59.83 ,$67.80 ,$67.80 , N/A ,$67.80 , N/A ,$63.02 ,$63.02 ,$63.02 ,$71.79 , N/A ,$71.79 , N/A ,$79.77 ,$52.25 , N/A ,$34.62 , N/A , N/A ,$71.79 , N/A ,$50.33 ,$47.86 ,$71.79 , N/A ,$71.79 ,$71.79 , N/A ,$51.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),62300010,A6197,HC DRESSING ALGINATE >16 = <48 SQ IN,623,1 ,$115.47 ,$75.06 ,$50.11 ,$115.47 ,$86.03 ,$75.63 , N/A ,$60.85 , N/A ,$72.86 ,$72.86 ,$72.86 ,$72.86 ,$103.92 ,$86.60 , N/A ,$101.61 , N/A ,$86.60 ,$86.60 ,$98.15 ,$98.15 , N/A ,$98.15 , N/A ,$91.22 ,$91.22 ,$91.22 ,$103.92 , N/A ,$103.92 , N/A ,$115.47 ,$75.63 , N/A ,$50.11 , N/A , N/A ,$103.92 , N/A ,$72.86 ,$69.28 ,$103.92 , N/A ,$103.92 ,$103.92 , N/A ,$75.06 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),62300024,A6211,HC DRESSING FOAM W/O BORDER BURN >48 SQ IN,623,1 ,$85.89 ,$55.83 ,$37.28 ,$85.89 ,$63.99 ,$56.26 , N/A ,$45.26 , N/A ,$54.20 ,$54.20 ,$54.20 ,$54.20 ,$77.30 ,$64.42 , N/A ,$75.58 , N/A ,$64.42 ,$64.42 ,$73.01 ,$73.01 , N/A ,$73.01 , N/A ,$67.85 ,$67.85 ,$67.85 ,$77.30 , N/A ,$77.30 , N/A ,$85.89 ,$56.26 , N/A ,$37.28 , N/A , N/A ,$77.30 , N/A ,$54.20 ,$51.53 ,$77.30 , N/A ,$77.30 ,$77.30 , N/A ,$55.83 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),62300031,A6448,HC BANDAGE COMPRESSION <3 IN PER YD,623,1 ,$107.33 ,$69.76 ,$46.58 ,$107.33 ,$79.96 ,$70.30 , N/A ,$56.56 , N/A ,$67.73 ,$67.73 ,$67.73 ,$67.73 ,$96.60 ,$80.50 , N/A ,$94.45 , N/A ,$80.50 ,$80.50 ,$91.23 ,$91.23 , N/A ,$91.23 , N/A ,$84.79 ,$84.79 ,$84.79 ,$96.60 , N/A ,$96.60 , N/A ,$107.33 ,$70.30 , N/A ,$46.58 , N/A , N/A ,$96.60 , N/A ,$67.73 ,$64.40 ,$96.60 , N/A ,$96.60 ,$96.60 , N/A ,$69.76 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),62300039,A6262,HC WOUND FILLER DRY NOS PER GRAM,623,1 ,$19.95 ,$12.97 ,$8.66 ,$19.95 ,$14.86 ,$13.07 , N/A ,$10.51 , N/A ,$12.59 ,$12.59 ,$12.59 ,$12.59 ,$17.96 ,$14.96 , N/A ,$17.56 , N/A ,$14.96 ,$14.96 ,$16.96 ,$16.96 , N/A ,$16.96 , N/A ,$15.76 ,$15.76 ,$15.76 ,$17.96 , N/A ,$17.96 , N/A ,$19.95 ,$13.07 , N/A ,$8.66 , N/A , N/A ,$17.96 , N/A ,$12.59 ,$11.97 ,$17.96 , N/A ,$17.96 ,$17.96 , N/A ,$12.97 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),63600183,Q4196,HC PURAPLY ANTIMICROBIAL PER SQ CENTIMETER USED - JC,636,1 ,$405.00 ,$263.25 ,$175.77 ,$405.00 ,$301.73 ,$265.28 , N/A ,$213.44 , N/A ,$255.56 ,$255.56 ,$255.56 ,$255.56 ,$364.50 ,$303.75 , N/A ,$356.40 , N/A ,$303.75 ,$303.75 ,$344.25 ,$344.25 , N/A ,$344.25 , N/A ,$319.95 ,$319.95 ,$319.95 ,$364.50 , N/A ,$364.50 , N/A ,$405.00 ,$265.28 , N/A ,$175.77 , N/A , N/A ,$364.50 , N/A ,$255.56 ,$243.00 ,$364.50 , N/A ,$364.50 ,$364.50 , N/A ,$263.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),63600184,Q4196,HC PURAPLY ANTIMICROBIAL PER SQ CENTIMETER WASTED - JW,636,1 ,$405.00 ,$263.25 ,$175.77 ,$405.00 ,$301.73 ,$265.28 , N/A ,$213.44 , N/A ,$255.56 ,$255.56 ,$255.56 ,$255.56 ,$364.50 ,$303.75 , N/A ,$356.40 , N/A ,$303.75 ,$303.75 ,$344.25 ,$344.25 , N/A ,$344.25 , N/A ,$319.95 ,$319.95 ,$319.95 ,$364.50 , N/A ,$364.50 , N/A ,$405.00 ,$265.28 , N/A ,$175.77 , N/A , N/A ,$364.50 , N/A ,$255.56 ,$243.00 ,$364.50 , N/A ,$364.50 ,$364.50 , N/A ,$263.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),63600185,Q4101,HC APLIGRAF PER SQ CM USED -JC,636,1 ,$142.58 ,$92.68 ,$61.88 ,$142.58 ,$106.22 ,$93.39 , N/A ,$75.14 , N/A ,$89.97 ,$89.97 ,$89.97 ,$89.97 ,$128.32 ,$106.94 , N/A ,$125.47 , N/A ,$106.94 ,$106.94 ,$121.19 ,$121.19 , N/A ,$121.19 , N/A ,$112.64 ,$112.64 ,$112.64 ,$128.32 , N/A ,$128.32 , N/A ,$142.58 ,$93.39 , N/A ,$61.88 , N/A , N/A ,$128.32 , N/A ,$89.97 ,$85.55 ,$128.32 , N/A ,$128.32 ,$128.32 , N/A ,$92.68 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),63600186,Q4101,HC APLIGRAF PER SQ CM WASTED - JW,636,1 ,$142.58 ,$92.68 ,$61.88 ,$142.58 ,$106.22 ,$93.39 , N/A ,$75.14 , N/A ,$89.97 ,$89.97 ,$89.97 ,$89.97 ,$128.32 ,$106.94 , N/A ,$125.47 , N/A ,$106.94 ,$106.94 ,$121.19 ,$121.19 , N/A ,$121.19 , N/A ,$112.64 ,$112.64 ,$112.64 ,$128.32 , N/A ,$128.32 , N/A ,$142.58 ,$93.39 , N/A ,$61.88 , N/A , N/A ,$128.32 , N/A ,$89.97 ,$85.55 ,$128.32 , N/A ,$128.32 ,$128.32 , N/A ,$92.68 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),63600187,Q4106,HC DERMAGRAFT PER SQ CM USED -JC,636,1 ,$173.65 ,$112.87 ,$75.36 ,$173.65 ,$129.37 ,$113.74 , N/A ,$91.51 , N/A ,$109.57 ,$109.57 ,$109.57 ,$109.57 ,$156.29 ,$130.24 , N/A ,$152.81 , N/A ,$130.24 ,$130.24 ,$147.60 ,$147.60 , N/A ,$147.60 , N/A ,$137.18 ,$137.18 ,$137.18 ,$156.29 , N/A ,$156.29 , N/A ,$173.65 ,$113.74 , N/A ,$75.36 , N/A , N/A ,$156.29 , N/A ,$109.57 ,$104.19 ,$156.29 , N/A ,$156.29 ,$156.29 , N/A ,$112.87 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),63600188,Q4106,HC DERMAGRAFT PER SQ CM WASTED -JW,636,1 ,$173.65 ,$112.87 ,$75.36 ,$173.65 ,$129.37 ,$113.74 , N/A ,$91.51 , N/A ,$109.57 ,$109.57 ,$109.57 ,$109.57 ,$156.29 ,$130.24 , N/A ,$152.81 , N/A ,$130.24 ,$130.24 ,$147.60 ,$147.60 , N/A ,$147.60 , N/A ,$137.18 ,$137.18 ,$137.18 ,$156.29 , N/A ,$156.29 , N/A ,$173.65 ,$113.74 , N/A ,$75.36 , N/A , N/A ,$156.29 , N/A ,$109.57 ,$104.19 ,$156.29 , N/A ,$156.29 ,$156.29 , N/A ,$112.87 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),63600191,Q4186,HC EPIFIX PER SQ CM USED- JC,636,1 ,$483.99 ,$314.59 ,$210.05 ,$483.99 ,$360.57 ,$317.01 , N/A ,$255.06 , N/A ,$305.40 ,$305.40 ,$305.40 ,$305.40 ,$435.59 ,$362.99 , N/A ,$425.91 , N/A ,$362.99 ,$362.99 ,$411.39 ,$411.39 , N/A ,$411.39 , N/A ,$382.35 ,$382.35 ,$382.35 ,$435.59 , N/A ,$435.59 , N/A ,$483.99 ,$317.01 , N/A ,$210.05 , N/A , N/A ,$435.59 , N/A ,$305.40 ,$290.39 ,$435.59 , N/A ,$435.59 ,$435.59 , N/A ,$314.59 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),63600192,Q4186,HC EPIFIX PER SQ CM WASTED - JW,636,1 ,$483.99 ,$314.59 ,$210.05 ,$483.99 ,$360.57 ,$317.01 , N/A ,$255.06 , N/A ,$305.40 ,$305.40 ,$305.40 ,$305.40 ,$435.59 ,$362.99 , N/A ,$425.91 , N/A ,$362.99 ,$362.99 ,$411.39 ,$411.39 , N/A ,$411.39 , N/A ,$382.35 ,$382.35 ,$382.35 ,$435.59 , N/A ,$435.59 , N/A ,$483.99 ,$317.01 , N/A ,$210.05 , N/A , N/A ,$435.59 , N/A ,$305.40 ,$290.39 ,$435.59 , N/A ,$435.59 ,$435.59 , N/A ,$314.59 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),63600195,Q4110,"HC PRIMATRIX, PER SQ CM USED - JC",636,1 ,$172.44 ,$112.09 ,$74.84 ,$172.44 ,$128.47 ,$112.95 , N/A ,$90.88 , N/A ,$108.81 ,$108.81 ,$108.81 ,$108.81 ,$155.20 ,$129.33 , N/A ,$151.75 , N/A ,$129.33 ,$129.33 ,$146.57 ,$146.57 , N/A ,$146.57 , N/A ,$136.23 ,$136.23 ,$136.23 ,$155.20 , N/A ,$155.20 , N/A ,$172.44 ,$112.95 , N/A ,$74.84 , N/A , N/A ,$155.20 , N/A ,$108.81 ,$103.46 ,$155.20 , N/A ,$155.20 ,$155.20 , N/A ,$112.09 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),63600196,Q4110,"HC PRIMATRIX, PER SQ CM WASTED - JW",636,1 ,$172.44 ,$112.09 ,$74.84 ,$172.44 ,$128.47 ,$112.95 , N/A ,$90.88 , N/A ,$108.81 ,$108.81 ,$108.81 ,$108.81 ,$155.20 ,$129.33 , N/A ,$151.75 , N/A ,$129.33 ,$129.33 ,$146.57 ,$146.57 , N/A ,$146.57 , N/A ,$136.23 ,$136.23 ,$136.23 ,$155.20 , N/A ,$155.20 , N/A ,$172.44 ,$112.95 , N/A ,$74.84 , N/A , N/A ,$155.20 , N/A ,$108.81 ,$103.46 ,$155.20 , N/A ,$155.20 ,$155.20 , N/A ,$112.09 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),63600197,Q4102,HC OASIS PER SQ CENTIMETER USED -JC,636,1 ,$19.18 ,$12.47 ,$8.32 ,$19.18 ,$14.29 ,$12.56 , N/A ,$10.11 , N/A ,$12.10 ,$12.10 ,$12.10 ,$12.10 ,$17.26 ,$14.39 , N/A ,$16.88 , N/A ,$14.39 ,$14.39 ,$16.30 ,$16.30 , N/A ,$16.30 , N/A ,$15.15 ,$15.15 ,$15.15 ,$17.26 , N/A ,$17.26 , N/A ,$19.18 ,$12.56 , N/A ,$8.32 , N/A , N/A ,$17.26 , N/A ,$12.10 ,$11.51 ,$17.26 , N/A ,$17.26 ,$17.26 , N/A ,$12.47 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),63600198,Q4102,HC OASIS PER SQ CENTIMETER WASTED -JW,636,1 ,$19.18 ,$12.47 ,$8.32 ,$19.18 ,$14.29 ,$12.56 , N/A ,$10.11 , N/A ,$12.10 ,$12.10 ,$12.10 ,$12.10 ,$17.26 ,$14.39 , N/A ,$16.88 , N/A ,$14.39 ,$14.39 ,$16.30 ,$16.30 , N/A ,$16.30 , N/A ,$15.15 ,$15.15 ,$15.15 ,$17.26 , N/A ,$17.26 , N/A ,$19.18 ,$12.56 , N/A ,$8.32 , N/A , N/A ,$17.26 , N/A ,$12.10 ,$11.51 ,$17.26 , N/A ,$17.26 ,$17.26 , N/A ,$12.47 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),63600215,Q4133,HC GRAFIX PER SQ CM USED - JC,636,1 ,$630.00 ,$409.50 ,$273.42 ,$630.00 ,$469.35 ,$412.65 , N/A ,$332.01 , N/A ,$397.53 ,$397.53 ,$397.53 ,$397.53 ,$567.00 ,$472.50 , N/A ,$554.40 , N/A ,$472.50 ,$472.50 ,$535.50 ,$535.50 , N/A ,$535.50 , N/A ,$497.70 ,$497.70 ,$497.70 ,$567.00 , N/A ,$567.00 , N/A ,$630.00 ,$412.65 , N/A ,$273.42 , N/A , N/A ,$567.00 , N/A ,$397.53 ,$378.00 ,$567.00 , N/A ,$567.00 ,$567.00 , N/A ,$409.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),63600216,Q4133,HC GRAFIX PER SQ CM WASTED - JW,636,1 ,$630.00 ,$409.50 ,$273.42 ,$630.00 ,$469.35 ,$412.65 , N/A ,$332.01 , N/A ,$397.53 ,$397.53 ,$397.53 ,$397.53 ,$567.00 ,$472.50 , N/A ,$554.40 , N/A ,$472.50 ,$472.50 ,$535.50 ,$535.50 , N/A ,$535.50 , N/A ,$497.70 ,$497.70 ,$497.70 ,$567.00 , N/A ,$567.00 , N/A ,$630.00 ,$412.65 , N/A ,$273.42 , N/A , N/A ,$567.00 , N/A ,$397.53 ,$378.00 ,$567.00 , N/A ,$567.00 ,$567.00 , N/A ,$409.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),71000220,N/A,HC C-SECTION RECOVERY,710,1 ,"$1,006.00 ",$653.90 ,$436.60 ,"$1,006.00 ",$749.47 ,$658.93 , N/A ,$530.16 , N/A ,$634.79 ,$634.79 ,$634.79 ,$634.79 ,$905.40 ,$754.50 , N/A ,$885.28 , N/A ,$754.50 ,$754.50 ,$855.10 ,$855.10 , N/A ,$855.10 , N/A ,$794.74 ,$794.74 ,$794.74 ,$905.40 , N/A ,$905.40 , N/A ,"$1,006.00 ",$658.93 , N/A ,$436.60 , N/A , N/A ,$905.40 , N/A ,$634.79 ,$603.60 ,$905.40 , N/A ,$905.40 ,$905.40 , N/A ,$653.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),71000230,N/A,HC PHASE II RECOVERY 15 MIN,710,1 ,$158.00 ,$102.70 ,$68.57 ,$158.00 ,$117.71 ,$103.49 , N/A ,$83.27 , N/A ,$99.70 ,$99.70 ,$99.70 ,$99.70 ,$142.20 ,$118.50 , N/A ,$139.04 , N/A ,$118.50 ,$118.50 ,$134.30 ,$134.30 , N/A ,$134.30 , N/A ,$124.82 ,$124.82 ,$124.82 ,$142.20 , N/A ,$142.20 , N/A ,$158.00 ,$103.49 , N/A ,$68.57 , N/A , N/A ,$142.20 , N/A ,$99.70 ,$94.80 ,$142.20 , N/A ,$142.20 ,$142.20 , N/A ,$102.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),71000231,N/A,HC RECOVERY <75 MIN,710,1 ,$828.32 ,$538.41 ,$359.49 ,$828.32 ,$617.10 ,$542.55 , N/A ,$436.52 , N/A ,$522.67 ,$522.67 ,$522.67 ,$522.67 ,$745.49 ,$621.24 , N/A ,$728.92 , N/A ,$621.24 ,$621.24 ,$704.07 ,$704.07 , N/A ,$704.07 , N/A ,$654.37 ,$654.37 ,$654.37 ,$745.49 , N/A ,$745.49 , N/A ,$828.32 ,$542.55 , N/A ,$359.49 , N/A , N/A ,$745.49 , N/A ,$522.67 ,$496.99 ,$745.49 , N/A ,$745.49 ,$745.49 , N/A ,$538.41 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),71000232,N/A,HC RECOVERY >75 MIN,710,1 ,$161.94 ,$105.26 ,$70.28 ,$161.94 ,$120.65 ,$106.07 , N/A ,$85.34 , N/A ,$102.18 ,$102.18 ,$102.18 ,$102.18 ,$145.75 ,$121.46 , N/A ,$142.51 , N/A ,$121.46 ,$121.46 ,$137.65 ,$137.65 , N/A ,$137.65 , N/A ,$127.93 ,$127.93 ,$127.93 ,$145.75 , N/A ,$145.75 , N/A ,$161.94 ,$106.07 , N/A ,$70.28 , N/A , N/A ,$145.75 , N/A ,$102.18 ,$97.16 ,$145.75 , N/A ,$145.75 ,$145.75 , N/A ,$105.26 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),71000233,N/A,HC PHASE I RECOVERY 30 MIN,710,1 ,"$1,213.00 ",$788.45 ,$526.44 ,"$1,213.00 ",$903.69 ,$794.52 , N/A ,$639.25 , N/A ,$765.40 ,$765.40 ,$765.40 ,$765.40 ,"$1,091.70 ",$909.75 , N/A ,"$1,067.44 ", N/A ,$909.75 ,$909.75 ,"$1,031.05 ","$1,031.05 ", N/A ,"$1,031.05 ", N/A ,$958.27 ,$958.27 ,$958.27 ,"$1,091.70 ", N/A ,"$1,091.70 ", N/A ,"$1,213.00 ",$794.52 , N/A ,$526.44 , N/A , N/A ,"$1,091.70 ", N/A ,$765.40 ,$727.80 ,"$1,091.70 ", N/A ,"$1,091.70 ","$1,091.70 ", N/A ,$788.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),71000234,N/A,HC PHASE I RECOVERY 15 MIN,710,1 ,$515.00 ,$334.75 ,$223.51 ,$515.00 ,$383.68 ,$337.33 , N/A ,$271.41 , N/A ,$324.97 ,$324.97 ,$324.97 ,$324.97 ,$463.50 ,$386.25 , N/A ,$453.20 , N/A ,$386.25 ,$386.25 ,$437.75 ,$437.75 , N/A ,$437.75 , N/A ,$406.85 ,$406.85 ,$406.85 ,$463.50 , N/A ,$463.50 , N/A ,$515.00 ,$337.33 , N/A ,$223.51 , N/A , N/A ,$463.50 , N/A ,$324.97 ,$309.00 ,$463.50 , N/A ,$463.50 ,$463.50 , N/A ,$334.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),71000252,N/A,HC RECOVERY EXTENDED INIT HR,710,1 ,$295.00 ,$191.75 ,$128.03 ,$295.00 ,$219.78 ,$193.23 , N/A ,$155.47 , N/A ,$186.15 ,$186.15 ,$186.15 ,$186.15 ,$265.50 ,$221.25 , N/A ,$259.60 , N/A ,$221.25 ,$221.25 ,$250.75 ,$250.75 , N/A ,$250.75 , N/A ,$233.05 ,$233.05 ,$233.05 ,$265.50 , N/A ,$265.50 , N/A ,$295.00 ,$193.23 , N/A ,$128.03 , N/A , N/A ,$265.50 , N/A ,$186.15 ,$177.00 ,$265.50 , N/A ,$265.50 ,$265.50 , N/A ,$191.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),71000253,N/A,HC RECOVERY EXTENDED ADDL HR,710,1 ,$98.00 ,$63.70 ,$42.53 ,$98.00 ,$73.01 ,$64.19 , N/A ,$51.65 , N/A ,$61.84 ,$61.84 ,$61.84 ,$61.84 ,$88.20 ,$73.50 , N/A ,$86.24 , N/A ,$73.50 ,$73.50 ,$83.30 ,$83.30 , N/A ,$83.30 , N/A ,$77.42 ,$77.42 ,$77.42 ,$88.20 , N/A ,$88.20 , N/A ,$98.00 ,$64.19 , N/A ,$42.53 , N/A , N/A ,$88.20 , N/A ,$61.84 ,$58.80 ,$88.20 , N/A ,$88.20 ,$88.20 , N/A ,$63.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),72000008,59412,HC EXTERNAL CEPHALIC VERSION,720,1 ,"$3,063.00 ","$1,990.95 ","$1,329.34 ","$5,779.05 ","$2,281.94 ","$2,006.27 ","$2,666.68 ","$1,614.20 ","$2,666.68 ","$1,932.75 ","$1,932.75 ","$1,932.75 ","$1,932.75 ","$2,756.70 ","$2,297.25 ","$2,666.68 ","$2,695.44 ","$2,666.68 ","$2,297.25 ","$2,297.25 ","$2,603.55 ","$2,603.55 ","$2,666.68 ","$2,603.55 ","$2,666.68 ","$2,419.77 ","$2,419.77 ","$2,419.77 ","$2,756.70 ","$3,063.00 ","$2,756.70 ","$2,666.68 ","$3,063.00 ","$2,006.27 ","$2,666.68 ","$1,329.34 ", N/A ,"$2,791.18 ","$2,756.70 ","$5,779.05 ","$1,932.75 ","$1,837.80 ","$2,756.70 ","$2,666.68 ","$2,756.70 ","$2,756.70 ","$2,666.68 ","$1,990.95 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),72000013,N/A,HC DELIVERY COMPLICATED,720,1 ,"$3,569.00 ","$2,319.85 ","$1,548.95 ","$3,569.00 ","$2,658.91 ","$2,337.70 ", N/A ,"$1,880.86 ", N/A ,"$2,252.04 ","$2,252.04 ","$2,252.04 ","$2,252.04 ","$3,212.10 ","$2,676.75 ", N/A ,"$3,140.72 ", N/A ,"$2,676.75 ","$2,676.75 ","$3,033.65 ","$3,033.65 ", N/A ,"$3,033.65 ", N/A ,"$2,819.51 ","$2,819.51 ","$2,819.51 ","$3,212.10 ", N/A ,"$3,212.10 ", N/A ,"$3,569.00 ","$2,337.70 ", N/A ,"$1,548.95 ", N/A , N/A ,"$3,212.10 ", N/A ,"$2,252.04 ","$2,141.40 ","$3,212.10 ", N/A ,"$3,212.10 ","$3,212.10 ", N/A ,"$2,319.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),72100005,N/A,HC LABOR PER HR,721,1 ,$113.00 ,$73.45 ,$49.04 ,$113.00 ,$84.19 ,$74.02 , N/A ,$59.55 , N/A ,$71.30 ,$71.30 ,$71.30 ,$71.30 ,$101.70 ,$84.75 , N/A ,$99.44 , N/A ,$84.75 ,$84.75 ,$96.05 ,$96.05 , N/A ,$96.05 , N/A ,$89.27 ,$89.27 ,$89.27 ,$101.70 , N/A ,$101.70 , N/A ,$113.00 ,$74.02 , N/A ,$49.04 , N/A , N/A ,$101.70 , N/A ,$71.30 ,$67.80 ,$101.70 , N/A ,$101.70 ,$101.70 , N/A ,$73.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),72200009,N/A,HC DELIVERY,722,1 ,"$2,054.00 ","$1,335.10 ",$891.44 ,"$2,054.00 ","$1,530.23 ","$1,345.37 ", N/A ,"$1,082.46 ", N/A ,"$1,296.07 ","$1,296.07 ","$1,296.07 ","$1,296.07 ","$1,848.60 ","$1,540.50 ", N/A ,"$1,807.52 ", N/A ,"$1,540.50 ","$1,540.50 ","$1,745.90 ","$1,745.90 ", N/A ,"$1,745.90 ", N/A ,"$1,622.66 ","$1,622.66 ","$1,622.66 ","$1,848.60 ", N/A ,"$1,848.60 ", N/A ,"$2,054.00 ","$1,345.37 ", N/A ,$891.44 , N/A , N/A ,"$1,848.60 ", N/A ,"$1,296.07 ","$1,232.40 ","$1,848.60 ", N/A ,"$1,848.60 ","$1,848.60 ", N/A ,"$1,335.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),72200014,N/A,HC C-SECTION,722,1 ,"$2,631.00 ","$1,710.15 ","$1,141.85 ","$2,631.00 ","$1,960.10 ","$1,723.31 ", N/A ,"$1,386.54 ", N/A ,"$1,660.16 ","$1,660.16 ","$1,660.16 ","$1,660.16 ","$2,367.90 ","$1,973.25 ", N/A ,"$2,315.28 ", N/A ,"$1,973.25 ","$1,973.25 ","$2,236.35 ","$2,236.35 ", N/A ,"$2,236.35 ", N/A ,"$2,078.49 ","$2,078.49 ","$2,078.49 ","$2,367.90 ", N/A ,"$2,367.90 ", N/A ,"$2,631.00 ","$1,723.31 ", N/A ,"$1,141.85 ", N/A , N/A ,"$2,367.90 ", N/A ,"$1,660.16 ","$1,578.60 ","$2,367.90 ", N/A ,"$2,367.90 ","$2,367.90 ", N/A ,"$1,710.15 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),72200015,N/A,HC C-SECTION COMPLICATED,722,1 ,"$4,362.00 ","$2,835.30 ","$1,893.11 ","$4,362.00 ","$3,249.69 ","$2,857.11 ", N/A ,"$2,298.77 ", N/A ,"$2,752.42 ","$2,752.42 ","$2,752.42 ","$2,752.42 ","$3,925.80 ","$3,271.50 ", N/A ,"$3,838.56 ", N/A ,"$3,271.50 ","$3,271.50 ","$3,707.70 ","$3,707.70 ", N/A ,"$3,707.70 ", N/A ,"$3,445.98 ","$3,445.98 ","$3,445.98 ","$3,925.80 ", N/A ,"$3,925.80 ", N/A ,"$4,362.00 ","$2,857.11 ", N/A ,"$1,893.11 ", N/A , N/A ,"$3,925.80 ", N/A ,"$2,752.42 ","$2,617.20 ","$3,925.80 ", N/A ,"$3,925.80 ","$3,925.80 ", N/A ,"$2,835.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),72300002,54160,HC CIRCUMCISION,723,1 ,$503.00 ,$326.95 ,$218.30 ,"$1,266.25 ",$374.74 ,$329.47 ,$503.00 ,$265.08 ,$503.00 ,$317.39 ,$317.39 ,$317.39 ,$317.39 ,$452.70 ,$377.25 ,$503.00 ,$442.64 ,$503.00 ,$377.25 ,$377.25 ,$427.55 ,$427.55 ,$503.00 ,$427.55 ,$503.00 ,$397.37 ,$397.37 ,$397.37 ,$452.70 ,$503.00 ,$452.70 ,$503.00 ,$503.00 ,$329.47 ,$503.00 ,$218.30 , N/A ,$503.00 ,$452.70 ,"$1,266.25 ",$317.39 ,$301.80 ,$452.70 ,$503.00 ,$452.70 ,$452.70 ,$503.00 ,$326.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),73000002,93005,HC EKG,730,1 ,$324.00 ,$210.60 ,$56.58 ,$324.00 ,$241.38 ,$212.22 ,$56.58 ,$170.75 ,$56.58 ,$204.44 ,$204.44 ,$204.44 ,$204.44 ,$291.60 ,$243.00 ,$56.58 ,$285.12 ,$56.58 ,$243.00 ,$243.00 ,$275.40 ,$275.40 ,$56.58 ,$275.40 ,$56.58 ,$255.96 ,$255.96 ,$255.96 ,$291.60 ,$135.83 ,$291.60 ,$56.58 ,$324.00 ,$212.22 ,$56.58 ,$140.62 , N/A ,$59.22 ,$291.60 ,$122.62 ,$204.44 ,$194.40 ,$291.60 ,$56.58 ,$291.60 ,$291.60 ,$56.58 ,$210.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),73100000,93225,HC HOLTER MONITOR RECORDING,731,1 ,$844.00 ,$548.60 ,$113.81 ,$844.00 ,$628.78 ,$552.82 ,$113.81 ,$444.79 ,$113.81 ,$532.56 ,$532.56 ,$532.56 ,$532.56 ,$759.60 ,$633.00 ,$113.81 ,$742.72 ,$113.81 ,$633.00 ,$633.00 ,$717.40 ,$717.40 ,$113.81 ,$717.40 ,$113.81 ,$666.76 ,$666.76 ,$666.76 ,$759.60 ,$273.20 ,$759.60 ,$113.81 ,$844.00 ,$552.82 ,$113.81 ,$366.30 , N/A ,$119.12 ,$759.60 ,$246.63 ,$532.56 ,$506.40 ,$759.60 ,$113.81 ,$759.60 ,$759.60 ,$113.81 ,$548.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),73100002,93226,HC HOLTER SCAN AND REPORT 48 HR,731,1 ,$859.00 ,$558.35 ,$113.81 ,$859.00 ,$639.96 ,$562.65 ,$113.81 ,$452.69 ,$113.81 ,$542.03 ,$542.03 ,$542.03 ,$542.03 ,$773.10 ,$644.25 ,$113.81 ,$755.92 ,$113.81 ,$644.25 ,$644.25 ,$730.15 ,$730.15 ,$113.81 ,$730.15 ,$113.81 ,$678.61 ,$678.61 ,$678.61 ,$773.10 ,$273.20 ,$773.10 ,$113.81 ,$859.00 ,$562.65 ,$113.81 ,$372.81 , N/A ,$119.12 ,$773.10 ,$246.63 ,$542.03 ,$515.40 ,$773.10 ,$113.81 ,$773.10 ,$773.10 ,$113.81 ,$558.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),73100004,93270,HC CARDIAC EVENT RECORDER,731,1 ,"$1,257.00 ",$817.05 ,$37.77 ,"$1,257.00 ",$936.47 ,$823.34 ,$37.77 ,$662.44 ,$37.77 ,$793.17 ,$793.17 ,$793.17 ,$793.17 ,"$1,131.30 ",$942.75 ,$37.77 ,"$1,106.16 ",$37.77 ,$942.75 ,$942.75 ,"$1,068.45 ","$1,068.45 ",$37.77 ,"$1,068.45 ",$37.77 ,$993.03 ,$993.03 ,$993.03 ,"$1,131.30 ",$90.66 ,"$1,131.30 ",$37.77 ,"$1,257.00 ",$823.34 ,$37.77 ,$545.54 , N/A ,$39.53 ,"$1,131.30 ",$81.84 ,$793.17 ,$754.20 ,"$1,131.30 ",$37.77 ,"$1,131.30 ","$1,131.30 ",$37.77 ,$817.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),74000002,95805,HC MULTIPLE SLEEP LATENCY,740,1 ,"$4,907.00 ","$3,189.55 ",$495.86 ,"$4,907.00 ","$3,655.72 ","$3,214.09 ",$495.86 ,"$2,585.99 ",$495.86 ,"$3,096.32 ","$3,096.32 ","$3,096.32 ","$3,096.32 ","$4,416.30 ","$3,680.25 ",$495.86 ,"$4,318.16 ",$495.86 ,"$3,680.25 ","$3,680.25 ","$4,170.95 ","$4,170.95 ",$495.86 ,"$4,170.95 ",$495.86 ,"$3,876.53 ","$3,876.53 ","$3,876.53 ","$4,416.30 ","$1,190.35 ","$4,416.30 ",$495.86 ,"$4,907.00 ","$3,214.09 ",$495.86 ,"$2,129.64 ", N/A ,$519.01 ,"$4,416.30 ","$1,074.60 ","$3,096.32 ","$2,944.20 ","$4,416.30 ",$495.86 ,"$4,416.30 ","$4,416.30 ",$495.86 ,"$3,189.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),74000006,95810,HC SLEEP STUDY,740,1 ,"$4,582.00 ","$2,978.30 ",$935.06 ,"$4,582.00 ","$3,413.59 ","$3,001.21 ",$935.06 ,"$2,414.71 ",$935.06 ,"$2,891.24 ","$2,891.24 ","$2,891.24 ","$2,891.24 ","$4,123.80 ","$3,436.50 ",$935.06 ,"$4,032.16 ",$935.06 ,"$3,436.50 ","$3,436.50 ","$3,894.70 ","$3,894.70 ",$935.06 ,"$3,894.70 ",$935.06 ,"$3,619.78 ","$3,619.78 ","$3,619.78 ","$4,123.80 ","$2,244.68 ","$4,123.80 ",$935.06 ,"$4,582.00 ","$3,001.21 ",$935.06 ,"$1,988.59 ", N/A ,$978.72 ,"$4,123.80 ","$2,026.41 ","$2,891.24 ","$2,749.20 ","$4,123.80 ",$935.06 ,"$4,123.80 ","$4,123.80 ",$935.06 ,"$2,978.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),74000009,95811,HC SLEEP STUDY W/CPAP,740,1 ,"$7,460.00 ","$4,849.00 ",$935.06 ,"$7,460.00 ","$5,557.70 ","$4,886.30 ",$935.06 ,"$3,931.42 ",$935.06 ,"$4,707.26 ","$4,707.26 ","$4,707.26 ","$4,707.26 ","$6,714.00 ","$5,595.00 ",$935.06 ,"$6,564.80 ",$935.06 ,"$5,595.00 ","$5,595.00 ","$6,341.00 ","$6,341.00 ",$935.06 ,"$6,341.00 ",$935.06 ,"$5,893.40 ","$5,893.40 ","$5,893.40 ","$6,714.00 ","$2,244.68 ","$6,714.00 ",$935.06 ,"$7,460.00 ","$4,886.30 ",$935.06 ,"$3,237.64 ", N/A ,$978.72 ,"$6,714.00 ","$2,026.41 ","$4,707.26 ","$4,476.00 ","$6,714.00 ",$935.06 ,"$6,714.00 ","$6,714.00 ",$935.06 ,"$4,849.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),74000014,95816,HC EEG AWAKE/DROWSY,740,1 ,"$1,075.00 ",$698.75 ,$268.83 ,"$1,075.00 ",$800.88 ,$704.13 ,$268.83 ,$566.53 ,$268.83 ,$678.33 ,$678.33 ,$678.33 ,$678.33 ,$967.50 ,$806.25 ,$268.83 ,$946.00 ,$268.83 ,$806.25 ,$806.25 ,$913.75 ,$913.75 ,$268.83 ,$913.75 ,$268.83 ,$849.25 ,$849.25 ,$849.25 ,$967.50 ,$645.35 ,$967.50 ,$268.83 ,"$1,075.00 ",$704.13 ,$268.83 ,$466.55 , N/A ,$281.38 ,$967.50 ,$582.60 ,$678.33 ,$645.00 ,$967.50 ,$268.83 ,$967.50 ,$967.50 ,$268.83 ,$698.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),74000016,95819,HC EEG AWAKE/ASLEEP,740,1 ,"$1,237.00 ",$804.05 ,$268.83 ,"$1,237.00 ",$921.57 ,$810.24 ,$268.83 ,$651.90 ,$268.83 ,$780.55 ,$780.55 ,$780.55 ,$780.55 ,"$1,113.30 ",$927.75 ,$268.83 ,"$1,088.56 ",$268.83 ,$927.75 ,$927.75 ,"$1,051.45 ","$1,051.45 ",$268.83 ,"$1,051.45 ",$268.83 ,$977.23 ,$977.23 ,$977.23 ,"$1,113.30 ",$645.35 ,"$1,113.30 ",$268.83 ,"$1,237.00 ",$810.24 ,$268.83 ,$536.86 , N/A ,$281.38 ,"$1,113.30 ",$582.60 ,$780.55 ,$742.20 ,"$1,113.30 ",$268.83 ,"$1,113.30 ","$1,113.30 ",$268.83 ,$804.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),74000023,95928,HC TCMEP UPPER LIMBS,740,1 ,$351.00 ,$228.15 ,$152.33 ,"$2,026.41 ",$261.50 ,$229.91 ,$351.00 ,$184.98 ,$351.00 ,$221.48 ,$221.48 ,$221.48 ,$221.48 ,$315.90 ,$263.25 ,$351.00 ,$308.88 ,$351.00 ,$263.25 ,$263.25 ,$298.35 ,$298.35 ,$351.00 ,$298.35 ,$351.00 ,$277.29 ,$277.29 ,$277.29 ,$315.90 ,$351.00 ,$315.90 ,$351.00 ,$351.00 ,$229.91 ,$351.00 ,$152.33 , N/A ,$351.00 ,$315.90 ,"$2,026.41 ",$221.48 ,$210.60 ,$315.90 ,$351.00 ,$315.90 ,$315.90 ,$351.00 ,$228.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),74000024,95929,HC TCMEP LWR LIMBS,740,1 ,$351.00 ,$228.15 ,$152.33 ,"$1,074.60 ",$261.50 ,$229.91 ,$351.00 ,$184.98 ,$351.00 ,$221.48 ,$221.48 ,$221.48 ,$221.48 ,$315.90 ,$263.25 ,$351.00 ,$308.88 ,$351.00 ,$263.25 ,$263.25 ,$298.35 ,$298.35 ,$351.00 ,$298.35 ,$351.00 ,$277.29 ,$277.29 ,$277.29 ,$315.90 ,$351.00 ,$315.90 ,$351.00 ,$351.00 ,$229.91 ,$351.00 ,$152.33 , N/A ,$351.00 ,$315.90 ,"$1,074.60 ",$221.48 ,$210.60 ,$315.90 ,$351.00 ,$315.90 ,$315.90 ,$351.00 ,$228.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),74000035,G0399,HC SLEEP STUDY HOME ADULT,740,1 ,"$1,447.00 ",$940.55 ,$141.86 ,"$1,447.00 ","$1,078.02 ",$947.79 ,$141.86 ,$762.57 ,$141.86 ,$913.06 ,$913.06 ,$913.06 ,$913.06 ,"$1,302.30 ","$1,085.25 ",$141.86 ,"$1,273.36 ",$141.86 ,"$1,085.25 ","$1,085.25 ","$1,229.95 ","$1,229.95 ",$141.86 ,"$1,229.95 ",$141.86 ,"$1,143.13 ","$1,143.13 ","$1,143.13 ","$1,302.30 ",$340.55 ,"$1,302.30 ",$141.86 ,"$1,447.00 ",$947.79 ,$141.86 ,$628.00 , N/A ,$148.49 ,"$1,302.30 ",$307.44 ,$913.06 ,$868.20 ,"$1,302.30 ",$141.86 ,"$1,302.30 ","$1,302.30 ",$141.86 ,$940.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),74000043,95940,HC NEURO TEST INTRAOPER PER 15MIN,740,1 ,$137.00 ,$89.05 ,$59.46 ,$137.00 ,$102.07 ,$89.74 , N/A ,$72.20 , N/A ,$86.45 ,$86.45 ,$86.45 ,$86.45 ,$123.30 ,$102.75 , N/A ,$120.56 , N/A ,$102.75 ,$102.75 ,$116.45 ,$116.45 , N/A ,$116.45 , N/A ,$108.23 ,$108.23 ,$108.23 ,$123.30 , N/A ,$123.30 , N/A ,$137.00 ,$89.74 , N/A ,$59.46 , N/A , N/A ,$123.30 , N/A ,$86.45 ,$82.20 ,$123.30 , N/A ,$123.30 ,$123.30 , N/A ,$89.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),74000044,95941,HC NEURO TEST INTRAOPER REMOTE/> 1 OR PER HR,740,1 ,$590.00 ,$383.50 ,$256.06 ,$590.00 ,$439.55 ,$386.45 , N/A ,$310.93 , N/A ,$372.29 ,$372.29 ,$372.29 ,$372.29 ,$531.00 ,$442.50 , N/A ,$519.20 , N/A ,$442.50 ,$442.50 ,$501.50 ,$501.50 , N/A ,$501.50 , N/A ,$466.10 ,$466.10 ,$466.10 ,$531.00 , N/A ,$531.00 , N/A ,$590.00 ,$386.45 , N/A ,$256.06 , N/A , N/A ,$531.00 , N/A ,$372.29 ,$354.00 ,$531.00 , N/A ,$531.00 ,$531.00 , N/A ,$383.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),74000045,95810,HC SLEEP STUDY PSG 4+ PARAMETERS >6YRS -52,740,1 ,"$4,582.00 ","$2,978.30 ",$935.06 ,"$4,582.00 ","$3,413.59 ","$3,001.21 ",$935.06 ,"$2,414.71 ",$935.06 ,"$2,891.24 ","$2,891.24 ","$2,891.24 ","$2,891.24 ","$4,123.80 ","$3,436.50 ",$935.06 ,"$4,032.16 ",$935.06 ,"$3,436.50 ","$3,436.50 ","$3,894.70 ","$3,894.70 ",$935.06 ,"$3,894.70 ",$935.06 ,"$3,619.78 ","$3,619.78 ","$3,619.78 ","$4,123.80 ","$2,244.68 ","$4,123.80 ",$935.06 ,"$4,582.00 ","$3,001.21 ",$935.06 ,"$1,988.59 ", N/A ,$978.72 ,"$4,123.80 ","$2,026.41 ","$2,891.24 ","$2,749.20 ","$4,123.80 ",$935.06 ,"$4,123.80 ","$4,123.80 ",$935.06 ,"$2,978.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),74000046,95811,HC SLEEP STUDY PSG 4+ PARAMTRS W/CPAP >6YR-52,740,1 ,"$7,460.00 ","$4,849.00 ",$935.06 ,"$7,460.00 ","$5,557.70 ","$4,886.30 ",$935.06 ,"$3,931.42 ",$935.06 ,"$4,707.26 ","$4,707.26 ","$4,707.26 ","$4,707.26 ","$6,714.00 ","$5,595.00 ",$935.06 ,"$6,564.80 ",$935.06 ,"$5,595.00 ","$5,595.00 ","$6,341.00 ","$6,341.00 ",$935.06 ,"$6,341.00 ",$935.06 ,"$5,893.40 ","$5,893.40 ","$5,893.40 ","$6,714.00 ","$2,244.68 ","$6,714.00 ",$935.06 ,"$7,460.00 ","$4,886.30 ",$935.06 ,"$3,237.64 ", N/A ,$978.72 ,"$6,714.00 ","$2,026.41 ","$4,707.26 ","$4,476.00 ","$6,714.00 ",$935.06 ,"$6,714.00 ","$6,714.00 ",$935.06 ,"$4,849.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),74000073,95807,HC SLEEP STUDY ATTENDED NAP-52,740,1 ,"$2,772.00 ","$1,801.80 ",$495.86 ,"$2,772.00 ","$2,065.14 ","$1,815.66 ",$495.86 ,"$1,460.84 ",$495.86 ,"$1,749.13 ","$1,749.13 ","$1,749.13 ","$1,749.13 ","$2,494.80 ","$2,079.00 ",$495.86 ,"$2,439.36 ",$495.86 ,"$2,079.00 ","$2,079.00 ","$2,356.20 ","$2,356.20 ",$495.86 ,"$2,356.20 ",$495.86 ,"$2,189.88 ","$2,189.88 ","$2,189.88 ","$2,494.80 ","$1,190.35 ","$2,494.80 ",$495.86 ,"$2,772.00 ","$1,815.66 ",$495.86 ,"$1,203.05 ", N/A ,$519.01 ,"$2,494.80 ","$1,074.60 ","$1,749.13 ","$1,663.20 ","$2,494.80 ",$495.86 ,"$2,494.80 ","$2,494.80 ",$495.86 ,"$1,801.80 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75000098,49083,HC PARACENTESIS W/IMAGING,750,1 ,"$1,255.00 ",$815.75 ,$544.67 ,"$1,783.59 ",$934.98 ,$822.03 ,$823.02 ,$661.39 ,$823.02 ,$791.91 ,$791.91 ,$791.91 ,$791.91 ,"$1,129.50 ",$941.25 ,$823.02 ,"$1,104.40 ",$823.02 ,$941.25 ,$941.25 ,"$1,066.75 ","$1,066.75 ",$823.02 ,"$1,066.75 ",$823.02 ,$991.45 ,$991.45 ,$991.45 ,"$1,129.50 ","$1,255.00 ","$1,129.50 ",$823.02 ,"$1,255.00 ",$822.03 ,$823.02 ,$544.67 , N/A ,$861.44 ,"$1,129.50 ","$1,783.59 ",$791.91 ,$753.00 ,"$1,129.50 ",$823.02 ,"$1,129.50 ","$1,129.50 ",$823.02 ,$815.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001062,43191,HC ESOPHAGOSCOPY RIGID W/BRUSH/WASH - 43191,750,1 ,"$1,946.00 ","$1,264.90 ",$844.56 ,"$3,580.00 ","$1,449.77 ","$1,274.63 ","$1,651.95 ","$1,025.54 ","$1,651.95 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,751.40 ","$1,459.50 ","$1,651.95 ","$1,712.48 ","$1,651.95 ","$1,459.50 ","$1,459.50 ","$1,654.10 ","$1,654.10 ","$1,651.95 ","$1,654.10 ","$1,651.95 ","$1,537.34 ","$1,537.34 ","$1,537.34 ","$1,751.40 ","$1,946.00 ","$1,751.40 ","$1,651.95 ","$1,946.00 ","$1,274.63 ","$1,651.95 ",$844.56 , N/A ,"$1,729.07 ","$1,751.40 ","$3,580.00 ","$1,227.93 ","$1,167.60 ","$1,751.40 ","$1,651.95 ","$1,751.40 ","$1,751.40 ","$1,651.95 ","$1,264.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001067,43202,HC ESOPHAGOSCOPY FLEXIBLE W/BIOPSY - 43202,750,1 ,"$1,575.00 ","$1,023.75 ",$683.55 ,"$3,580.00 ","$1,173.38 ","$1,031.63 ","$1,575.00 ",$830.03 ,"$1,575.00 ",$993.83 ,$993.83 ,$993.83 ,$993.83 ,"$1,417.50 ","$1,181.25 ","$1,575.00 ","$1,386.00 ","$1,575.00 ","$1,181.25 ","$1,181.25 ","$1,338.75 ","$1,338.75 ","$1,575.00 ","$1,338.75 ","$1,575.00 ","$1,244.25 ","$1,244.25 ","$1,244.25 ","$1,417.50 ","$1,575.00 ","$1,417.50 ","$1,575.00 ","$1,575.00 ","$1,031.63 ","$1,575.00 ",$683.55 , N/A ,"$1,575.00 ","$1,417.50 ","$3,580.00 ",$993.83 ,$945.00 ,"$1,417.50 ","$1,575.00 ","$1,417.50 ","$1,417.50 ","$1,575.00 ","$1,023.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001068,43215,HC ESOPHAGOSCOPY FLEXIBLE W/FB REMOVAL - 43215,750,1 ,"$1,946.00 ","$1,264.90 ",$844.56 ,"$3,580.00 ","$1,449.77 ","$1,274.63 ","$1,651.95 ","$1,025.54 ","$1,651.95 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,751.40 ","$1,459.50 ","$1,651.95 ","$1,712.48 ","$1,651.95 ","$1,459.50 ","$1,459.50 ","$1,654.10 ","$1,654.10 ","$1,651.95 ","$1,654.10 ","$1,651.95 ","$1,537.34 ","$1,537.34 ","$1,537.34 ","$1,751.40 ","$1,946.00 ","$1,751.40 ","$1,651.95 ","$1,946.00 ","$1,274.63 ","$1,651.95 ",$844.56 , N/A ,"$1,729.07 ","$1,751.40 ","$3,580.00 ","$1,227.93 ","$1,167.60 ","$1,751.40 ","$1,651.95 ","$1,751.40 ","$1,751.40 ","$1,651.95 ","$1,264.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001069,43220,HC ESOPHAGOSCOPY FLEXIBLE W/BALLOON DILATION - 43220,750,1 ,"$1,946.00 ","$1,264.90 ",$844.56 ,"$3,580.00 ","$1,449.77 ","$1,274.63 ","$1,651.95 ","$1,025.54 ","$1,651.95 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,751.40 ","$1,459.50 ","$1,651.95 ","$1,712.48 ","$1,651.95 ","$1,459.50 ","$1,459.50 ","$1,654.10 ","$1,654.10 ","$1,651.95 ","$1,654.10 ","$1,651.95 ","$1,537.34 ","$1,537.34 ","$1,537.34 ","$1,751.40 ","$1,946.00 ","$1,751.40 ","$1,651.95 ","$1,946.00 ","$1,274.63 ","$1,651.95 ",$844.56 , N/A ,"$1,729.07 ","$1,751.40 ","$3,580.00 ","$1,227.93 ","$1,167.60 ","$1,751.40 ","$1,651.95 ","$1,751.40 ","$1,751.40 ","$1,651.95 ","$1,264.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001071,43233,HC EGD W/BALLOON DILAT >30MM - 43233,750,1 ,"$1,946.00 ","$1,264.90 ",$844.56 ,"$3,580.00 ","$1,449.77 ","$1,274.63 ","$1,651.95 ","$1,025.54 ","$1,651.95 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,751.40 ","$1,459.50 ","$1,651.95 ","$1,712.48 ","$1,651.95 ","$1,459.50 ","$1,459.50 ","$1,654.10 ","$1,654.10 ","$1,651.95 ","$1,654.10 ","$1,651.95 ","$1,537.34 ","$1,537.34 ","$1,537.34 ","$1,751.40 ","$1,946.00 ","$1,751.40 ","$1,651.95 ","$1,946.00 ","$1,274.63 ","$1,651.95 ",$844.56 , N/A ,"$1,729.07 ","$1,751.40 ","$3,580.00 ","$1,227.93 ","$1,167.60 ","$1,751.40 ","$1,651.95 ","$1,751.40 ","$1,751.40 ","$1,651.95 ","$1,264.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001072,43235,HC EGD W/BRUSH/WASH - 43235,750,1 ,"$1,946.00 ","$1,264.90 ",$823.02 ,"$1,946.00 ","$1,449.77 ","$1,274.63 ",$823.02 ,"$1,025.54 ",$823.02 ,"$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,751.40 ","$1,459.50 ",$823.02 ,"$1,712.48 ",$823.02 ,"$1,459.50 ","$1,459.50 ","$1,654.10 ","$1,654.10 ",$823.02 ,"$1,654.10 ",$823.02 ,"$1,537.34 ","$1,537.34 ","$1,537.34 ","$1,751.40 ","$1,946.00 ","$1,751.40 ",$823.02 ,"$1,946.00 ","$1,274.63 ",$823.02 ,$844.56 , N/A ,$861.44 ,"$1,751.40 ","$1,783.59 ","$1,227.93 ","$1,167.60 ","$1,751.40 ",$823.02 ,"$1,751.40 ","$1,751.40 ",$823.02 ,"$1,264.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001073,43236,HC EGD W/SUBMUCOSAL INJ - 43236,750,1 ,"$1,946.00 ","$1,264.90 ",$823.02 ,"$1,946.00 ","$1,449.77 ","$1,274.63 ",$823.02 ,"$1,025.54 ",$823.02 ,"$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,751.40 ","$1,459.50 ",$823.02 ,"$1,712.48 ",$823.02 ,"$1,459.50 ","$1,459.50 ","$1,654.10 ","$1,654.10 ",$823.02 ,"$1,654.10 ",$823.02 ,"$1,537.34 ","$1,537.34 ","$1,537.34 ","$1,751.40 ","$1,946.00 ","$1,751.40 ",$823.02 ,"$1,946.00 ","$1,274.63 ",$823.02 ,$844.56 , N/A ,$861.44 ,"$1,751.40 ","$1,783.59 ","$1,227.93 ","$1,167.60 ","$1,751.40 ",$823.02 ,"$1,751.40 ","$1,751.40 ",$823.02 ,"$1,264.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001076,43239,HC EGD W/BIOPSY SGL/MULT - 43239,750,1 ,"$1,946.00 ","$1,264.90 ",$823.02 ,"$1,946.00 ","$1,449.77 ","$1,274.63 ",$823.02 ,"$1,025.54 ",$823.02 ,"$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,751.40 ","$1,459.50 ",$823.02 ,"$1,712.48 ",$823.02 ,"$1,459.50 ","$1,459.50 ","$1,654.10 ","$1,654.10 ",$823.02 ,"$1,654.10 ",$823.02 ,"$1,537.34 ","$1,537.34 ","$1,537.34 ","$1,751.40 ","$1,946.00 ","$1,751.40 ",$823.02 ,"$1,946.00 ","$1,274.63 ",$823.02 ,$844.56 , N/A ,$861.44 ,"$1,751.40 ","$1,783.59 ","$1,227.93 ","$1,167.60 ","$1,751.40 ",$823.02 ,"$1,751.40 ","$1,751.40 ",$823.02 ,"$1,264.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001081,43245,HC EGD W/DILAT STRICTURE - 43245,750,1 ,"$1,946.00 ","$1,264.90 ",$844.56 ,"$3,580.00 ","$1,449.77 ","$1,274.63 ","$1,651.95 ","$1,025.54 ","$1,651.95 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,751.40 ","$1,459.50 ","$1,651.95 ","$1,712.48 ","$1,651.95 ","$1,459.50 ","$1,459.50 ","$1,654.10 ","$1,654.10 ","$1,651.95 ","$1,654.10 ","$1,651.95 ","$1,537.34 ","$1,537.34 ","$1,537.34 ","$1,751.40 ","$1,946.00 ","$1,751.40 ","$1,651.95 ","$1,946.00 ","$1,274.63 ","$1,651.95 ",$844.56 , N/A ,"$1,729.07 ","$1,751.40 ","$3,580.00 ","$1,227.93 ","$1,167.60 ","$1,751.40 ","$1,651.95 ","$1,751.40 ","$1,751.40 ","$1,651.95 ","$1,264.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001082,43246,HC EGD W/PLACEMENT G-TUBE - 43246,750,1 ,"$1,946.00 ","$1,264.90 ",$844.56 ,"$3,580.00 ","$1,449.77 ","$1,274.63 ","$1,651.95 ","$1,025.54 ","$1,651.95 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,751.40 ","$1,459.50 ","$1,651.95 ","$1,712.48 ","$1,651.95 ","$1,459.50 ","$1,459.50 ","$1,654.10 ","$1,654.10 ","$1,651.95 ","$1,654.10 ","$1,651.95 ","$1,537.34 ","$1,537.34 ","$1,537.34 ","$1,751.40 ","$1,946.00 ","$1,751.40 ","$1,651.95 ","$1,946.00 ","$1,274.63 ","$1,651.95 ",$844.56 , N/A ,"$1,729.07 ","$1,751.40 ","$3,580.00 ","$1,227.93 ","$1,167.60 ","$1,751.40 ","$1,651.95 ","$1,751.40 ","$1,751.40 ","$1,651.95 ","$1,264.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001083,43247,HC EGD W/FB REMOVAL - 43247,750,1 ,"$1,946.00 ","$1,264.90 ",$823.02 ,"$1,946.00 ","$1,449.77 ","$1,274.63 ",$823.02 ,"$1,025.54 ",$823.02 ,"$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,751.40 ","$1,459.50 ",$823.02 ,"$1,712.48 ",$823.02 ,"$1,459.50 ","$1,459.50 ","$1,654.10 ","$1,654.10 ",$823.02 ,"$1,654.10 ",$823.02 ,"$1,537.34 ","$1,537.34 ","$1,537.34 ","$1,751.40 ","$1,946.00 ","$1,751.40 ",$823.02 ,"$1,946.00 ","$1,274.63 ",$823.02 ,$844.56 , N/A ,$861.44 ,"$1,751.40 ","$1,783.59 ","$1,227.93 ","$1,167.60 ","$1,751.40 ",$823.02 ,"$1,751.40 ","$1,751.40 ",$823.02 ,"$1,264.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001084,43248,HC EGD W/INSERT GUIDEWIRE - 43248,750,1 ,"$1,946.00 ","$1,264.90 ",$823.02 ,"$1,946.00 ","$1,449.77 ","$1,274.63 ",$823.02 ,"$1,025.54 ",$823.02 ,"$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,751.40 ","$1,459.50 ",$823.02 ,"$1,712.48 ",$823.02 ,"$1,459.50 ","$1,459.50 ","$1,654.10 ","$1,654.10 ",$823.02 ,"$1,654.10 ",$823.02 ,"$1,537.34 ","$1,537.34 ","$1,537.34 ","$1,751.40 ","$1,946.00 ","$1,751.40 ",$823.02 ,"$1,946.00 ","$1,274.63 ",$823.02 ,$844.56 , N/A ,$861.44 ,"$1,751.40 ","$1,783.59 ","$1,227.93 ","$1,167.60 ","$1,751.40 ",$823.02 ,"$1,751.40 ","$1,751.40 ",$823.02 ,"$1,264.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001085,43249,HC EGD W/BALLOON DILAT <30MM - 43249,750,1 ,"$1,946.00 ","$1,264.90 ",$844.56 ,"$3,580.00 ","$1,449.77 ","$1,274.63 ","$1,651.95 ","$1,025.54 ","$1,651.95 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,751.40 ","$1,459.50 ","$1,651.95 ","$1,712.48 ","$1,651.95 ","$1,459.50 ","$1,459.50 ","$1,654.10 ","$1,654.10 ","$1,651.95 ","$1,654.10 ","$1,651.95 ","$1,537.34 ","$1,537.34 ","$1,537.34 ","$1,751.40 ","$1,946.00 ","$1,751.40 ","$1,651.95 ","$1,946.00 ","$1,274.63 ","$1,651.95 ",$844.56 , N/A ,"$1,729.07 ","$1,751.40 ","$3,580.00 ","$1,227.93 ","$1,167.60 ","$1,751.40 ","$1,651.95 ","$1,751.40 ","$1,751.40 ","$1,651.95 ","$1,264.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001086,43250,HC EGD W/REMOVAL TUMOR/POLYP/LESN HOT BIOPSY - 43250,750,1 ,"$4,429.00 ","$2,878.85 ","$1,651.95 ","$4,429.00 ","$3,299.61 ","$2,901.00 ","$1,651.95 ","$2,334.08 ","$1,651.95 ","$2,794.70 ","$2,794.70 ","$2,794.70 ","$2,794.70 ","$3,986.10 ","$3,321.75 ","$1,651.95 ","$3,897.52 ","$1,651.95 ","$3,321.75 ","$3,321.75 ","$3,764.65 ","$3,764.65 ","$1,651.95 ","$3,764.65 ","$1,651.95 ","$3,498.91 ","$3,498.91 ","$3,498.91 ","$3,986.10 ","$3,965.60 ","$3,986.10 ","$1,651.95 ","$4,429.00 ","$2,901.00 ","$1,651.95 ","$1,922.19 ", N/A ,"$1,729.07 ","$3,986.10 ","$3,580.00 ","$2,794.70 ","$2,657.40 ","$3,986.10 ","$1,651.95 ","$3,986.10 ","$3,986.10 ","$1,651.95 ","$2,878.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001087,43251,HC EGD W/REMOVAL TUMOR/POLYP/LESN SNARE TECH - 43251,750,1 ,"$1,946.00 ","$1,264.90 ",$844.56 ,"$3,580.00 ","$1,449.77 ","$1,274.63 ","$1,651.95 ","$1,025.54 ","$1,651.95 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,751.40 ","$1,459.50 ","$1,651.95 ","$1,712.48 ","$1,651.95 ","$1,459.50 ","$1,459.50 ","$1,654.10 ","$1,654.10 ","$1,651.95 ","$1,654.10 ","$1,651.95 ","$1,537.34 ","$1,537.34 ","$1,537.34 ","$1,751.40 ","$1,946.00 ","$1,751.40 ","$1,651.95 ","$1,946.00 ","$1,274.63 ","$1,651.95 ",$844.56 , N/A ,"$1,729.07 ","$1,751.40 ","$3,580.00 ","$1,227.93 ","$1,167.60 ","$1,751.40 ","$1,651.95 ","$1,751.40 ","$1,751.40 ","$1,651.95 ","$1,264.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001090,43255,HC EGD W/CONTROL BLEEDING - 43255,750,1 ,"$1,946.00 ","$1,264.90 ",$844.56 ,"$3,580.00 ","$1,449.77 ","$1,274.63 ","$1,651.95 ","$1,025.54 ","$1,651.95 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,751.40 ","$1,459.50 ","$1,651.95 ","$1,712.48 ","$1,651.95 ","$1,459.50 ","$1,459.50 ","$1,654.10 ","$1,654.10 ","$1,651.95 ","$1,654.10 ","$1,651.95 ","$1,537.34 ","$1,537.34 ","$1,537.34 ","$1,751.40 ","$1,946.00 ","$1,751.40 ","$1,651.95 ","$1,946.00 ","$1,274.63 ","$1,651.95 ",$844.56 , N/A ,"$1,729.07 ","$1,751.40 ","$3,580.00 ","$1,227.93 ","$1,167.60 ","$1,751.40 ","$1,651.95 ","$1,751.40 ","$1,751.40 ","$1,651.95 ","$1,264.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001106,43450,HC ESOPHAGUS DILATION UNGUIDED SGL/MULT PASS - 43450,750,1 ,"$1,946.00 ","$1,264.90 ",$823.02 ,"$1,946.00 ","$1,449.77 ","$1,274.63 ",$823.02 ,"$1,025.54 ",$823.02 ,"$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,227.93 ","$1,751.40 ","$1,459.50 ",$823.02 ,"$1,712.48 ",$823.02 ,"$1,459.50 ","$1,459.50 ","$1,654.10 ","$1,654.10 ",$823.02 ,"$1,654.10 ",$823.02 ,"$1,537.34 ","$1,537.34 ","$1,537.34 ","$1,751.40 ","$1,946.00 ","$1,751.40 ",$823.02 ,"$1,946.00 ","$1,274.63 ",$823.02 ,$844.56 , N/A ,$861.44 ,"$1,751.40 ","$1,783.59 ","$1,227.93 ","$1,167.60 ","$1,751.40 ",$823.02 ,"$1,751.40 ","$1,751.40 ",$823.02 ,"$1,264.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001122,44382,HC ILEOSCOPY STOMA W/BIOPSY SGL/MULT - 44382,750,1 ,"$2,253.09 ","$1,464.51 ",$823.02 ,"$2,253.09 ","$1,678.55 ","$1,475.77 ",$823.02 ,"$1,187.38 ",$823.02 ,"$1,421.70 ","$1,421.70 ","$1,421.70 ","$1,421.70 ","$2,027.78 ","$1,689.82 ",$823.02 ,"$1,982.72 ",$823.02 ,"$1,689.82 ","$1,689.82 ","$1,915.13 ","$1,915.13 ",$823.02 ,"$1,915.13 ",$823.02 ,"$1,779.94 ","$1,779.94 ","$1,779.94 ","$2,027.78 ","$1,975.70 ","$2,027.78 ",$823.02 ,"$2,253.09 ","$1,475.77 ",$823.02 ,$977.84 , N/A ,$861.44 ,"$2,027.78 ","$1,783.59 ","$1,421.70 ","$1,351.85 ","$2,027.78 ",$823.02 ,"$2,027.78 ","$2,027.78 ",$823.02 ,"$1,464.51 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001124,44386,HC ENDOSCOPY POUCH W/BIOPSY SGL/MULT - 44386,750,1 ,"$2,265.00 ","$1,472.25 ",$806.80 ,"$2,265.00 ","$1,687.43 ","$1,483.58 ",$806.80 ,"$1,193.66 ",$806.80 ,"$1,429.22 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$2,038.50 ","$1,698.75 ",$806.80 ,"$1,993.20 ",$806.80 ,"$1,698.75 ","$1,698.75 ","$1,925.25 ","$1,925.25 ",$806.80 ,"$1,925.25 ",$806.80 ,"$1,789.35 ","$1,789.35 ","$1,789.35 ","$2,038.50 ","$1,936.78 ","$2,038.50 ",$806.80 ,"$2,265.00 ","$1,483.58 ",$806.80 ,$983.01 , N/A ,$844.47 ,"$2,038.50 ","$1,748.45 ","$1,429.22 ","$1,359.00 ","$2,038.50 ",$806.80 ,"$2,038.50 ","$2,038.50 ",$806.80 ,"$1,472.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001125,44388,HC COLONOSCOPY STOMA DX W/BRUSH/WASH - 44388,750,1 ,"$2,265.00 ","$1,472.25 ",$806.80 ,"$2,265.00 ","$1,687.43 ","$1,483.58 ",$806.80 ,"$1,193.66 ",$806.80 ,"$1,429.22 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$2,038.50 ","$1,698.75 ",$806.80 ,"$1,993.20 ",$806.80 ,"$1,698.75 ","$1,698.75 ","$1,925.25 ","$1,925.25 ",$806.80 ,"$1,925.25 ",$806.80 ,"$1,789.35 ","$1,789.35 ","$1,789.35 ","$2,038.50 ","$1,936.78 ","$2,038.50 ",$806.80 ,"$2,265.00 ","$1,483.58 ",$806.80 ,$983.01 , N/A ,$844.47 ,"$2,038.50 ","$1,748.45 ","$1,429.22 ","$1,359.00 ","$2,038.50 ",$806.80 ,"$2,038.50 ","$2,038.50 ",$806.80 ,"$1,472.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001126,44389,HC COLONOSCOPY STOMA W/BX SGL/MULT - 44389,750,1 ,"$2,265.00 ","$1,472.25 ",$983.01 ,"$2,284.47 ","$1,687.43 ","$1,483.58 ","$1,054.14 ","$1,193.66 ","$1,054.14 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$2,038.50 ","$1,698.75 ","$1,054.14 ","$1,993.20 ","$1,054.14 ","$1,698.75 ","$1,698.75 ","$1,925.25 ","$1,925.25 ","$1,054.14 ","$1,925.25 ","$1,054.14 ","$1,789.35 ","$1,789.35 ","$1,789.35 ","$2,038.50 ","$2,265.00 ","$2,038.50 ","$1,054.14 ","$2,265.00 ","$1,483.58 ","$1,054.14 ",$983.01 , N/A ,"$1,103.36 ","$2,038.50 ","$2,284.47 ","$1,429.22 ","$1,359.00 ","$2,038.50 ","$1,054.14 ","$2,038.50 ","$2,038.50 ","$1,054.14 ","$1,472.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001130,44394,HC COLONOSCOPY STOMA W/REM TUMOR SNARE TECH - 44394,750,1 ,"$2,265.00 ","$1,472.25 ",$983.01 ,"$2,284.47 ","$1,687.43 ","$1,483.58 ","$1,054.14 ","$1,193.66 ","$1,054.14 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$2,038.50 ","$1,698.75 ","$1,054.14 ","$1,993.20 ","$1,054.14 ","$1,698.75 ","$1,698.75 ","$1,925.25 ","$1,925.25 ","$1,054.14 ","$1,925.25 ","$1,054.14 ","$1,789.35 ","$1,789.35 ","$1,789.35 ","$2,038.50 ","$2,265.00 ","$2,038.50 ","$1,054.14 ","$2,265.00 ","$1,483.58 ","$1,054.14 ",$983.01 , N/A ,"$1,103.36 ","$2,038.50 ","$2,284.47 ","$1,429.22 ","$1,359.00 ","$2,038.50 ","$1,054.14 ","$2,038.50 ","$2,038.50 ","$1,054.14 ","$1,472.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001140,45307,HC PROCTOSIGMOIDOSCOPY RIGID W/FB REMOVAL - 45307,750,1 ,"$7,187.00 ","$4,671.55 ","$2,483.88 ","$7,187.00 ","$5,354.32 ","$4,707.49 ","$2,483.88 ","$3,787.55 ","$2,483.88 ","$4,535.00 ","$4,535.00 ","$4,535.00 ","$4,535.00 ","$6,468.30 ","$5,390.25 ","$2,483.88 ","$6,324.56 ","$2,483.88 ","$5,390.25 ","$5,390.25 ","$6,108.95 ","$6,108.95 ","$2,483.88 ","$6,108.95 ","$2,483.88 ","$5,677.73 ","$5,677.73 ","$5,677.73 ","$6,468.30 ","$5,962.71 ","$6,468.30 ","$2,483.88 ","$7,187.00 ","$4,707.49 ","$2,483.88 ","$3,119.16 ", N/A ,"$2,599.84 ","$6,468.30 ","$5,382.90 ","$4,535.00 ","$4,312.20 ","$6,468.30 ","$2,483.88 ","$6,468.30 ","$6,468.30 ","$2,483.88 ","$4,671.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001142,45330,HC SIGMOIDOSCOPY DX W/BRUSH/WASH - 45330,750,1 ,"$2,265.00 ","$1,472.25 ",$806.80 ,"$2,265.00 ","$1,687.43 ","$1,483.58 ",$806.80 ,"$1,193.66 ",$806.80 ,"$1,429.22 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$2,038.50 ","$1,698.75 ",$806.80 ,"$1,993.20 ",$806.80 ,"$1,698.75 ","$1,698.75 ","$1,925.25 ","$1,925.25 ",$806.80 ,"$1,925.25 ",$806.80 ,"$1,789.35 ","$1,789.35 ","$1,789.35 ","$2,038.50 ","$1,936.78 ","$2,038.50 ",$806.80 ,"$2,265.00 ","$1,483.58 ",$806.80 ,$983.01 , N/A ,$844.47 ,"$2,038.50 ","$1,748.45 ","$1,429.22 ","$1,359.00 ","$2,038.50 ",$806.80 ,"$2,038.50 ","$2,038.50 ",$806.80 ,"$1,472.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001143,45331,HC SIGMOIDOSCOPY W/BIOPSY SGL/MULT -45331,750,1 ,"$2,265.00 ","$1,472.25 ",$806.80 ,"$2,265.00 ","$1,687.43 ","$1,483.58 ",$806.80 ,"$1,193.66 ",$806.80 ,"$1,429.22 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$2,038.50 ","$1,698.75 ",$806.80 ,"$1,993.20 ",$806.80 ,"$1,698.75 ","$1,698.75 ","$1,925.25 ","$1,925.25 ",$806.80 ,"$1,925.25 ",$806.80 ,"$1,789.35 ","$1,789.35 ","$1,789.35 ","$2,038.50 ","$1,936.78 ","$2,038.50 ",$806.80 ,"$2,265.00 ","$1,483.58 ",$806.80 ,$983.01 , N/A ,$844.47 ,"$2,038.50 ","$1,748.45 ","$1,429.22 ","$1,359.00 ","$2,038.50 ",$806.80 ,"$2,038.50 ","$2,038.50 ",$806.80 ,"$1,472.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001144,45332,HC SIGMOIDOSCOPY W/FB REMOVAL -45332,750,1 ,"$2,904.00 ","$1,887.60 ","$1,054.14 ","$2,904.00 ","$2,163.48 ","$1,902.12 ","$1,054.14 ","$1,530.41 ","$1,054.14 ","$1,832.42 ","$1,832.42 ","$1,832.42 ","$1,832.42 ","$2,613.60 ","$2,178.00 ","$1,054.14 ","$2,555.52 ","$1,054.14 ","$2,178.00 ","$2,178.00 ","$2,468.40 ","$2,468.40 ","$1,054.14 ","$2,468.40 ","$1,054.14 ","$2,294.16 ","$2,294.16 ","$2,294.16 ","$2,613.60 ","$2,530.54 ","$2,613.60 ","$1,054.14 ","$2,904.00 ","$1,902.12 ","$1,054.14 ","$1,260.34 ", N/A ,"$1,103.36 ","$2,613.60 ","$2,284.47 ","$1,832.42 ","$1,742.40 ","$2,613.60 ","$1,054.14 ","$2,613.60 ","$2,613.60 ","$1,054.14 ","$1,887.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001145,45333,HC SIGMOIDOSCOPY W/REM TUMOR/POLYP/LESN HOT BIOPSY -45333,750,1 ,"$2,265.00 ","$1,472.25 ",$806.80 ,"$2,265.00 ","$1,687.43 ","$1,483.58 ",$806.80 ,"$1,193.66 ",$806.80 ,"$1,429.22 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$2,038.50 ","$1,698.75 ",$806.80 ,"$1,993.20 ",$806.80 ,"$1,698.75 ","$1,698.75 ","$1,925.25 ","$1,925.25 ",$806.80 ,"$1,925.25 ",$806.80 ,"$1,789.35 ","$1,789.35 ","$1,789.35 ","$2,038.50 ","$1,936.78 ","$2,038.50 ",$806.80 ,"$2,265.00 ","$1,483.58 ",$806.80 ,$983.01 , N/A ,$844.47 ,"$2,038.50 ","$1,748.45 ","$1,429.22 ","$1,359.00 ","$2,038.50 ",$806.80 ,"$2,038.50 ","$2,038.50 ",$806.80 ,"$1,472.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001147,45335,HC SIGMOIDOSCOPY W/SUBMUCOSAL INJ - 45335,750,1 ,"$2,265.00 ","$1,472.25 ",$806.80 ,"$2,265.00 ","$1,687.43 ","$1,483.58 ",$806.80 ,"$1,193.66 ",$806.80 ,"$1,429.22 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$2,038.50 ","$1,698.75 ",$806.80 ,"$1,993.20 ",$806.80 ,"$1,698.75 ","$1,698.75 ","$1,925.25 ","$1,925.25 ",$806.80 ,"$1,925.25 ",$806.80 ,"$1,789.35 ","$1,789.35 ","$1,789.35 ","$2,038.50 ","$1,936.78 ","$2,038.50 ",$806.80 ,"$2,265.00 ","$1,483.58 ",$806.80 ,$983.01 , N/A ,$844.47 ,"$2,038.50 ","$1,748.45 ","$1,429.22 ","$1,359.00 ","$2,038.50 ",$806.80 ,"$2,038.50 ","$2,038.50 ",$806.80 ,"$1,472.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001149,45338,HC SIGMOIDOSCOPY W/REM TUMOR/POLYP/LESN SNARE TECH - 45338,750,1 ,"$2,265.00 ","$1,472.25 ",$983.01 ,"$2,284.47 ","$1,687.43 ","$1,483.58 ","$1,054.14 ","$1,193.66 ","$1,054.14 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$2,038.50 ","$1,698.75 ","$1,054.14 ","$1,993.20 ","$1,054.14 ","$1,698.75 ","$1,698.75 ","$1,925.25 ","$1,925.25 ","$1,054.14 ","$1,925.25 ","$1,054.14 ","$1,789.35 ","$1,789.35 ","$1,789.35 ","$2,038.50 ","$2,265.00 ","$2,038.50 ","$1,054.14 ","$2,265.00 ","$1,483.58 ","$1,054.14 ",$983.01 , N/A ,"$1,103.36 ","$2,038.50 ","$2,284.47 ","$1,429.22 ","$1,359.00 ","$2,038.50 ","$1,054.14 ","$2,038.50 ","$2,038.50 ","$1,054.14 ","$1,472.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001157,45378,HC COLONOSCOPY DX W/SPECIMEN BRUSH/WASH - 45378,750,1 ,"$2,265.00 ","$1,472.25 ",$806.80 ,"$2,265.00 ","$1,687.43 ","$1,483.58 ",$806.80 ,"$1,193.66 ",$806.80 ,"$1,429.22 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$2,038.50 ","$1,698.75 ",$806.80 ,"$1,993.20 ",$806.80 ,"$1,698.75 ","$1,698.75 ","$1,925.25 ","$1,925.25 ",$806.80 ,"$1,925.25 ",$806.80 ,"$1,789.35 ","$1,789.35 ","$1,789.35 ","$2,038.50 ","$1,936.78 ","$2,038.50 ",$806.80 ,"$2,265.00 ","$1,483.58 ",$806.80 ,$983.01 , N/A ,$844.47 ,"$2,038.50 ","$1,748.45 ","$1,429.22 ","$1,359.00 ","$2,038.50 ",$806.80 ,"$2,038.50 ","$2,038.50 ",$806.80 ,"$1,472.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001158,45379,HC COLONOSCOPY W/FB REMOVAL - 45379,750,1 ,"$2,904.00 ","$1,887.60 ","$1,054.14 ","$2,904.00 ","$2,163.48 ","$1,902.12 ","$1,054.14 ","$1,530.41 ","$1,054.14 ","$1,832.42 ","$1,832.42 ","$1,832.42 ","$1,832.42 ","$2,613.60 ","$2,178.00 ","$1,054.14 ","$2,555.52 ","$1,054.14 ","$2,178.00 ","$2,178.00 ","$2,468.40 ","$2,468.40 ","$1,054.14 ","$2,468.40 ","$1,054.14 ","$2,294.16 ","$2,294.16 ","$2,294.16 ","$2,613.60 ","$2,530.54 ","$2,613.60 ","$1,054.14 ","$2,904.00 ","$1,902.12 ","$1,054.14 ","$1,260.34 ", N/A ,"$1,103.36 ","$2,613.60 ","$2,284.47 ","$1,832.42 ","$1,742.40 ","$2,613.60 ","$1,054.14 ","$2,613.60 ","$2,613.60 ","$1,054.14 ","$1,887.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001159,45380,HC COLONOSCOPY W/BIOPSY SGL/MULT - 45380,750,1 ,"$2,265.00 ","$1,472.25 ",$983.01 ,"$2,284.47 ","$1,687.43 ","$1,483.58 ","$1,054.14 ","$1,193.66 ","$1,054.14 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$2,038.50 ","$1,698.75 ","$1,054.14 ","$1,993.20 ","$1,054.14 ","$1,698.75 ","$1,698.75 ","$1,925.25 ","$1,925.25 ","$1,054.14 ","$1,925.25 ","$1,054.14 ","$1,789.35 ","$1,789.35 ","$1,789.35 ","$2,038.50 ","$2,265.00 ","$2,038.50 ","$1,054.14 ","$2,265.00 ","$1,483.58 ","$1,054.14 ",$983.01 , N/A ,"$1,103.36 ","$2,038.50 ","$2,284.47 ","$1,429.22 ","$1,359.00 ","$2,038.50 ","$1,054.14 ","$2,038.50 ","$2,038.50 ","$1,054.14 ","$1,472.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001160,45381,HC COLONOSCOPY W/SUBMUCOSAL INJ - 45381,750,1 ,"$2,265.00 ","$1,472.25 ",$983.01 ,"$2,284.47 ","$1,687.43 ","$1,483.58 ","$1,054.14 ","$1,193.66 ","$1,054.14 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$2,038.50 ","$1,698.75 ","$1,054.14 ","$1,993.20 ","$1,054.14 ","$1,698.75 ","$1,698.75 ","$1,925.25 ","$1,925.25 ","$1,054.14 ","$1,925.25 ","$1,054.14 ","$1,789.35 ","$1,789.35 ","$1,789.35 ","$2,038.50 ","$2,265.00 ","$2,038.50 ","$1,054.14 ","$2,265.00 ","$1,483.58 ","$1,054.14 ",$983.01 , N/A ,"$1,103.36 ","$2,038.50 ","$2,284.47 ","$1,429.22 ","$1,359.00 ","$2,038.50 ","$1,054.14 ","$2,038.50 ","$2,038.50 ","$1,054.14 ","$1,472.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001161,45382,HC COLONOSCOPY W/CONTROL BLEEDING - 45382,750,1 ,"$2,265.00 ","$1,472.25 ",$983.01 ,"$2,284.47 ","$1,687.43 ","$1,483.58 ","$1,054.14 ","$1,193.66 ","$1,054.14 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$2,038.50 ","$1,698.75 ","$1,054.14 ","$1,993.20 ","$1,054.14 ","$1,698.75 ","$1,698.75 ","$1,925.25 ","$1,925.25 ","$1,054.14 ","$1,925.25 ","$1,054.14 ","$1,789.35 ","$1,789.35 ","$1,789.35 ","$2,038.50 ","$2,265.00 ","$2,038.50 ","$1,054.14 ","$2,265.00 ","$1,483.58 ","$1,054.14 ",$983.01 , N/A ,"$1,103.36 ","$2,038.50 ","$2,284.47 ","$1,429.22 ","$1,359.00 ","$2,038.50 ","$1,054.14 ","$2,038.50 ","$2,038.50 ","$1,054.14 ","$1,472.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001162,45384,HC COLONOSCOPY W/REM TUMOR/POLYP/LESN HOT BIOPSY - 45384,750,1 ,"$2,265.00 ","$1,472.25 ",$983.01 ,"$2,284.47 ","$1,687.43 ","$1,483.58 ","$1,054.14 ","$1,193.66 ","$1,054.14 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$2,038.50 ","$1,698.75 ","$1,054.14 ","$1,993.20 ","$1,054.14 ","$1,698.75 ","$1,698.75 ","$1,925.25 ","$1,925.25 ","$1,054.14 ","$1,925.25 ","$1,054.14 ","$1,789.35 ","$1,789.35 ","$1,789.35 ","$2,038.50 ","$2,265.00 ","$2,038.50 ","$1,054.14 ","$2,265.00 ","$1,483.58 ","$1,054.14 ",$983.01 , N/A ,"$1,103.36 ","$2,038.50 ","$2,284.47 ","$1,429.22 ","$1,359.00 ","$2,038.50 ","$1,054.14 ","$2,038.50 ","$2,038.50 ","$1,054.14 ","$1,472.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001163,45385,HC COLONOSCOPY W/REM TUMOR/POLYP/LESN SNARE TECH - 45385,750,1 ,"$2,265.00 ","$1,472.25 ",$983.01 ,"$2,284.47 ","$1,687.43 ","$1,483.58 ","$1,054.14 ","$1,193.66 ","$1,054.14 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$2,038.50 ","$1,698.75 ","$1,054.14 ","$1,993.20 ","$1,054.14 ","$1,698.75 ","$1,698.75 ","$1,925.25 ","$1,925.25 ","$1,054.14 ","$1,925.25 ","$1,054.14 ","$1,789.35 ","$1,789.35 ","$1,789.35 ","$2,038.50 ","$2,265.00 ","$2,038.50 ","$1,054.14 ","$2,265.00 ","$1,483.58 ","$1,054.14 ",$983.01 , N/A ,"$1,103.36 ","$2,038.50 ","$2,284.47 ","$1,429.22 ","$1,359.00 ","$2,038.50 ","$1,054.14 ","$2,038.50 ","$2,038.50 ","$1,054.14 ","$1,472.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001165,45388,HC COLONOSCOPY W/ABLATION TUMOR - 45388,750,1 ,"$2,879.00 ","$1,871.35 ","$1,054.14 ","$2,879.00 ","$2,144.86 ","$1,885.75 ","$1,054.14 ","$1,517.23 ","$1,054.14 ","$1,816.65 ","$1,816.65 ","$1,816.65 ","$1,816.65 ","$2,591.10 ","$2,159.25 ","$1,054.14 ","$2,533.52 ","$1,054.14 ","$2,159.25 ","$2,159.25 ","$2,447.15 ","$2,447.15 ","$1,054.14 ","$2,447.15 ","$1,054.14 ","$2,274.41 ","$2,274.41 ","$2,274.41 ","$2,591.10 ","$2,530.54 ","$2,591.10 ","$1,054.14 ","$2,879.00 ","$1,885.75 ","$1,054.14 ","$1,249.49 ", N/A ,"$1,103.36 ","$2,591.10 ","$2,284.47 ","$1,816.65 ","$1,727.40 ","$2,591.10 ","$1,054.14 ","$2,591.10 ","$2,591.10 ","$1,054.14 ","$1,871.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001171,45398,HC COLONOSCOPY W/BAND LIGATION - 45398,750,1 ,"$3,059.00 ","$1,988.35 ","$1,054.14 ","$3,059.00 ","$2,278.96 ","$2,003.65 ","$1,054.14 ","$1,612.09 ","$1,054.14 ","$1,930.23 ","$1,930.23 ","$1,930.23 ","$1,930.23 ","$2,753.10 ","$2,294.25 ","$1,054.14 ","$2,691.92 ","$1,054.14 ","$2,294.25 ","$2,294.25 ","$2,600.15 ","$2,600.15 ","$1,054.14 ","$2,600.15 ","$1,054.14 ","$2,416.61 ","$2,416.61 ","$2,416.61 ","$2,753.10 ","$2,530.54 ","$2,753.10 ","$1,054.14 ","$3,059.00 ","$2,003.65 ","$1,054.14 ","$1,327.61 ", N/A ,"$1,103.36 ","$2,753.10 ","$2,284.47 ","$1,930.23 ","$1,835.40 ","$2,753.10 ","$1,054.14 ","$2,753.10 ","$2,753.10 ","$1,054.14 ","$1,988.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001173,46221,HC HERMORRHOIDECTOMY INTERNAL W/LIGATION - 46221,750,1 ,"$2,189.88 ","$1,423.42 ",$806.80 ,"$2,189.88 ","$1,631.46 ","$1,434.37 ",$806.80 ,"$1,154.07 ",$806.80 ,"$1,381.81 ","$1,381.81 ","$1,381.81 ","$1,381.81 ","$1,970.89 ","$1,642.41 ",$806.80 ,"$1,927.09 ",$806.80 ,"$1,642.41 ","$1,642.41 ","$1,861.40 ","$1,861.40 ",$806.80 ,"$1,861.40 ",$806.80 ,"$1,730.01 ","$1,730.01 ","$1,730.01 ","$1,970.89 ","$1,936.78 ","$1,970.89 ",$806.80 ,"$2,189.88 ","$1,434.37 ",$806.80 ,$950.41 , N/A ,$844.47 ,"$1,970.89 ","$1,748.45 ","$1,381.81 ","$1,313.93 ","$1,970.89 ",$806.80 ,"$1,970.89 ","$1,970.89 ",$806.80 ,"$1,423.42 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001176,46606,HC ANOSCOPY W/BIOPSY SGL/MULT - 46606,750,1 ,"$2,265.00 ","$1,472.25 ",$983.01 ,"$2,284.47 ","$1,687.43 ","$1,483.58 ","$1,054.14 ","$1,193.66 ","$1,054.14 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$1,429.22 ","$2,038.50 ","$1,698.75 ","$1,054.14 ","$1,993.20 ","$1,054.14 ","$1,698.75 ","$1,698.75 ","$1,925.25 ","$1,925.25 ","$1,054.14 ","$1,925.25 ","$1,054.14 ","$1,789.35 ","$1,789.35 ","$1,789.35 ","$2,038.50 ","$2,265.00 ","$2,038.50 ","$1,054.14 ","$2,265.00 ","$1,483.58 ","$1,054.14 ",$983.01 , N/A ,"$1,103.36 ","$2,038.50 ","$2,284.47 ","$1,429.22 ","$1,359.00 ","$2,038.50 ","$1,054.14 ","$2,038.50 ","$2,038.50 ","$1,054.14 ","$1,472.25 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001177,46610,HC ANOSCOPY W/REM TUMOR/POLYP/LESN HOT BIOPSY - 46610,750,1 ,"$6,720.30 ","$4,368.20 ","$2,483.88 ","$6,720.30 ","$5,006.62 ","$4,401.80 ","$2,483.88 ","$3,541.60 ","$2,483.88 ","$4,240.51 ","$4,240.51 ","$4,240.51 ","$4,240.51 ","$6,048.27 ","$5,040.23 ","$2,483.88 ","$5,913.86 ","$2,483.88 ","$5,040.23 ","$5,040.23 ","$5,712.26 ","$5,712.26 ","$2,483.88 ","$5,712.26 ","$2,483.88 ","$5,309.04 ","$5,309.04 ","$5,309.04 ","$6,048.27 ","$5,962.71 ","$6,048.27 ","$2,483.88 ","$6,720.30 ","$4,401.80 ","$2,483.88 ","$2,916.61 ", N/A ,"$2,599.84 ","$6,048.27 ","$5,382.90 ","$4,240.51 ","$4,032.18 ","$6,048.27 ","$2,483.88 ","$6,048.27 ","$6,048.27 ","$2,483.88 ","$4,368.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001201,45305,HC PROCTOSIGMOIDOSCOPY RIGID W/BX - 45305,750,1 ,"$1,787.00 ","$1,161.55 ",$775.56 ,"$2,284.47 ","$1,331.32 ","$1,170.49 ","$1,054.14 ",$941.75 ,"$1,054.14 ","$1,127.60 ","$1,127.60 ","$1,127.60 ","$1,127.60 ","$1,608.30 ","$1,340.25 ","$1,054.14 ","$1,572.56 ","$1,054.14 ","$1,340.25 ","$1,340.25 ","$1,518.95 ","$1,518.95 ","$1,054.14 ","$1,518.95 ","$1,054.14 ","$1,411.73 ","$1,411.73 ","$1,411.73 ","$1,608.30 ","$1,787.00 ","$1,608.30 ","$1,054.14 ","$1,787.00 ","$1,170.49 ","$1,054.14 ",$775.56 , N/A ,"$1,103.36 ","$1,608.30 ","$2,284.47 ","$1,127.60 ","$1,072.20 ","$1,608.30 ","$1,054.14 ","$1,608.30 ","$1,608.30 ","$1,054.14 ","$1,161.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001202,43762,HC REPLACE GASTRO TUBE PERC - 43762,750,1 ,$723.00 ,$469.95 ,$270.55 ,$723.00 ,$538.64 ,$473.57 ,$270.55 ,$381.02 ,$270.55 ,$456.21 ,$456.21 ,$456.21 ,$456.21 ,$650.70 ,$542.25 ,$270.55 ,$636.24 ,$270.55 ,$542.25 ,$542.25 ,$614.55 ,$614.55 ,$270.55 ,$614.55 ,$270.55 ,$571.17 ,$571.17 ,$571.17 ,$650.70 ,$649.47 ,$650.70 ,$270.55 ,$723.00 ,$473.57 ,$270.55 ,$313.78 , N/A ,$283.18 ,$650.70 ,$586.32 ,$456.21 ,$433.80 ,$650.70 ,$270.55 ,$650.70 ,$650.70 ,$270.55 ,$469.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001203,43763,HC REPLACE GASTRO TUBE PERC W/REVISE TRACT - 43763,750,1 ,$723.00 ,$469.95 ,$270.55 ,$723.00 ,$538.64 ,$473.57 ,$270.55 ,$381.02 ,$270.55 ,$456.21 ,$456.21 ,$456.21 ,$456.21 ,$650.70 ,$542.25 ,$270.55 ,$636.24 ,$270.55 ,$542.25 ,$542.25 ,$614.55 ,$614.55 ,$270.55 ,$614.55 ,$270.55 ,$571.17 ,$571.17 ,$571.17 ,$650.70 ,$649.47 ,$650.70 ,$270.55 ,$723.00 ,$473.57 ,$270.55 ,$313.78 , N/A ,$283.18 ,$650.70 ,$586.32 ,$456.21 ,$433.80 ,$650.70 ,$270.55 ,$650.70 ,$650.70 ,$270.55 ,$469.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001204,43999,HC REMOVE G TUBE W/ANESTHESIA - 43999,750,1 ,"$2,378.00 ","$1,545.70 ",$823.02 ,"$2,378.00 ","$1,771.61 ","$1,557.59 ",$823.02 ,"$1,253.21 ",$823.02 ,"$1,500.52 ","$1,500.52 ","$1,500.52 ","$1,500.52 ","$2,140.20 ","$1,783.50 ",$823.02 ,"$2,092.64 ",$823.02 ,"$1,783.50 ","$1,783.50 ","$2,021.30 ","$2,021.30 ",$823.02 ,"$2,021.30 ",$823.02 ,"$1,878.62 ","$1,878.62 ","$1,878.62 ","$2,140.20 ","$1,975.70 ","$2,140.20 ",$823.02 ,"$2,378.00 ","$1,557.59 ",$823.02 ,"$1,032.05 ", N/A ,$861.44 ,"$2,140.20 ","$1,783.59 ","$1,500.52 ","$1,426.80 ","$2,140.20 ",$823.02 ,"$2,140.20 ","$2,140.20 ",$823.02 ,"$1,545.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001205,46270,HC REMOVE ANAL FISTULA SUBQ 46270,750,1 ,"$6,720.30 ","$4,368.20 ","$2,483.88 ","$6,720.30 ","$5,006.62 ","$4,401.80 ","$2,483.88 ","$3,541.60 ","$2,483.88 ","$4,240.51 ","$4,240.51 ","$4,240.51 ","$4,240.51 ","$6,048.27 ","$5,040.23 ","$2,483.88 ","$5,913.86 ","$2,483.88 ","$5,040.23 ","$5,040.23 ","$5,712.26 ","$5,712.26 ","$2,483.88 ","$5,712.26 ","$2,483.88 ","$5,309.04 ","$5,309.04 ","$5,309.04 ","$6,048.27 ","$5,962.71 ","$6,048.27 ","$2,483.88 ","$6,720.30 ","$4,401.80 ","$2,483.88 ","$2,916.61 ", N/A ,"$2,599.84 ","$6,048.27 ","$5,382.90 ","$4,240.51 ","$4,032.18 ","$6,048.27 ","$2,483.88 ","$6,048.27 ","$6,048.27 ","$2,483.88 ","$4,368.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001206,46250,HC HEMORRHOIDECTOMY;EXT 2/MO 46250,750,1 ,"$6,720.30 ","$4,368.20 ","$2,483.88 ","$6,720.30 ","$5,006.62 ","$4,401.80 ","$2,483.88 ","$3,541.60 ","$2,483.88 ","$4,240.51 ","$4,240.51 ","$4,240.51 ","$4,240.51 ","$6,048.27 ","$5,040.23 ","$2,483.88 ","$5,913.86 ","$2,483.88 ","$5,040.23 ","$5,040.23 ","$5,712.26 ","$5,712.26 ","$2,483.88 ","$5,712.26 ","$2,483.88 ","$5,309.04 ","$5,309.04 ","$5,309.04 ","$6,048.27 ","$5,962.71 ","$6,048.27 ","$2,483.88 ","$6,720.30 ","$4,401.80 ","$2,483.88 ","$2,916.61 ", N/A ,"$2,599.84 ","$6,048.27 ","$5,382.90 ","$4,240.51 ","$4,032.18 ","$6,048.27 ","$2,483.88 ","$6,048.27 ","$6,048.27 ","$2,483.88 ","$4,368.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001207,46020,HC PLACEMENT OF SETON - 46020,750,1 ,"$6,720.30 ","$4,368.20 ","$2,483.88 ","$6,720.30 ","$5,006.62 ","$4,401.80 ","$2,483.88 ","$3,541.60 ","$2,483.88 ","$4,240.51 ","$4,240.51 ","$4,240.51 ","$4,240.51 ","$6,048.27 ","$5,040.23 ","$2,483.88 ","$5,913.86 ","$2,483.88 ","$5,040.23 ","$5,040.23 ","$5,712.26 ","$5,712.26 ","$2,483.88 ","$5,712.26 ","$2,483.88 ","$5,309.04 ","$5,309.04 ","$5,309.04 ","$6,048.27 ","$5,962.71 ","$6,048.27 ","$2,483.88 ","$6,720.30 ","$4,401.80 ","$2,483.88 ","$2,916.61 ", N/A ,"$2,599.84 ","$6,048.27 ","$5,382.90 ","$4,240.51 ","$4,032.18 ","$6,048.27 ","$2,483.88 ","$6,048.27 ","$6,048.27 ","$2,483.88 ","$4,368.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),75001209,46221,HC HEMORRHOIDECTOMY INTERNAL W/LIGATION-46221,750,1 ,"$2,189.88 ","$1,423.42 ",$806.80 ,"$2,189.88 ","$1,631.46 ","$1,434.37 ",$806.80 ,"$1,154.07 ",$806.80 ,"$1,381.81 ","$1,381.81 ","$1,381.81 ","$1,381.81 ","$1,970.89 ","$1,642.41 ",$806.80 ,"$1,927.09 ",$806.80 ,"$1,642.41 ","$1,642.41 ","$1,861.40 ","$1,861.40 ",$806.80 ,"$1,861.40 ",$806.80 ,"$1,730.01 ","$1,730.01 ","$1,730.01 ","$1,970.89 ","$1,936.78 ","$1,970.89 ",$806.80 ,"$2,189.88 ","$1,434.37 ",$806.80 ,$950.41 , N/A ,$844.47 ,"$1,970.89 ","$1,748.45 ","$1,381.81 ","$1,313.93 ","$1,970.89 ",$806.80 ,"$1,970.89 ","$1,970.89 ",$806.80 ,"$1,423.42 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76000014,62273,HC INJ EPIDURAL BLD/CLOT PATCH,760,1 ,"$3,894.00 ","$2,531.10 ",$645.11 ,"$3,894.00 ","$2,901.03 ","$2,550.57 ",$645.11 ,"$2,052.14 ",$645.11 ,"$2,457.11 ","$2,457.11 ","$2,457.11 ","$2,457.11 ","$3,504.60 ","$2,920.50 ",$645.11 ,"$3,426.72 ",$645.11 ,"$2,920.50 ","$2,920.50 ","$3,309.90 ","$3,309.90 ",$645.11 ,"$3,309.90 ",$645.11 ,"$3,076.26 ","$3,076.26 ","$3,076.26 ","$3,504.60 ","$1,548.62 ","$3,504.60 ",$645.11 ,"$3,894.00 ","$2,550.57 ",$645.11 ,"$1,690.00 ", N/A ,$675.22 ,"$3,504.60 ","$1,398.03 ","$2,457.11 ","$2,336.40 ","$3,504.60 ",$645.11 ,"$3,504.60 ","$3,504.60 ",$645.11 ,"$2,531.10 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100005,64615,HC CHEMODENERVATION FACE/NECK/SPINE MUSCLES BIL,761,1 ,"$1,059.00 ",$688.35 ,$265.50 ,"$1,059.00 ",$788.96 ,$693.65 ,$265.50 ,$558.09 ,$265.50 ,$668.23 ,$668.23 ,$668.23 ,$668.23 ,$953.10 ,$794.25 ,$265.50 ,$931.92 ,$265.50 ,$794.25 ,$794.25 ,$900.15 ,$900.15 ,$265.50 ,$900.15 ,$265.50 ,$836.61 ,$836.61 ,$836.61 ,$953.10 ,$637.34 ,$953.10 ,$265.50 ,"$1,059.00 ",$693.65 ,$265.50 ,$459.61 , N/A ,$277.89 ,$953.10 ,$575.37 ,$668.23 ,$635.40 ,$953.10 ,$265.50 ,$953.10 ,$953.10 ,$265.50 ,$688.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100006,64447,HC INJ ANES NERVE FEMORAL SINGLE-BI,761,1 ,"$2,548.00 ","$1,656.20 ",$645.11 ,"$2,548.00 ","$1,898.26 ","$1,668.94 ",$645.11 ,"$1,342.80 ",$645.11 ,"$1,607.79 ","$1,607.79 ","$1,607.79 ","$1,607.79 ","$2,293.20 ","$1,911.00 ",$645.11 ,"$2,242.24 ",$645.11 ,"$1,911.00 ","$1,911.00 ","$2,165.80 ","$2,165.80 ",$645.11 ,"$2,165.80 ",$645.11 ,"$2,012.92 ","$2,012.92 ","$2,012.92 ","$2,293.20 ","$1,548.62 ","$2,293.20 ",$645.11 ,"$2,548.00 ","$1,668.94 ",$645.11 ,"$1,105.83 ", N/A ,$675.22 ,"$2,293.20 ","$1,398.03 ","$1,607.79 ","$1,528.80 ","$2,293.20 ",$645.11 ,"$2,293.20 ","$2,293.20 ",$645.11 ,"$1,656.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100007,64447,HC INJ ANES NERVE FEMORAL SINGLE-LT,761,1 ,"$1,818.00 ","$1,181.70 ",$645.11 ,"$1,818.00 ","$1,354.41 ","$1,190.79 ",$645.11 ,$958.09 ,$645.11 ,"$1,147.16 ","$1,147.16 ","$1,147.16 ","$1,147.16 ","$1,636.20 ","$1,363.50 ",$645.11 ,"$1,599.84 ",$645.11 ,"$1,363.50 ","$1,363.50 ","$1,545.30 ","$1,545.30 ",$645.11 ,"$1,545.30 ",$645.11 ,"$1,436.22 ","$1,436.22 ","$1,436.22 ","$1,636.20 ","$1,548.62 ","$1,636.20 ",$645.11 ,"$1,818.00 ","$1,190.79 ",$645.11 ,$789.01 , N/A ,$675.22 ,"$1,636.20 ","$1,398.03 ","$1,147.16 ","$1,090.80 ","$1,636.20 ",$645.11 ,"$1,636.20 ","$1,636.20 ",$645.11 ,"$1,181.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100008,64447,HC INJ ANES NERVE FEMORAL SINGLE-RT,761,1 ,"$1,818.00 ","$1,181.70 ",$645.11 ,"$1,818.00 ","$1,354.41 ","$1,190.79 ",$645.11 ,$958.09 ,$645.11 ,"$1,147.16 ","$1,147.16 ","$1,147.16 ","$1,147.16 ","$1,636.20 ","$1,363.50 ",$645.11 ,"$1,599.84 ",$645.11 ,"$1,363.50 ","$1,363.50 ","$1,545.30 ","$1,545.30 ",$645.11 ,"$1,545.30 ",$645.11 ,"$1,436.22 ","$1,436.22 ","$1,436.22 ","$1,636.20 ","$1,548.62 ","$1,636.20 ",$645.11 ,"$1,818.00 ","$1,190.79 ",$645.11 ,$789.01 , N/A ,$675.22 ,"$1,636.20 ","$1,398.03 ","$1,147.16 ","$1,090.80 ","$1,636.20 ",$645.11 ,"$1,636.20 ","$1,636.20 ",$645.11 ,"$1,181.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100009,64425,HC INJ ANES NERVE ILIOINGUINAL-LT,761,1 ,"$1,698.00 ","$1,103.70 ",$645.11 ,"$1,698.00 ","$1,265.01 ","$1,112.19 ",$645.11 ,$894.85 ,$645.11 ,"$1,071.44 ","$1,071.44 ","$1,071.44 ","$1,071.44 ","$1,528.20 ","$1,273.50 ",$645.11 ,"$1,494.24 ",$645.11 ,"$1,273.50 ","$1,273.50 ","$1,443.30 ","$1,443.30 ",$645.11 ,"$1,443.30 ",$645.11 ,"$1,341.42 ","$1,341.42 ","$1,341.42 ","$1,528.20 ","$1,548.62 ","$1,528.20 ",$645.11 ,"$1,698.00 ","$1,112.19 ",$645.11 ,$736.93 , N/A ,$675.22 ,"$1,528.20 ","$1,398.03 ","$1,071.44 ","$1,018.80 ","$1,528.20 ",$645.11 ,"$1,528.20 ","$1,528.20 ",$645.11 ,"$1,103.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100010,64425,HC INJ ANES NERVE ILIOINGUINAL-RT,761,1 ,"$1,698.00 ","$1,103.70 ",$645.11 ,"$1,698.00 ","$1,265.01 ","$1,112.19 ",$645.11 ,$894.85 ,$645.11 ,"$1,071.44 ","$1,071.44 ","$1,071.44 ","$1,071.44 ","$1,528.20 ","$1,273.50 ",$645.11 ,"$1,494.24 ",$645.11 ,"$1,273.50 ","$1,273.50 ","$1,443.30 ","$1,443.30 ",$645.11 ,"$1,443.30 ",$645.11 ,"$1,341.42 ","$1,341.42 ","$1,341.42 ","$1,528.20 ","$1,548.62 ","$1,528.20 ",$645.11 ,"$1,698.00 ","$1,112.19 ",$645.11 ,$736.93 , N/A ,$675.22 ,"$1,528.20 ","$1,398.03 ","$1,071.44 ","$1,018.80 ","$1,528.20 ",$645.11 ,"$1,528.20 ","$1,528.20 ",$645.11 ,"$1,103.70 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100011,64450,HC INJ ANES NERVE PERIPHERAL-BI,761,1 ,"$2,548.00 ","$1,656.20 ",$645.11 ,"$2,548.00 ","$1,898.26 ","$1,668.94 ",$645.11 ,"$1,342.80 ",$645.11 ,"$1,607.79 ","$1,607.79 ","$1,607.79 ","$1,607.79 ","$2,293.20 ","$1,911.00 ",$645.11 ,"$2,242.24 ",$645.11 ,"$1,911.00 ","$1,911.00 ","$2,165.80 ","$2,165.80 ",$645.11 ,"$2,165.80 ",$645.11 ,"$2,012.92 ","$2,012.92 ","$2,012.92 ","$2,293.20 ","$1,548.62 ","$2,293.20 ",$645.11 ,"$2,548.00 ","$1,668.94 ",$645.11 ,"$1,105.83 ", N/A ,$675.22 ,"$2,293.20 ","$1,398.03 ","$1,607.79 ","$1,528.80 ","$2,293.20 ",$645.11 ,"$2,293.20 ","$2,293.20 ",$645.11 ,"$1,656.20 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100015,64405,HC INJ ANES NERVE GREAT OCCIPITAL-BI,761,1 ,"$1,382.00 ",$898.30 ,$265.50 ,"$1,382.00 ","$1,029.59 ",$905.21 ,$265.50 ,$728.31 ,$265.50 ,$872.04 ,$872.04 ,$872.04 ,$872.04 ,"$1,243.80 ","$1,036.50 ",$265.50 ,"$1,216.16 ",$265.50 ,"$1,036.50 ","$1,036.50 ","$1,174.70 ","$1,174.70 ",$265.50 ,"$1,174.70 ",$265.50 ,"$1,091.78 ","$1,091.78 ","$1,091.78 ","$1,243.80 ",$637.34 ,"$1,243.80 ",$265.50 ,"$1,382.00 ",$905.21 ,$265.50 ,$599.79 , N/A ,$277.89 ,"$1,243.80 ",$575.37 ,$872.04 ,$829.20 ,"$1,243.80 ",$265.50 ,"$1,243.80 ","$1,243.80 ",$265.50 ,$898.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100016,64405,HC INJ ANES NERVE GREAT OCCIPITAL-LT,761,1 ,$921.00 ,$598.65 ,$265.50 ,$921.00 ,$686.15 ,$603.26 ,$265.50 ,$485.37 ,$265.50 ,$581.15 ,$581.15 ,$581.15 ,$581.15 ,$828.90 ,$690.75 ,$265.50 ,$810.48 ,$265.50 ,$690.75 ,$690.75 ,$782.85 ,$782.85 ,$265.50 ,$782.85 ,$265.50 ,$727.59 ,$727.59 ,$727.59 ,$828.90 ,$637.34 ,$828.90 ,$265.50 ,$921.00 ,$603.26 ,$265.50 ,$399.71 , N/A ,$277.89 ,$828.90 ,$575.37 ,$581.15 ,$552.60 ,$828.90 ,$265.50 ,$828.90 ,$828.90 ,$265.50 ,$598.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100017,64405,HC INJ ANES NERVE GREAT OCCIPITAL-RT,761,1 ,$921.00 ,$598.65 ,$265.50 ,$921.00 ,$686.15 ,$603.26 ,$265.50 ,$485.37 ,$265.50 ,$581.15 ,$581.15 ,$581.15 ,$581.15 ,$828.90 ,$690.75 ,$265.50 ,$810.48 ,$265.50 ,$690.75 ,$690.75 ,$782.85 ,$782.85 ,$265.50 ,$782.85 ,$265.50 ,$727.59 ,$727.59 ,$727.59 ,$828.90 ,$637.34 ,$828.90 ,$265.50 ,$921.00 ,$603.26 ,$265.50 ,$399.71 , N/A ,$277.89 ,$828.90 ,$575.37 ,$581.15 ,$552.60 ,$828.90 ,$265.50 ,$828.90 ,$828.90 ,$265.50 ,$598.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100018,G0260,HC INJ ARTHROGRAM SACROILIAC-BI,761,1 ,"$5,006.00 ","$3,253.90 ",$645.11 ,"$5,006.00 ","$3,729.47 ","$3,278.93 ",$645.11 ,"$2,638.16 ",$645.11 ,"$3,158.79 ","$3,158.79 ","$3,158.79 ","$3,158.79 ","$4,505.40 ","$3,754.50 ",$645.11 ,"$4,405.28 ",$645.11 ,"$3,754.50 ","$3,754.50 ","$4,255.10 ","$4,255.10 ",$645.11 ,"$4,255.10 ",$645.11 ,"$3,954.74 ","$3,954.74 ","$3,954.74 ","$4,505.40 ","$1,548.62 ","$4,505.40 ",$645.11 ,"$5,006.00 ","$3,278.93 ",$645.11 ,"$2,172.60 ", N/A ,$675.22 ,"$4,505.40 ","$1,398.03 ","$3,158.79 ","$3,003.60 ","$4,505.40 ",$645.11 ,"$4,505.40 ","$4,505.40 ",$645.11 ,"$3,253.90 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100019,G0260,HC INJ ARTHROGRAM SACROILIAC-LT,761,1 ,"$3,337.00 ","$2,169.05 ",$645.11 ,"$3,337.00 ","$2,486.07 ","$2,185.74 ",$645.11 ,"$1,758.60 ",$645.11 ,"$2,105.65 ","$2,105.65 ","$2,105.65 ","$2,105.65 ","$3,003.30 ","$2,502.75 ",$645.11 ,"$2,936.56 ",$645.11 ,"$2,502.75 ","$2,502.75 ","$2,836.45 ","$2,836.45 ",$645.11 ,"$2,836.45 ",$645.11 ,"$2,636.23 ","$2,636.23 ","$2,636.23 ","$3,003.30 ","$1,548.62 ","$3,003.30 ",$645.11 ,"$3,337.00 ","$2,185.74 ",$645.11 ,"$1,448.26 ", N/A ,$675.22 ,"$3,003.30 ","$1,398.03 ","$2,105.65 ","$2,002.20 ","$3,003.30 ",$645.11 ,"$3,003.30 ","$3,003.30 ",$645.11 ,"$2,169.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100020,G0260,HC INJ ARTHROGRAM SACROILIAC-RT,761,1 ,"$3,337.00 ","$2,169.05 ",$645.11 ,"$3,337.00 ","$2,486.07 ","$2,185.74 ",$645.11 ,"$1,758.60 ",$645.11 ,"$2,105.65 ","$2,105.65 ","$2,105.65 ","$2,105.65 ","$3,003.30 ","$2,502.75 ",$645.11 ,"$2,936.56 ",$645.11 ,"$2,502.75 ","$2,502.75 ","$2,836.45 ","$2,836.45 ",$645.11 ,"$2,836.45 ",$645.11 ,"$2,636.23 ","$2,636.23 ","$2,636.23 ","$3,003.30 ","$1,548.62 ","$3,003.30 ",$645.11 ,"$3,337.00 ","$2,185.74 ",$645.11 ,"$1,448.26 ", N/A ,$675.22 ,"$3,003.30 ","$1,398.03 ","$2,105.65 ","$2,002.20 ","$3,003.30 ",$645.11 ,"$3,003.30 ","$3,003.30 ",$645.11 ,"$2,169.05 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100021,64484,HC INJ EPID LUMBAR/SACRAL ADDL,761,1 ,"$3,382.00 ","$2,198.30 ","$1,467.79 ","$3,382.00 ","$2,519.59 ","$2,215.21 ", N/A ,"$1,782.31 ", N/A ,"$2,134.04 ","$2,134.04 ","$2,134.04 ","$2,134.04 ","$3,043.80 ","$2,536.50 ", N/A ,"$2,976.16 ", N/A ,"$2,536.50 ","$2,536.50 ","$2,874.70 ","$2,874.70 ", N/A ,"$2,874.70 ", N/A ,"$2,671.78 ","$2,671.78 ","$2,671.78 ","$3,043.80 ", N/A ,"$3,043.80 ", N/A ,"$3,382.00 ","$2,215.21 ", N/A ,"$1,467.79 ", N/A , N/A ,"$3,043.80 ", N/A ,"$2,134.04 ","$2,029.20 ","$3,043.80 ", N/A ,"$3,043.80 ","$3,043.80 ", N/A ,"$2,198.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100022,64484,HC INJ EPID LUMBAR/SACRAL ADDL-LT,761,1 ,"$3,382.00 ","$2,198.30 ","$1,467.79 ","$3,382.00 ","$2,519.59 ","$2,215.21 ", N/A ,"$1,782.31 ", N/A ,"$2,134.04 ","$2,134.04 ","$2,134.04 ","$2,134.04 ","$3,043.80 ","$2,536.50 ", N/A ,"$2,976.16 ", N/A ,"$2,536.50 ","$2,536.50 ","$2,874.70 ","$2,874.70 ", N/A ,"$2,874.70 ", N/A ,"$2,671.78 ","$2,671.78 ","$2,671.78 ","$3,043.80 ", N/A ,"$3,043.80 ", N/A ,"$3,382.00 ","$2,215.21 ", N/A ,"$1,467.79 ", N/A , N/A ,"$3,043.80 ", N/A ,"$2,134.04 ","$2,029.20 ","$3,043.80 ", N/A ,"$3,043.80 ","$3,043.80 ", N/A ,"$2,198.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100023,64484,HC INJ EPID LUMBAR/SACRAL ADDL-RT,761,1 ,"$3,382.00 ","$2,198.30 ","$1,467.79 ","$3,382.00 ","$2,519.59 ","$2,215.21 ", N/A ,"$1,782.31 ", N/A ,"$2,134.04 ","$2,134.04 ","$2,134.04 ","$2,134.04 ","$3,043.80 ","$2,536.50 ", N/A ,"$2,976.16 ", N/A ,"$2,536.50 ","$2,536.50 ","$2,874.70 ","$2,874.70 ", N/A ,"$2,874.70 ", N/A ,"$2,671.78 ","$2,671.78 ","$2,671.78 ","$3,043.80 ", N/A ,"$3,043.80 ", N/A ,"$3,382.00 ","$2,215.21 ", N/A ,"$1,467.79 ", N/A , N/A ,"$3,043.80 ", N/A ,"$2,134.04 ","$2,029.20 ","$3,043.80 ", N/A ,"$3,043.80 ","$3,043.80 ", N/A ,"$2,198.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100024,64483,HC INJ EPID LUMBAR/SACRAL SGL-BI,761,1 ,"$6,670.00 ","$4,335.50 ",$836.09 ,"$6,670.00 ","$4,969.15 ","$4,368.85 ",$836.09 ,"$3,515.09 ",$836.09 ,"$4,208.77 ","$4,208.77 ","$4,208.77 ","$4,208.77 ","$6,003.00 ","$5,002.50 ",$836.09 ,"$5,869.60 ",$836.09 ,"$5,002.50 ","$5,002.50 ","$5,669.50 ","$5,669.50 ",$836.09 ,"$5,669.50 ",$836.09 ,"$5,269.30 ","$5,269.30 ","$5,269.30 ","$6,003.00 ","$2,007.08 ","$6,003.00 ",$836.09 ,"$6,670.00 ","$4,368.85 ",$836.09 ,"$2,894.78 ", N/A ,$875.12 ,"$6,003.00 ","$1,811.92 ","$4,208.77 ","$4,002.00 ","$6,003.00 ",$836.09 ,"$6,003.00 ","$6,003.00 ",$836.09 ,"$4,335.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100025,64483,HC INJ EPID LUMBAR/SACRAL SGL-LT,761,1 ,"$4,447.00 ","$2,890.55 ",$836.09 ,"$4,447.00 ","$3,313.02 ","$2,912.79 ",$836.09 ,"$2,343.57 ",$836.09 ,"$2,806.06 ","$2,806.06 ","$2,806.06 ","$2,806.06 ","$4,002.30 ","$3,335.25 ",$836.09 ,"$3,913.36 ",$836.09 ,"$3,335.25 ","$3,335.25 ","$3,779.95 ","$3,779.95 ",$836.09 ,"$3,779.95 ",$836.09 ,"$3,513.13 ","$3,513.13 ","$3,513.13 ","$4,002.30 ","$2,007.08 ","$4,002.30 ",$836.09 ,"$4,447.00 ","$2,912.79 ",$836.09 ,"$1,930.00 ", N/A ,$875.12 ,"$4,002.30 ","$1,811.92 ","$2,806.06 ","$2,668.20 ","$4,002.30 ",$836.09 ,"$4,002.30 ","$4,002.30 ",$836.09 ,"$2,890.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100026,64483,HC INJ EPID LUMBAR/SACRAL SGL-RT,761,1 ,"$4,447.00 ","$2,890.55 ",$836.09 ,"$4,447.00 ","$3,313.02 ","$2,912.79 ",$836.09 ,"$2,343.57 ",$836.09 ,"$2,806.06 ","$2,806.06 ","$2,806.06 ","$2,806.06 ","$4,002.30 ","$3,335.25 ",$836.09 ,"$3,913.36 ",$836.09 ,"$3,335.25 ","$3,335.25 ","$3,779.95 ","$3,779.95 ",$836.09 ,"$3,779.95 ",$836.09 ,"$3,513.13 ","$3,513.13 ","$3,513.13 ","$4,002.30 ","$2,007.08 ","$4,002.30 ",$836.09 ,"$4,447.00 ","$2,912.79 ",$836.09 ,"$1,930.00 ", N/A ,$875.12 ,"$4,002.30 ","$1,811.92 ","$2,806.06 ","$2,668.20 ","$4,002.30 ",$836.09 ,"$4,002.30 ","$4,002.30 ",$836.09 ,"$2,890.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100027,64479,HC INJ EPIDURAL CREV/THOR SGL-BI,761,1 ,"$6,853.00 ","$4,454.45 ",$836.09 ,"$6,853.00 ","$5,105.49 ","$4,488.72 ",$836.09 ,"$3,611.53 ",$836.09 ,"$4,324.24 ","$4,324.24 ","$4,324.24 ","$4,324.24 ","$6,167.70 ","$5,139.75 ",$836.09 ,"$6,030.64 ",$836.09 ,"$5,139.75 ","$5,139.75 ","$5,825.05 ","$5,825.05 ",$836.09 ,"$5,825.05 ",$836.09 ,"$5,413.87 ","$5,413.87 ","$5,413.87 ","$6,167.70 ","$2,007.08 ","$6,167.70 ",$836.09 ,"$6,853.00 ","$4,488.72 ",$836.09 ,"$2,974.20 ", N/A ,$875.12 ,"$6,167.70 ","$1,811.92 ","$4,324.24 ","$4,111.80 ","$6,167.70 ",$836.09 ,"$6,167.70 ","$6,167.70 ",$836.09 ,"$4,454.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100028,64479,HC INJ EPIDURAL CREV/THOR SGL-LT,761,1 ,"$4,569.00 ","$2,969.85 ",$836.09 ,"$4,569.00 ","$3,403.91 ","$2,992.70 ",$836.09 ,"$2,407.86 ",$836.09 ,"$2,883.04 ","$2,883.04 ","$2,883.04 ","$2,883.04 ","$4,112.10 ","$3,426.75 ",$836.09 ,"$4,020.72 ",$836.09 ,"$3,426.75 ","$3,426.75 ","$3,883.65 ","$3,883.65 ",$836.09 ,"$3,883.65 ",$836.09 ,"$3,609.51 ","$3,609.51 ","$3,609.51 ","$4,112.10 ","$2,007.08 ","$4,112.10 ",$836.09 ,"$4,569.00 ","$2,992.70 ",$836.09 ,"$1,982.95 ", N/A ,$875.12 ,"$4,112.10 ","$1,811.92 ","$2,883.04 ","$2,741.40 ","$4,112.10 ",$836.09 ,"$4,112.10 ","$4,112.10 ",$836.09 ,"$2,969.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100030,64490,HC INJ PARAVERT F JNT C/T 1 LV-BI,761,1 ,"$6,853.00 ","$4,454.45 ",$836.09 ,"$6,853.00 ","$5,105.49 ","$4,488.72 ",$836.09 ,"$3,611.53 ",$836.09 ,"$4,324.24 ","$4,324.24 ","$4,324.24 ","$4,324.24 ","$6,167.70 ","$5,139.75 ",$836.09 ,"$6,030.64 ",$836.09 ,"$5,139.75 ","$5,139.75 ","$5,825.05 ","$5,825.05 ",$836.09 ,"$5,825.05 ",$836.09 ,"$5,413.87 ","$5,413.87 ","$5,413.87 ","$6,167.70 ","$2,007.08 ","$6,167.70 ",$836.09 ,"$6,853.00 ","$4,488.72 ",$836.09 ,"$2,974.20 ", N/A ,$875.12 ,"$6,167.70 ","$1,811.92 ","$4,324.24 ","$4,111.80 ","$6,167.70 ",$836.09 ,"$6,167.70 ","$6,167.70 ",$836.09 ,"$4,454.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100031,64490,HC INJ PARAVERT F JNT C/T 1 LV-LT,761,1 ,"$4,569.00 ","$2,969.85 ",$836.09 ,"$4,569.00 ","$3,403.91 ","$2,992.70 ",$836.09 ,"$2,407.86 ",$836.09 ,"$2,883.04 ","$2,883.04 ","$2,883.04 ","$2,883.04 ","$4,112.10 ","$3,426.75 ",$836.09 ,"$4,020.72 ",$836.09 ,"$3,426.75 ","$3,426.75 ","$3,883.65 ","$3,883.65 ",$836.09 ,"$3,883.65 ",$836.09 ,"$3,609.51 ","$3,609.51 ","$3,609.51 ","$4,112.10 ","$2,007.08 ","$4,112.10 ",$836.09 ,"$4,569.00 ","$2,992.70 ",$836.09 ,"$1,982.95 ", N/A ,$875.12 ,"$4,112.10 ","$1,811.92 ","$2,883.04 ","$2,741.40 ","$4,112.10 ",$836.09 ,"$4,112.10 ","$4,112.10 ",$836.09 ,"$2,969.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100032,64490,HC INJ PARAVERT F JNT C/T 1 LV-RT,761,1 ,"$4,569.00 ","$2,969.85 ",$836.09 ,"$4,569.00 ","$3,403.91 ","$2,992.70 ",$836.09 ,"$2,407.86 ",$836.09 ,"$2,883.04 ","$2,883.04 ","$2,883.04 ","$2,883.04 ","$4,112.10 ","$3,426.75 ",$836.09 ,"$4,020.72 ",$836.09 ,"$3,426.75 ","$3,426.75 ","$3,883.65 ","$3,883.65 ",$836.09 ,"$3,883.65 ",$836.09 ,"$3,609.51 ","$3,609.51 ","$3,609.51 ","$4,112.10 ","$2,007.08 ","$4,112.10 ",$836.09 ,"$4,569.00 ","$2,992.70 ",$836.09 ,"$1,982.95 ", N/A ,$875.12 ,"$4,112.10 ","$1,811.92 ","$2,883.04 ","$2,741.40 ","$4,112.10 ",$836.09 ,"$4,112.10 ","$4,112.10 ",$836.09 ,"$2,969.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100033,64491,HC INJ PARAVERT F JNT C/T 2 LV,761,1 ,"$1,412.00 ",$917.80 ,$612.81 ,"$1,412.00 ","$1,051.94 ",$924.86 , N/A ,$744.12 , N/A ,$890.97 ,$890.97 ,$890.97 ,$890.97 ,"$1,270.80 ","$1,059.00 ", N/A ,"$1,242.56 ", N/A ,"$1,059.00 ","$1,059.00 ","$1,200.20 ","$1,200.20 ", N/A ,"$1,200.20 ", N/A ,"$1,115.48 ","$1,115.48 ","$1,115.48 ","$1,270.80 ", N/A ,"$1,270.80 ", N/A ,"$1,412.00 ",$924.86 , N/A ,$612.81 , N/A , N/A ,"$1,270.80 ", N/A ,$890.97 ,$847.20 ,"$1,270.80 ", N/A ,"$1,270.80 ","$1,270.80 ", N/A ,$917.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100034,64491,HC INJ PARAVERT F JNT C/T 2 LV-LT,761,1 ,"$1,412.00 ",$917.80 ,$612.81 ,"$1,412.00 ","$1,051.94 ",$924.86 , N/A ,$744.12 , N/A ,$890.97 ,$890.97 ,$890.97 ,$890.97 ,"$1,270.80 ","$1,059.00 ", N/A ,"$1,242.56 ", N/A ,"$1,059.00 ","$1,059.00 ","$1,200.20 ","$1,200.20 ", N/A ,"$1,200.20 ", N/A ,"$1,115.48 ","$1,115.48 ","$1,115.48 ","$1,270.80 ", N/A ,"$1,270.80 ", N/A ,"$1,412.00 ",$924.86 , N/A ,$612.81 , N/A , N/A ,"$1,270.80 ", N/A ,$890.97 ,$847.20 ,"$1,270.80 ", N/A ,"$1,270.80 ","$1,270.80 ", N/A ,$917.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100035,64491,HC INJ PARAVERT F JNT C/T 2 LV-RT,761,1 ,"$1,412.00 ",$917.80 ,$612.81 ,"$1,412.00 ","$1,051.94 ",$924.86 , N/A ,$744.12 , N/A ,$890.97 ,$890.97 ,$890.97 ,$890.97 ,"$1,270.80 ","$1,059.00 ", N/A ,"$1,242.56 ", N/A ,"$1,059.00 ","$1,059.00 ","$1,200.20 ","$1,200.20 ", N/A ,"$1,200.20 ", N/A ,"$1,115.48 ","$1,115.48 ","$1,115.48 ","$1,270.80 ", N/A ,"$1,270.80 ", N/A ,"$1,412.00 ",$924.86 , N/A ,$612.81 , N/A , N/A ,"$1,270.80 ", N/A ,$890.97 ,$847.20 ,"$1,270.80 ", N/A ,"$1,270.80 ","$1,270.80 ", N/A ,$917.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100036,64492,HC INJ PARAVERT F JNT C/T 3 LV,761,1 ,"$1,218.00 ",$791.70 ,$528.61 ,"$1,218.00 ",$907.41 ,$797.79 , N/A ,$641.89 , N/A ,$768.56 ,$768.56 ,$768.56 ,$768.56 ,"$1,096.20 ",$913.50 , N/A ,"$1,071.84 ", N/A ,$913.50 ,$913.50 ,"$1,035.30 ","$1,035.30 ", N/A ,"$1,035.30 ", N/A ,$962.22 ,$962.22 ,$962.22 ,"$1,096.20 ", N/A ,"$1,096.20 ", N/A ,"$1,218.00 ",$797.79 , N/A ,$528.61 , N/A , N/A ,"$1,096.20 ", N/A ,$768.56 ,$730.80 ,"$1,096.20 ", N/A ,"$1,096.20 ","$1,096.20 ", N/A ,$791.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100037,64492,HC INJ PARAVERT F JNT C/T 3 LV-LT,761,1 ,"$1,218.00 ",$791.70 ,$528.61 ,"$1,218.00 ",$907.41 ,$797.79 , N/A ,$641.89 , N/A ,$768.56 ,$768.56 ,$768.56 ,$768.56 ,"$1,096.20 ",$913.50 , N/A ,"$1,071.84 ", N/A ,$913.50 ,$913.50 ,"$1,035.30 ","$1,035.30 ", N/A ,"$1,035.30 ", N/A ,$962.22 ,$962.22 ,$962.22 ,"$1,096.20 ", N/A ,"$1,096.20 ", N/A ,"$1,218.00 ",$797.79 , N/A ,$528.61 , N/A , N/A ,"$1,096.20 ", N/A ,$768.56 ,$730.80 ,"$1,096.20 ", N/A ,"$1,096.20 ","$1,096.20 ", N/A ,$791.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100038,64492,HC INJ PARAVERT F JNT C/T 3 LV-RT,761,1 ,"$1,218.00 ",$791.70 ,$528.61 ,"$1,218.00 ",$907.41 ,$797.79 , N/A ,$641.89 , N/A ,$768.56 ,$768.56 ,$768.56 ,$768.56 ,"$1,096.20 ",$913.50 , N/A ,"$1,071.84 ", N/A ,$913.50 ,$913.50 ,"$1,035.30 ","$1,035.30 ", N/A ,"$1,035.30 ", N/A ,$962.22 ,$962.22 ,$962.22 ,"$1,096.20 ", N/A ,"$1,096.20 ", N/A ,"$1,218.00 ",$797.79 , N/A ,$528.61 , N/A , N/A ,"$1,096.20 ", N/A ,$768.56 ,$730.80 ,"$1,096.20 ", N/A ,"$1,096.20 ","$1,096.20 ", N/A ,$791.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100039,64493,HC INJ PARAVERT F JNT L/S 1 LV-BI,761,1 ,"$6,853.00 ","$4,454.45 ",$836.09 ,"$6,853.00 ","$5,105.49 ","$4,488.72 ",$836.09 ,"$3,611.53 ",$836.09 ,"$4,324.24 ","$4,324.24 ","$4,324.24 ","$4,324.24 ","$6,167.70 ","$5,139.75 ",$836.09 ,"$6,030.64 ",$836.09 ,"$5,139.75 ","$5,139.75 ","$5,825.05 ","$5,825.05 ",$836.09 ,"$5,825.05 ",$836.09 ,"$5,413.87 ","$5,413.87 ","$5,413.87 ","$6,167.70 ","$2,007.08 ","$6,167.70 ",$836.09 ,"$6,853.00 ","$4,488.72 ",$836.09 ,"$2,974.20 ", N/A ,$875.12 ,"$6,167.70 ","$1,811.92 ","$4,324.24 ","$4,111.80 ","$6,167.70 ",$836.09 ,"$6,167.70 ","$6,167.70 ",$836.09 ,"$4,454.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100040,64493,HC INJ PARAVERT F JNT L/S 1 LV-LT,761,1 ,"$4,569.00 ","$2,969.85 ",$836.09 ,"$4,569.00 ","$3,403.91 ","$2,992.70 ",$836.09 ,"$2,407.86 ",$836.09 ,"$2,883.04 ","$2,883.04 ","$2,883.04 ","$2,883.04 ","$4,112.10 ","$3,426.75 ",$836.09 ,"$4,020.72 ",$836.09 ,"$3,426.75 ","$3,426.75 ","$3,883.65 ","$3,883.65 ",$836.09 ,"$3,883.65 ",$836.09 ,"$3,609.51 ","$3,609.51 ","$3,609.51 ","$4,112.10 ","$2,007.08 ","$4,112.10 ",$836.09 ,"$4,569.00 ","$2,992.70 ",$836.09 ,"$1,982.95 ", N/A ,$875.12 ,"$4,112.10 ","$1,811.92 ","$2,883.04 ","$2,741.40 ","$4,112.10 ",$836.09 ,"$4,112.10 ","$4,112.10 ",$836.09 ,"$2,969.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100041,64493,HC INJ PARAVERT F JNT L/S 1 LV-RT,761,1 ,"$4,569.00 ","$2,969.85 ",$836.09 ,"$4,569.00 ","$3,403.91 ","$2,992.70 ",$836.09 ,"$2,407.86 ",$836.09 ,"$2,883.04 ","$2,883.04 ","$2,883.04 ","$2,883.04 ","$4,112.10 ","$3,426.75 ",$836.09 ,"$4,020.72 ",$836.09 ,"$3,426.75 ","$3,426.75 ","$3,883.65 ","$3,883.65 ",$836.09 ,"$3,883.65 ",$836.09 ,"$3,609.51 ","$3,609.51 ","$3,609.51 ","$4,112.10 ","$2,007.08 ","$4,112.10 ",$836.09 ,"$4,569.00 ","$2,992.70 ",$836.09 ,"$1,982.95 ", N/A ,$875.12 ,"$4,112.10 ","$1,811.92 ","$2,883.04 ","$2,741.40 ","$4,112.10 ",$836.09 ,"$4,112.10 ","$4,112.10 ",$836.09 ,"$2,969.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100042,64494,HC INJ PARAVERT F JNT L/S 2 LV,761,1 ,"$1,412.00 ",$917.80 ,$612.81 ,"$1,412.00 ","$1,051.94 ",$924.86 , N/A ,$744.12 , N/A ,$890.97 ,$890.97 ,$890.97 ,$890.97 ,"$1,270.80 ","$1,059.00 ", N/A ,"$1,242.56 ", N/A ,"$1,059.00 ","$1,059.00 ","$1,200.20 ","$1,200.20 ", N/A ,"$1,200.20 ", N/A ,"$1,115.48 ","$1,115.48 ","$1,115.48 ","$1,270.80 ", N/A ,"$1,270.80 ", N/A ,"$1,412.00 ",$924.86 , N/A ,$612.81 , N/A , N/A ,"$1,270.80 ", N/A ,$890.97 ,$847.20 ,"$1,270.80 ", N/A ,"$1,270.80 ","$1,270.80 ", N/A ,$917.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100043,64494,HC INJ PARAVERT F JNT L/S 2 LV-LT,761,1 ,"$1,412.00 ",$917.80 ,$612.81 ,"$1,412.00 ","$1,051.94 ",$924.86 , N/A ,$744.12 , N/A ,$890.97 ,$890.97 ,$890.97 ,$890.97 ,"$1,270.80 ","$1,059.00 ", N/A ,"$1,242.56 ", N/A ,"$1,059.00 ","$1,059.00 ","$1,200.20 ","$1,200.20 ", N/A ,"$1,200.20 ", N/A ,"$1,115.48 ","$1,115.48 ","$1,115.48 ","$1,270.80 ", N/A ,"$1,270.80 ", N/A ,"$1,412.00 ",$924.86 , N/A ,$612.81 , N/A , N/A ,"$1,270.80 ", N/A ,$890.97 ,$847.20 ,"$1,270.80 ", N/A ,"$1,270.80 ","$1,270.80 ", N/A ,$917.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100044,64494,HC INJ PARAVERT F JNT L/S 2 LV-RT,761,1 ,"$1,412.00 ",$917.80 ,$612.81 ,"$1,412.00 ","$1,051.94 ",$924.86 , N/A ,$744.12 , N/A ,$890.97 ,$890.97 ,$890.97 ,$890.97 ,"$1,270.80 ","$1,059.00 ", N/A ,"$1,242.56 ", N/A ,"$1,059.00 ","$1,059.00 ","$1,200.20 ","$1,200.20 ", N/A ,"$1,200.20 ", N/A ,"$1,115.48 ","$1,115.48 ","$1,115.48 ","$1,270.80 ", N/A ,"$1,270.80 ", N/A ,"$1,412.00 ",$924.86 , N/A ,$612.81 , N/A , N/A ,"$1,270.80 ", N/A ,$890.97 ,$847.20 ,"$1,270.80 ", N/A ,"$1,270.80 ","$1,270.80 ", N/A ,$917.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100045,64495,HC INJ PARAVRT F JNT L/S 3+ LV,761,1 ,"$1,412.00 ",$917.80 ,$612.81 ,"$1,412.00 ","$1,051.94 ",$924.86 , N/A ,$744.12 , N/A ,$890.97 ,$890.97 ,$890.97 ,$890.97 ,"$1,270.80 ","$1,059.00 ", N/A ,"$1,242.56 ", N/A ,"$1,059.00 ","$1,059.00 ","$1,200.20 ","$1,200.20 ", N/A ,"$1,200.20 ", N/A ,"$1,115.48 ","$1,115.48 ","$1,115.48 ","$1,270.80 ", N/A ,"$1,270.80 ", N/A ,"$1,412.00 ",$924.86 , N/A ,$612.81 , N/A , N/A ,"$1,270.80 ", N/A ,$890.97 ,$847.20 ,"$1,270.80 ", N/A ,"$1,270.80 ","$1,270.80 ", N/A ,$917.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100046,64495,HC INJ PARAVRT F JNT L/S 3+ LV-LT,761,1 ,"$1,412.00 ",$917.80 ,$612.81 ,"$1,412.00 ","$1,051.94 ",$924.86 , N/A ,$744.12 , N/A ,$890.97 ,$890.97 ,$890.97 ,$890.97 ,"$1,270.80 ","$1,059.00 ", N/A ,"$1,242.56 ", N/A ,"$1,059.00 ","$1,059.00 ","$1,200.20 ","$1,200.20 ", N/A ,"$1,200.20 ", N/A ,"$1,115.48 ","$1,115.48 ","$1,115.48 ","$1,270.80 ", N/A ,"$1,270.80 ", N/A ,"$1,412.00 ",$924.86 , N/A ,$612.81 , N/A , N/A ,"$1,270.80 ", N/A ,$890.97 ,$847.20 ,"$1,270.80 ", N/A ,"$1,270.80 ","$1,270.80 ", N/A ,$917.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100047,64495,HC INJ PARAVRT F JNT L/S 3+ LV-RT,761,1 ,"$1,412.00 ",$917.80 ,$612.81 ,"$1,412.00 ","$1,051.94 ",$924.86 , N/A ,$744.12 , N/A ,$890.97 ,$890.97 ,$890.97 ,$890.97 ,"$1,270.80 ","$1,059.00 ", N/A ,"$1,242.56 ", N/A ,"$1,059.00 ","$1,059.00 ","$1,200.20 ","$1,200.20 ", N/A ,"$1,200.20 ", N/A ,"$1,115.48 ","$1,115.48 ","$1,115.48 ","$1,270.80 ", N/A ,"$1,270.80 ", N/A ,"$1,412.00 ",$924.86 , N/A ,$612.81 , N/A , N/A ,"$1,270.80 ", N/A ,$890.97 ,$847.20 ,"$1,270.80 ", N/A ,"$1,270.80 ","$1,270.80 ", N/A ,$917.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100048,97607,HC NEG PRESS WOUND THERAPY WO DME<50CM,761,1 ,$891.00 ,$579.15 ,$351.57 ,$891.00 ,$663.80 ,$583.61 ,$351.57 ,$469.56 ,$351.57 ,$562.22 ,$562.22 ,$562.22 ,$562.22 ,$801.90 ,$668.25 ,$351.57 ,$784.08 ,$351.57 ,$668.25 ,$668.25 ,$757.35 ,$757.35 ,$351.57 ,$757.35 ,$351.57 ,$703.89 ,$703.89 ,$703.89 ,$801.90 ,$843.97 ,$801.90 ,$351.57 ,$891.00 ,$583.61 ,$351.57 ,$386.69 , N/A ,$367.98 ,$801.90 ,$761.90 ,$562.22 ,$534.60 ,$801.90 ,$351.57 ,$801.90 ,$801.90 ,$351.57 ,$579.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76100054,64999,HC GANGLION IMPAR BLOCK,761,1 ,"$6,369.00 ","$4,139.85 ",$265.50 ,"$6,369.00 ","$4,744.91 ","$4,171.70 ",$265.50 ,"$3,356.46 ",$265.50 ,"$4,018.84 ","$4,018.84 ","$4,018.84 ","$4,018.84 ","$5,732.10 ","$4,776.75 ",$265.50 ,"$5,604.72 ",$265.50 ,"$4,776.75 ","$4,776.75 ","$5,413.65 ","$5,413.65 ",$265.50 ,"$5,413.65 ",$265.50 ,"$5,031.51 ","$5,031.51 ","$5,031.51 ","$5,732.10 ",$637.34 ,"$5,732.10 ",$265.50 ,"$6,369.00 ","$4,171.70 ",$265.50 ,"$2,764.15 ", N/A ,$277.89 ,"$5,732.10 ",$575.37 ,"$4,018.84 ","$3,821.40 ","$5,732.10 ",$265.50 ,"$5,732.10 ","$5,732.10 ",$265.50 ,"$4,139.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76200008,G0379,HC OBSERVATION DIRECT ADMIT,762,1 ,"$1,770.00 ","$1,150.50 ",$768.18 ,"$1,770.00 ","$1,318.65 ","$1,159.35 ", N/A ,$932.79 , N/A ,"$1,116.87 ","$1,116.87 ","$1,116.87 ","$1,116.87 ","$1,593.00 ","$1,327.50 ", N/A ,"$1,557.60 ", N/A ,"$1,327.50 ","$1,327.50 ","$1,504.50 ","$1,504.50 ", N/A ,"$1,504.50 ", N/A ,"$1,398.30 ","$1,398.30 ","$1,398.30 ","$1,593.00 ", N/A ,"$1,593.00 ", N/A ,"$1,770.00 ","$1,159.35 ", N/A ,$768.18 , N/A , N/A ,"$1,593.00 ", N/A ,"$1,116.87 ","$1,062.00 ","$1,593.00 ", N/A ,"$1,593.00 ","$1,593.00 ", N/A ,"$1,150.50 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76200009,G0378,HC OBSERVATION HOURLY,762,1 ,$81.00 ,$52.65 ,$35.15 ,$81.00 ,$60.35 ,$53.06 , N/A ,$42.69 , N/A ,$51.11 ,$51.11 ,$51.11 ,$51.11 ,$72.90 ,$60.75 , N/A ,$71.28 , N/A ,$60.75 ,$60.75 ,$68.85 ,$68.85 , N/A ,$68.85 , N/A ,$63.99 ,$63.99 ,$63.99 ,$72.90 , N/A ,$72.90 , N/A ,$81.00 ,$53.06 , N/A ,$35.15 , N/A , N/A ,$72.90 , N/A ,$51.11 ,$48.60 ,$72.90 , N/A ,$72.90 ,$72.90 , N/A ,$52.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76200020,G0378,HC OBSERVATION W/INTENSIVE CARE PER HR,762,1 ,$81.00 ,$52.65 ,$35.15 ,$81.00 ,$60.35 ,$53.06 , N/A ,$42.69 , N/A ,$51.11 ,$51.11 ,$51.11 ,$51.11 ,$72.90 ,$60.75 , N/A ,$71.28 , N/A ,$60.75 ,$60.75 ,$68.85 ,$68.85 , N/A ,$68.85 , N/A ,$63.99 ,$63.99 ,$63.99 ,$72.90 , N/A ,$72.90 , N/A ,$81.00 ,$53.06 , N/A ,$35.15 , N/A , N/A ,$72.90 , N/A ,$51.11 ,$48.60 ,$72.90 , N/A ,$72.90 ,$72.90 , N/A ,$52.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76200021,G0378,HC OBSERVATION W/INTERMEDIATE CARE PER HR,762,1 ,$81.00 ,$52.65 ,$35.15 ,$81.00 ,$60.35 ,$53.06 , N/A ,$42.69 , N/A ,$51.11 ,$51.11 ,$51.11 ,$51.11 ,$72.90 ,$60.75 , N/A ,$71.28 , N/A ,$60.75 ,$60.75 ,$68.85 ,$68.85 , N/A ,$68.85 , N/A ,$63.99 ,$63.99 ,$63.99 ,$72.90 , N/A ,$72.90 , N/A ,$81.00 ,$53.06 , N/A ,$35.15 , N/A , N/A ,$72.90 , N/A ,$51.11 ,$48.60 ,$72.90 , N/A ,$72.90 ,$72.90 , N/A ,$52.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),76200022,G0378,HC OBSERVATION W/TELEMETRY PER HR,762,1 ,$81.00 ,$52.65 ,$35.15 ,$81.00 ,$60.35 ,$53.06 , N/A ,$42.69 , N/A ,$51.11 ,$51.11 ,$51.11 ,$51.11 ,$72.90 ,$60.75 , N/A ,$71.28 , N/A ,$60.75 ,$60.75 ,$68.85 ,$68.85 , N/A ,$68.85 , N/A ,$63.99 ,$63.99 ,$63.99 ,$72.90 , N/A ,$72.90 , N/A ,$81.00 ,$53.06 , N/A ,$35.15 , N/A , N/A ,$72.90 , N/A ,$51.11 ,$48.60 ,$72.90 , N/A ,$72.90 ,$72.90 , N/A ,$52.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),77100000,90471,HC IMMUN ADMIN ONE VACC,771,1 ,$117.00 ,$76.05 ,$50.78 ,$136.52 ,$87.17 ,$76.64 ,$63.00 ,$61.66 ,$63.00 ,$73.83 ,$73.83 ,$73.83 ,$73.83 ,$105.30 ,$87.75 ,$63.00 ,$102.96 ,$63.00 ,$87.75 ,$87.75 ,$99.45 ,$99.45 ,$63.00 ,$99.45 ,$63.00 ,$92.43 ,$92.43 ,$92.43 ,$105.30 ,$117.00 ,$105.30 ,$63.00 ,$117.00 ,$76.64 ,$63.00 ,$50.78 , N/A ,$65.94 ,$105.30 ,$136.52 ,$73.83 ,$70.20 ,$105.30 ,$63.00 , N/A , N/A ,$63.00 ,$76.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),77100002,90472,HC IMMUN ADMIN EA ADD VACC,771,1 ,$102.00 ,$66.30 ,$44.27 ,$102.00 ,$75.99 ,$66.81 , N/A ,$53.75 , N/A ,$64.36 ,$64.36 ,$64.36 ,$64.36 ,$91.80 ,$76.50 , N/A ,$89.76 , N/A ,$76.50 ,$76.50 ,$86.70 ,$86.70 , N/A ,$86.70 , N/A ,$80.58 ,$80.58 ,$80.58 ,$91.80 , N/A ,$91.80 , N/A ,$102.00 ,$66.81 , N/A ,$44.27 , N/A , N/A ,$91.80 , N/A ,$64.36 ,$61.20 ,$91.80 , N/A , N/A , N/A , N/A ,$66.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),77100003,G0008,HC ADMIN INFLUENZA VACCINE,771,1 ,$112.00 ,$72.80 ,$40.66 ,$112.00 ,$83.44 ,$73.36 ,$40.66 ,$59.02 ,$40.66 ,$70.67 ,$70.67 ,$70.67 ,$70.67 ,$100.80 ,$84.00 ,$40.66 ,$98.56 ,$40.66 ,$84.00 ,$84.00 ,$95.20 ,$95.20 ,$40.66 ,$95.20 ,$40.66 ,$88.48 ,$88.48 ,$88.48 ,$100.80 ,$97.61 ,$100.80 ,$40.66 ,$112.00 ,$73.36 ,$40.66 ,$48.61 , N/A ,$42.56 ,$100.80 ,$88.12 ,$70.67 ,$67.20 ,$100.80 ,$40.66 , N/A , N/A ,$40.66 ,$72.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),77100005,G0009,HC ADMIN PNEUMOCOCCAL VACCINE,771,1 ,$112.00 ,$72.80 ,$40.66 ,$112.00 ,$83.44 ,$73.36 ,$40.66 ,$59.02 ,$40.66 ,$70.67 ,$70.67 ,$70.67 ,$70.67 ,$100.80 ,$84.00 ,$40.66 ,$98.56 ,$40.66 ,$84.00 ,$84.00 ,$95.20 ,$95.20 ,$40.66 ,$95.20 ,$40.66 ,$88.48 ,$88.48 ,$88.48 ,$100.80 ,$97.61 ,$100.80 ,$40.66 ,$112.00 ,$73.36 ,$40.66 ,$48.61 , N/A ,$42.56 ,$100.80 ,$88.12 ,$70.67 ,$67.20 ,$100.80 ,$40.66 , N/A , N/A ,$40.66 ,$72.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),77100006,G0010,HC INJECTION-HEPATITIS B VACCINE,771,1 ,$112.00 ,$72.80 ,$40.66 ,$112.00 ,$83.44 ,$73.36 ,$40.66 ,$59.02 ,$40.66 ,$70.67 ,$70.67 ,$70.67 ,$70.67 ,$100.80 ,$84.00 ,$40.66 ,$98.56 ,$40.66 ,$84.00 ,$84.00 ,$95.20 ,$95.20 ,$40.66 ,$95.20 ,$40.66 ,$88.48 ,$88.48 ,$88.48 ,$100.80 ,$97.61 ,$100.80 ,$40.66 ,$112.00 ,$73.36 ,$40.66 ,$48.61 , N/A ,$42.56 ,$100.80 ,$88.12 ,$70.67 ,$67.20 ,$100.80 ,$40.66 , N/A , N/A ,$40.66 ,$72.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000001,Q3014,HC TELEHEALTH ORIGINATING FAC FEE,780,1 ,$80.00 ,$52.00 ,$27.02 ,$80.00 ,$59.60 ,$52.40 ,$27.02 ,$42.16 ,$27.02 ,$50.48 ,$50.48 ,$50.48 ,$50.48 ,$72.00 ,$60.00 ,$27.02 ,$70.40 ,$27.02 ,$60.00 ,$60.00 ,$68.00 ,$68.00 ,$27.02 ,$68.00 ,$27.02 ,$63.20 ,$63.20 ,$63.20 ,$72.00 ,$67.55 ,$72.00 ,$27.02 ,$80.00 ,$52.40 ,$27.02 ,$34.72 , N/A ,$28.37 ,$72.00 ,$60.80 ,$50.48 ,$48.00 ,$72.00 ,$27.02 ,$72.00 ,$72.00 ,$27.02 ,$52.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000003,97110,HC THERA EXER; EA 15 MIN - 95,780,1 ,$63.00 ,$40.95 ,$27.34 ,$65.84 ,$46.94 ,$41.27 ,$29.26 ,$33.20 ,$29.26 ,$39.75 ,$39.75 ,$39.75 ,$39.75 ,$56.70 ,$47.25 ,$29.26 ,$55.44 ,$29.26 ,$47.25 ,$47.25 ,$53.55 ,$53.55 ,$29.26 ,$53.55 ,$29.26 ,$49.77 ,$49.77 ,$49.77 ,$56.70 ,$63.00 ,$56.70 ,$29.26 ,$63.00 ,$41.27 ,$29.26 ,$27.34 , N/A ,$30.72 ,$56.70 ,$65.84 ,$39.75 ,$37.80 ,$56.70 ,$29.26 ,$56.70 ,$56.70 ,$29.26 ,$40.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000004,97112,HC NEUROMUSCULAR RE ED EA 15 MIN - 95,780,1 ,$130.00 ,$84.50 ,$33.86 ,$130.00 ,$96.85 ,$85.15 ,$33.86 ,$68.51 ,$33.86 ,$82.03 ,$82.03 ,$82.03 ,$82.03 ,$117.00 ,$97.50 ,$33.86 ,$114.40 ,$33.86 ,$97.50 ,$97.50 ,$110.50 ,$110.50 ,$33.86 ,$110.50 ,$33.86 ,$102.70 ,$102.70 ,$102.70 ,$117.00 ,$84.65 ,$117.00 ,$33.86 ,$130.00 ,$85.15 ,$33.86 ,$56.42 , N/A ,$35.55 ,$117.00 ,$76.19 ,$82.03 ,$78.00 ,$117.00 ,$33.86 ,$117.00 ,$117.00 ,$33.86 ,$84.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000005,97530,HC THERAPEUTIC ACTIVITIES EA 15 MIN - 95,780,1 ,$223.00 ,$144.95 ,$37.50 ,$223.00 ,$166.14 ,$146.07 ,$37.50 ,$117.52 ,$37.50 ,$140.71 ,$140.71 ,$140.71 ,$140.71 ,$200.70 ,$167.25 ,$37.50 ,$196.24 ,$37.50 ,$167.25 ,$167.25 ,$189.55 ,$189.55 ,$37.50 ,$189.55 ,$37.50 ,$176.17 ,$176.17 ,$176.17 ,$200.70 ,$93.75 ,$200.70 ,$37.50 ,$223.00 ,$146.07 ,$37.50 ,$96.78 , N/A ,$39.38 ,$200.70 ,$84.38 ,$140.71 ,$133.80 ,$200.70 ,$37.50 ,$200.70 ,$200.70 ,$37.50 ,$144.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000006,97535,HC SELF CARE ADL TRAINING EA 15 MIN - 95,780,1 ,$84.00 ,$54.60 ,$32.44 ,$84.00 ,$62.58 ,$55.02 ,$32.44 ,$44.27 ,$32.44 ,$53.00 ,$53.00 ,$53.00 ,$53.00 ,$75.60 ,$63.00 ,$32.44 ,$73.92 ,$32.44 ,$63.00 ,$63.00 ,$71.40 ,$71.40 ,$32.44 ,$71.40 ,$32.44 ,$66.36 ,$66.36 ,$66.36 ,$75.60 ,$81.10 ,$75.60 ,$32.44 ,$84.00 ,$55.02 ,$32.44 ,$36.46 , N/A ,$34.06 ,$75.60 ,$72.99 ,$53.00 ,$50.40 ,$75.60 ,$32.44 ,$75.60 ,$75.60 ,$32.44 ,$54.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000007,97129,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION INITIAL 15 MIN - 95,780,1 ,$199.00 ,$129.35 ,$23.04 ,$199.00 ,$148.26 ,$130.35 ,$23.04 ,$104.87 ,$23.04 ,$125.57 ,$125.57 ,$125.57 ,$125.57 ,$179.10 ,$149.25 ,$23.04 ,$175.12 ,$23.04 ,$149.25 ,$149.25 ,$169.15 ,$169.15 ,$23.04 ,$169.15 ,$23.04 ,$157.21 ,$157.21 ,$157.21 ,$179.10 ,$57.60 ,$179.10 ,$23.04 ,$199.00 ,$130.35 ,$23.04 ,$86.37 , N/A ,$24.19 ,$179.10 ,$51.84 ,$125.57 ,$119.40 ,$179.10 ,$23.04 ,$179.10 ,$179.10 ,$23.04 ,$129.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000008,97130,HC COGNITIVE FUNCTION THERAPEUTIC INTERVENTION ADDL 15 MIN - 95,780,1 ,$163.00 ,$105.95 ,$22.35 ,$163.00 ,$121.44 ,$106.77 ,$22.35 ,$85.90 ,$22.35 ,$102.85 ,$102.85 ,$102.85 ,$102.85 ,$146.70 ,$122.25 ,$22.35 ,$143.44 ,$22.35 ,$122.25 ,$122.25 ,$138.55 ,$138.55 ,$22.35 ,$138.55 ,$22.35 ,$128.77 ,$128.77 ,$128.77 ,$146.70 ,$55.88 ,$146.70 ,$22.35 ,$163.00 ,$106.77 ,$22.35 ,$70.74 , N/A ,$23.47 ,$146.70 ,$50.29 ,$102.85 ,$97.80 ,$146.70 ,$22.35 ,$146.70 ,$146.70 ,$22.35 ,$105.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000009,97161,HC PT EVAL LOW COMPLEXITY 15 MIN - 95,780,1 ,$381.00 ,$247.65 ,$98.12 ,$381.00 ,$283.85 ,$249.56 ,$98.12 ,$200.79 ,$98.12 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$98.12 ,$335.28 ,$98.12 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$98.12 ,$323.85 ,$98.12 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$245.30 ,$342.90 ,$98.12 ,$381.00 ,$249.56 ,$98.12 ,$165.35 , N/A ,$103.03 ,$342.90 ,$220.77 ,$240.41 ,$228.60 ,$342.90 ,$98.12 ,$342.90 ,$342.90 ,$98.12 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000010,97162,HC PT EVAL MOD COMPLEXITY 30 MIN - 95,780,1 ,$443.00 ,$287.95 ,$98.12 ,$443.00 ,$330.04 ,$290.17 ,$98.12 ,$233.46 ,$98.12 ,$279.53 ,$279.53 ,$279.53 ,$279.53 ,$398.70 ,$332.25 ,$98.12 ,$389.84 ,$98.12 ,$332.25 ,$332.25 ,$376.55 ,$376.55 ,$98.12 ,$376.55 ,$98.12 ,$349.97 ,$349.97 ,$349.97 ,$398.70 ,$245.30 ,$398.70 ,$98.12 ,$443.00 ,$290.17 ,$98.12 ,$192.26 , N/A ,$103.03 ,$398.70 ,$220.77 ,$279.53 ,$265.80 ,$398.70 ,$98.12 ,$398.70 ,$398.70 ,$98.12 ,$287.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000011,97163,HC PT EVAL HIGH COMPLEXITY 45 MIN - 95,780,1 ,$618.00 ,$401.70 ,$98.12 ,$618.00 ,$460.41 ,$404.79 ,$98.12 ,$325.69 ,$98.12 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$98.12 ,$543.84 ,$98.12 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$98.12 ,$525.30 ,$98.12 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$245.30 ,$556.20 ,$98.12 ,$618.00 ,$404.79 ,$98.12 ,$268.21 , N/A ,$103.03 ,$556.20 ,$220.77 ,$389.96 ,$370.80 ,$556.20 ,$98.12 ,$556.20 ,$556.20 ,$98.12 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000012,97164,HC PT RE-EVAL 15 MIN - 95,780,1 ,$214.00 ,$139.10 ,$66.97 ,$214.00 ,$159.43 ,$140.17 ,$66.97 ,$112.78 ,$66.97 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$66.97 ,$188.32 ,$66.97 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$66.97 ,$181.90 ,$66.97 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$167.43 ,$192.60 ,$66.97 ,$214.00 ,$140.17 ,$66.97 ,$92.88 , N/A ,$70.32 ,$192.60 ,$150.68 ,$135.03 ,$128.40 ,$192.60 ,$66.97 ,$192.60 ,$192.60 ,$66.97 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000013,97165,HC OT EVAL LOW COMPLEXITY 30 MIN - 95,780,1 ,$381.00 ,$247.65 ,$95.26 ,$381.00 ,$283.85 ,$249.56 ,$95.26 ,$200.79 ,$95.26 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$95.26 ,$335.28 ,$95.26 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$95.26 ,$323.85 ,$95.26 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$238.15 ,$342.90 ,$95.26 ,$381.00 ,$249.56 ,$95.26 ,$165.35 , N/A ,$100.02 ,$342.90 ,$214.34 ,$240.41 ,$228.60 ,$342.90 ,$95.26 ,$342.90 ,$342.90 ,$95.26 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000014,97116,HC AMBULATION GAIT TRAIN EA 15 MIN - 95,780,1 ,$77.00 ,$50.05 ,$29.26 ,$77.00 ,$57.37 ,$50.44 ,$29.26 ,$40.58 ,$29.26 ,$48.59 ,$48.59 ,$48.59 ,$48.59 ,$69.30 ,$57.75 ,$29.26 ,$67.76 ,$29.26 ,$57.75 ,$57.75 ,$65.45 ,$65.45 ,$29.26 ,$65.45 ,$29.26 ,$60.83 ,$60.83 ,$60.83 ,$69.30 ,$73.15 ,$69.30 ,$29.26 ,$77.00 ,$50.44 ,$29.26 ,$33.42 , N/A ,$30.72 ,$69.30 ,$65.84 ,$48.59 ,$46.20 ,$69.30 ,$29.26 ,$69.30 ,$69.30 ,$29.26 ,$50.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000015,97167,HC OT EVAL HIGH COMPLEXITY 60 MIN - 95,780,1 ,$618.00 ,$401.70 ,$95.26 ,$618.00 ,$460.41 ,$404.79 ,$95.26 ,$325.69 ,$95.26 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$95.26 ,$543.84 ,$95.26 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$95.26 ,$525.30 ,$95.26 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$238.15 ,$556.20 ,$95.26 ,$618.00 ,$404.79 ,$95.26 ,$268.21 , N/A ,$100.02 ,$556.20 ,$214.34 ,$389.96 ,$370.80 ,$556.20 ,$95.26 ,$556.20 ,$556.20 ,$95.26 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000016,97168,HC OT RE-EVAL 30 MIN - 95,780,1 ,$214.00 ,$139.10 ,$64.11 ,$214.00 ,$159.43 ,$140.17 ,$64.11 ,$112.78 ,$64.11 ,$135.03 ,$135.03 ,$135.03 ,$135.03 ,$192.60 ,$160.50 ,$64.11 ,$188.32 ,$64.11 ,$160.50 ,$160.50 ,$181.90 ,$181.90 ,$64.11 ,$181.90 ,$64.11 ,$169.06 ,$169.06 ,$169.06 ,$192.60 ,$160.28 ,$192.60 ,$64.11 ,$214.00 ,$140.17 ,$64.11 ,$92.88 , N/A ,$67.32 ,$192.60 ,$144.25 ,$135.03 ,$128.40 ,$192.60 ,$64.11 ,$192.60 ,$192.60 ,$64.11 ,$139.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000017,92507,HC SPEECH THERAPY TREATMENT 15 MIN - 95,780,1 ,$241.00 ,$156.65 ,$75.75 ,$241.00 ,$179.55 ,$157.86 ,$75.75 ,$127.01 ,$75.75 ,$152.07 ,$152.07 ,$152.07 ,$152.07 ,$216.90 ,$180.75 ,$75.75 ,$212.08 ,$75.75 ,$180.75 ,$180.75 ,$204.85 ,$204.85 ,$75.75 ,$204.85 ,$75.75 ,$190.39 ,$190.39 ,$190.39 ,$216.90 ,$189.38 ,$216.90 ,$75.75 ,$241.00 ,$157.86 ,$75.75 ,$104.59 , N/A ,$79.54 ,$216.90 ,$170.44 ,$152.07 ,$144.60 ,$216.90 ,$75.75 ,$216.90 ,$216.90 ,$75.75 ,$156.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000018,92521,HC EVALUATION OF SPEECH FLUENCY 15 MIN - 95,780,1 ,$339.00 ,$220.35 ,$132.47 ,$339.00 ,$252.56 ,$222.05 ,$132.47 ,$178.65 ,$132.47 ,$213.91 ,$213.91 ,$213.91 ,$213.91 ,$305.10 ,$254.25 ,$132.47 ,$298.32 ,$132.47 ,$254.25 ,$254.25 ,$288.15 ,$288.15 ,$132.47 ,$288.15 ,$132.47 ,$267.81 ,$267.81 ,$267.81 ,$305.10 ,$331.18 ,$305.10 ,$132.47 ,$339.00 ,$222.05 ,$132.47 ,$147.13 , N/A ,$139.09 ,$305.10 ,$298.06 ,$213.91 ,$203.40 ,$305.10 ,$132.47 ,$305.10 ,$305.10 ,$132.47 ,$220.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000019,92526,HC DYSPHAGIA TREATMENT 15 MIN - 95,780,1 ,$152.00 ,$98.80 ,$65.97 ,$187.90 ,$113.24 ,$99.56 ,$83.51 ,$80.10 ,$83.51 ,$95.91 ,$95.91 ,$95.91 ,$95.91 ,$136.80 ,$114.00 ,$83.51 ,$133.76 ,$83.51 ,$114.00 ,$114.00 ,$129.20 ,$129.20 ,$83.51 ,$129.20 ,$83.51 ,$120.08 ,$120.08 ,$120.08 ,$136.80 ,$152.00 ,$136.80 ,$83.51 ,$152.00 ,$99.56 ,$83.51 ,$65.97 , N/A ,$87.69 ,$136.80 ,$187.90 ,$95.91 ,$91.20 ,$136.80 ,$83.51 ,$136.80 ,$136.80 ,$83.51 ,$98.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000198,92526,PC DYSPHAGIA TREATMENT 30 MIN - 95,961,1 ,$152.00 ,$98.80 ,$80.10 ,$193.83 ,$113.24 ,$99.56 ,$89.44 ,$80.10 ,$89.44 ,$95.91 ,$95.91 ,$95.91 ,$95.91 ,$136.80 ,$114.00 ,$89.44 ,$133.76 ,$89.44 ,$114.00 ,$114.00 ,$129.20 ,$129.20 ,$89.44 ,$129.20 ,$89.44 ,$120.08 ,$120.08 ,$120.08 ,$136.80 ,$152.00 ,$136.80 ,$89.44 ,$152.00 ,$99.56 ,$89.44 ,$152.00 , N/A ,$93.61 ,$136.80 ,$193.83 ,$95.91 ,$91.20 ,$136.80 ,$89.44 , N/A , N/A ,$89.44 ,$98.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000199,92526,PC DYSPHAGIA TREATMENT 45 MIN - 95,780,1 ,$152.00 ,$98.80 ,$65.97 ,$187.90 ,$113.24 ,$99.56 ,$83.51 ,$80.10 ,$83.51 ,$95.91 ,$95.91 ,$95.91 ,$95.91 ,$136.80 ,$114.00 ,$83.51 ,$133.76 ,$83.51 ,$114.00 ,$114.00 ,$129.20 ,$129.20 ,$83.51 ,$129.20 ,$83.51 ,$120.08 ,$120.08 ,$120.08 ,$136.80 ,$152.00 ,$136.80 ,$83.51 ,$152.00 ,$99.56 ,$83.51 ,$65.97 , N/A ,$87.69 ,$136.80 ,$187.90 ,$95.91 ,$91.20 ,$136.80 ,$83.51 ,$136.80 ,$136.80 ,$83.51 ,$98.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000201,92507,HC SPEECH THERAPY TREATMENT 30 MIN - 95,780,1 ,$241.00 ,$156.65 ,$75.75 ,$241.00 ,$179.55 ,$157.86 ,$75.75 ,$127.01 ,$75.75 ,$152.07 ,$152.07 ,$152.07 ,$152.07 ,$216.90 ,$180.75 ,$75.75 ,$212.08 ,$75.75 ,$180.75 ,$180.75 ,$204.85 ,$204.85 ,$75.75 ,$204.85 ,$75.75 ,$190.39 ,$190.39 ,$190.39 ,$216.90 ,$189.38 ,$216.90 ,$75.75 ,$241.00 ,$157.86 ,$75.75 ,$104.59 , N/A ,$79.54 ,$216.90 ,$170.44 ,$152.07 ,$144.60 ,$216.90 ,$75.75 ,$216.90 ,$216.90 ,$75.75 ,$156.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000202,92507,PC SPEECH THERAPY TREATMENT 45 MIN - 95,780,1 ,$241.00 ,$156.65 ,$75.75 ,$241.00 ,$179.55 ,$157.86 ,$75.75 ,$127.01 ,$75.75 ,$152.07 ,$152.07 ,$152.07 ,$152.07 ,$216.90 ,$180.75 ,$75.75 ,$212.08 ,$75.75 ,$180.75 ,$180.75 ,$204.85 ,$204.85 ,$75.75 ,$204.85 ,$75.75 ,$190.39 ,$190.39 ,$190.39 ,$216.90 ,$189.38 ,$216.90 ,$75.75 ,$241.00 ,$157.86 ,$75.75 ,$104.59 , N/A ,$79.54 ,$216.90 ,$170.44 ,$152.07 ,$144.60 ,$216.90 ,$75.75 ,$216.90 ,$216.90 ,$75.75 ,$156.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000203,92507,PC SPEECH THERAPY TREATMENT 60 MIN - 95,780,1 ,$241.00 ,$156.65 ,$75.75 ,$241.00 ,$179.55 ,$157.86 ,$75.75 ,$127.01 ,$75.75 ,$152.07 ,$152.07 ,$152.07 ,$152.07 ,$216.90 ,$180.75 ,$75.75 ,$212.08 ,$75.75 ,$180.75 ,$180.75 ,$204.85 ,$204.85 ,$75.75 ,$204.85 ,$75.75 ,$190.39 ,$190.39 ,$190.39 ,$216.90 ,$189.38 ,$216.90 ,$75.75 ,$241.00 ,$157.86 ,$75.75 ,$104.59 , N/A ,$79.54 ,$216.90 ,$170.44 ,$152.07 ,$144.60 ,$216.90 ,$75.75 ,$216.90 ,$216.90 ,$75.75 ,$156.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000204,92521,PC EVALUATION OF SPEECH FLUENCY 30 MIN - 95,780,1 ,$339.00 ,$220.35 ,$132.47 ,$339.00 ,$252.56 ,$222.05 ,$132.47 ,$178.65 ,$132.47 ,$213.91 ,$213.91 ,$213.91 ,$213.91 ,$305.10 ,$254.25 ,$132.47 ,$298.32 ,$132.47 ,$254.25 ,$254.25 ,$288.15 ,$288.15 ,$132.47 ,$288.15 ,$132.47 ,$267.81 ,$267.81 ,$267.81 ,$305.10 ,$331.18 ,$305.10 ,$132.47 ,$339.00 ,$222.05 ,$132.47 ,$147.13 , N/A ,$139.09 ,$305.10 ,$298.06 ,$213.91 ,$203.40 ,$305.10 ,$132.47 ,$305.10 ,$305.10 ,$132.47 ,$220.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000205,92521,PC EVALUATION OF SPEECH FLUENCY 45 MIN - 95,780,1 ,$339.00 ,$220.35 ,$132.47 ,$339.00 ,$252.56 ,$222.05 ,$132.47 ,$178.65 ,$132.47 ,$213.91 ,$213.91 ,$213.91 ,$213.91 ,$305.10 ,$254.25 ,$132.47 ,$298.32 ,$132.47 ,$254.25 ,$254.25 ,$288.15 ,$288.15 ,$132.47 ,$288.15 ,$132.47 ,$267.81 ,$267.81 ,$267.81 ,$305.10 ,$331.18 ,$305.10 ,$132.47 ,$339.00 ,$222.05 ,$132.47 ,$147.13 , N/A ,$139.09 ,$305.10 ,$298.06 ,$213.91 ,$203.40 ,$305.10 ,$132.47 ,$305.10 ,$305.10 ,$132.47 ,$220.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000206,92521,PC EVALUATION OF SPEECH FLUENCY 60 MIN - 95,780,1 ,$339.00 ,$220.35 ,$132.47 ,$339.00 ,$252.56 ,$222.05 ,$132.47 ,$178.65 ,$132.47 ,$213.91 ,$213.91 ,$213.91 ,$213.91 ,$305.10 ,$254.25 ,$132.47 ,$298.32 ,$132.47 ,$254.25 ,$254.25 ,$288.15 ,$288.15 ,$132.47 ,$288.15 ,$132.47 ,$267.81 ,$267.81 ,$267.81 ,$305.10 ,$331.18 ,$305.10 ,$132.47 ,$339.00 ,$222.05 ,$132.47 ,$147.13 , N/A ,$139.09 ,$305.10 ,$298.06 ,$213.91 ,$203.40 ,$305.10 ,$132.47 ,$305.10 ,$305.10 ,$132.47 ,$220.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000207,97165,PC OT EVAL LOW COMPLEXITY 15 MIN - 95,780,1 ,$381.00 ,$247.65 ,$95.26 ,$381.00 ,$283.85 ,$249.56 ,$95.26 ,$200.79 ,$95.26 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$95.26 ,$335.28 ,$95.26 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$95.26 ,$323.85 ,$95.26 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$238.15 ,$342.90 ,$95.26 ,$381.00 ,$249.56 ,$95.26 ,$165.35 , N/A ,$100.02 ,$342.90 ,$214.34 ,$240.41 ,$228.60 ,$342.90 ,$95.26 ,$342.90 ,$342.90 ,$95.26 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000208,97165,PC OT EVAL LOW COMPLEXITY 45 MIN - 95,780,1 ,$381.00 ,$247.65 ,$95.26 ,$381.00 ,$283.85 ,$249.56 ,$95.26 ,$200.79 ,$95.26 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$95.26 ,$335.28 ,$95.26 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$95.26 ,$323.85 ,$95.26 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$238.15 ,$342.90 ,$95.26 ,$381.00 ,$249.56 ,$95.26 ,$165.35 , N/A ,$100.02 ,$342.90 ,$214.34 ,$240.41 ,$228.60 ,$342.90 ,$95.26 ,$342.90 ,$342.90 ,$95.26 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000209,97165,PC OT EVAL LOW COMPLEXITY 60 MIN - 95,780,1 ,$381.00 ,$247.65 ,$95.26 ,$381.00 ,$283.85 ,$249.56 ,$95.26 ,$200.79 ,$95.26 ,$240.41 ,$240.41 ,$240.41 ,$240.41 ,$342.90 ,$285.75 ,$95.26 ,$335.28 ,$95.26 ,$285.75 ,$285.75 ,$323.85 ,$323.85 ,$95.26 ,$323.85 ,$95.26 ,$300.99 ,$300.99 ,$300.99 ,$342.90 ,$238.15 ,$342.90 ,$95.26 ,$381.00 ,$249.56 ,$95.26 ,$165.35 , N/A ,$100.02 ,$342.90 ,$214.34 ,$240.41 ,$228.60 ,$342.90 ,$95.26 ,$342.90 ,$342.90 ,$95.26 ,$247.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000210,97166,PC OT EVAL MOD COMPLEXITY 15 MIN - 95,780,1 ,$509.00 ,$330.85 ,$95.26 ,$509.00 ,$379.21 ,$333.40 ,$95.26 ,$268.24 ,$95.26 ,$321.18 ,$321.18 ,$321.18 ,$321.18 ,$458.10 ,$381.75 ,$95.26 ,$447.92 ,$95.26 ,$381.75 ,$381.75 ,$432.65 ,$432.65 ,$95.26 ,$432.65 ,$95.26 ,$402.11 ,$402.11 ,$402.11 ,$458.10 ,$238.15 ,$458.10 ,$95.26 ,$509.00 ,$333.40 ,$95.26 ,$220.91 , N/A ,$100.02 ,$458.10 ,$214.34 ,$321.18 ,$305.40 ,$458.10 ,$95.26 ,$458.10 ,$458.10 ,$95.26 ,$330.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000211,97166,HC OT EVAL MOD COMPLEXITY 30 MIN - 95,780,1 ,$509.00 ,$330.85 ,$95.26 ,$509.00 ,$379.21 ,$333.40 ,$95.26 ,$268.24 ,$95.26 ,$321.18 ,$321.18 ,$321.18 ,$321.18 ,$458.10 ,$381.75 ,$95.26 ,$447.92 ,$95.26 ,$381.75 ,$381.75 ,$432.65 ,$432.65 ,$95.26 ,$432.65 ,$95.26 ,$402.11 ,$402.11 ,$402.11 ,$458.10 ,$238.15 ,$458.10 ,$95.26 ,$509.00 ,$333.40 ,$95.26 ,$220.91 , N/A ,$100.02 ,$458.10 ,$214.34 ,$321.18 ,$305.40 ,$458.10 ,$95.26 ,$458.10 ,$458.10 ,$95.26 ,$330.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000212,97166,PC OT EVAL MOD COMPLEXITY 60 MIN - 95,780,1 ,$509.00 ,$330.85 ,$95.26 ,$509.00 ,$379.21 ,$333.40 ,$95.26 ,$268.24 ,$95.26 ,$321.18 ,$321.18 ,$321.18 ,$321.18 ,$458.10 ,$381.75 ,$95.26 ,$447.92 ,$95.26 ,$381.75 ,$381.75 ,$432.65 ,$432.65 ,$95.26 ,$432.65 ,$95.26 ,$402.11 ,$402.11 ,$402.11 ,$458.10 ,$238.15 ,$458.10 ,$95.26 ,$509.00 ,$333.40 ,$95.26 ,$220.91 , N/A ,$100.02 ,$458.10 ,$214.34 ,$321.18 ,$305.40 ,$458.10 ,$95.26 ,$458.10 ,$458.10 ,$95.26 ,$330.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000213,97167,PC OT EVAL HIGH COMPLEXITY 15 MIN - 95,780,1 ,$618.00 ,$401.70 ,$95.26 ,$618.00 ,$460.41 ,$404.79 ,$95.26 ,$325.69 ,$95.26 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$95.26 ,$543.84 ,$95.26 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$95.26 ,$525.30 ,$95.26 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$238.15 ,$556.20 ,$95.26 ,$618.00 ,$404.79 ,$95.26 ,$268.21 , N/A ,$100.02 ,$556.20 ,$214.34 ,$389.96 ,$370.80 ,$556.20 ,$95.26 ,$556.20 ,$556.20 ,$95.26 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000214,97167,PC OT EVAL HIGH COMPLEXITY 30 MIN - 95,961,1 ,$618.00 ,$401.70 ,$102.02 ,$618.00 ,$460.41 ,$404.79 ,$102.02 ,$325.69 ,$102.02 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$102.02 ,$543.84 ,$102.02 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$102.02 ,$525.30 ,$102.02 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$244.91 ,$556.20 ,$102.02 ,$618.00 ,$404.79 ,$102.02 ,$115.83 , N/A ,$106.79 ,$556.20 ,$221.10 ,$389.96 ,$370.80 ,$556.20 ,$102.02 , N/A , N/A ,$102.02 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000215,97167,PC OT EVAL HIGH COMPLEXITY 45 MIN - 95,780,1 ,$618.00 ,$401.70 ,$95.26 ,$618.00 ,$460.41 ,$404.79 ,$95.26 ,$325.69 ,$95.26 ,$389.96 ,$389.96 ,$389.96 ,$389.96 ,$556.20 ,$463.50 ,$95.26 ,$543.84 ,$95.26 ,$463.50 ,$463.50 ,$525.30 ,$525.30 ,$95.26 ,$525.30 ,$95.26 ,$488.22 ,$488.22 ,$488.22 ,$556.20 ,$238.15 ,$556.20 ,$95.26 ,$618.00 ,$404.79 ,$95.26 ,$268.21 , N/A ,$100.02 ,$556.20 ,$214.34 ,$389.96 ,$370.80 ,$556.20 ,$95.26 ,$556.20 ,$556.20 ,$95.26 ,$401.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000216,92523,PC SPEECH SOUND LANGUAGE COMPRHEN 30 MIN - 95,780,1 ,$573.00 ,$372.45 ,$227.69 ,$573.00 ,$426.89 ,$375.32 ,$227.69 ,$301.97 ,$227.69 ,$361.56 ,$361.56 ,$361.56 ,$361.56 ,$515.70 ,$429.75 ,$227.69 ,$504.24 ,$227.69 ,$429.75 ,$429.75 ,$487.05 ,$487.05 ,$227.69 ,$487.05 ,$227.69 ,$452.67 ,$452.67 ,$452.67 ,$515.70 ,$569.23 ,$515.70 ,$227.69 ,$573.00 ,$375.32 ,$227.69 ,$248.68 , N/A ,$239.07 ,$515.70 ,$512.30 ,$361.56 ,$343.80 ,$515.70 ,$227.69 ,$515.70 ,$515.70 ,$227.69 ,$372.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000217,92523,PC SPEECH SOUND LANGUAGE COMPRHEN 45 MIN - 95,780,1 ,$573.00 ,$372.45 ,$227.69 ,$573.00 ,$426.89 ,$375.32 ,$227.69 ,$301.97 ,$227.69 ,$361.56 ,$361.56 ,$361.56 ,$361.56 ,$515.70 ,$429.75 ,$227.69 ,$504.24 ,$227.69 ,$429.75 ,$429.75 ,$487.05 ,$487.05 ,$227.69 ,$487.05 ,$227.69 ,$452.67 ,$452.67 ,$452.67 ,$515.70 ,$569.23 ,$515.70 ,$227.69 ,$573.00 ,$375.32 ,$227.69 ,$248.68 , N/A ,$239.07 ,$515.70 ,$512.30 ,$361.56 ,$343.80 ,$515.70 ,$227.69 ,$515.70 ,$515.70 ,$227.69 ,$372.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),78000218,92523,HC SPEECH SOUND LANGUAGE COMPRHEN 60 MIN - 95,780,1 ,$573.00 ,$372.45 ,$227.69 ,$573.00 ,$426.89 ,$375.32 ,$227.69 ,$301.97 ,$227.69 ,$361.56 ,$361.56 ,$361.56 ,$361.56 ,$515.70 ,$429.75 ,$227.69 ,$504.24 ,$227.69 ,$429.75 ,$429.75 ,$487.05 ,$487.05 ,$227.69 ,$487.05 ,$227.69 ,$452.67 ,$452.67 ,$452.67 ,$515.70 ,$569.23 ,$515.70 ,$227.69 ,$573.00 ,$375.32 ,$227.69 ,$248.68 , N/A ,$239.07 ,$515.70 ,$512.30 ,$361.56 ,$343.80 ,$515.70 ,$227.69 ,$515.70 ,$515.70 ,$227.69 ,$372.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),80100011,G0257,HC HEMODIALYSIS INPATIENT,801,1 ,"$1,352.00 ",$878.80 ,$586.77 ,"$1,441.54 ","$1,007.24 ",$885.56 ,$665.18 ,$712.50 ,$665.18 ,$853.11 ,$853.11 ,$853.11 ,$853.11 ,"$1,216.80 ","$1,014.00 ",$665.18 ,"$1,189.76 ",$665.18 ,"$1,014.00 ","$1,014.00 ","$1,149.20 ","$1,149.20 ",$665.18 ,"$1,149.20 ",$665.18 ,"$1,068.08 ","$1,068.08 ","$1,068.08 ","$1,216.80 ","$1,352.00 ","$1,216.80 ",$665.18 ,"$1,352.00 ",$885.56 ,$665.18 ,$586.77 , N/A ,$696.24 ,"$1,216.80 ","$1,441.54 ",$853.11 ,$811.20 ,"$1,216.80 ",$665.18 ,"$1,216.80 ","$1,216.80 ",$665.18 ,$878.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),82900001,G0257,HC HEMODIALYSIS OUTPATIENT,829,1 ,"$1,352.00 ",$878.80 ,$586.77 ,"$1,441.54 ","$1,007.24 ",$885.56 ,$665.18 ,$712.50 ,$665.18 ,$853.11 ,$853.11 ,$853.11 ,$853.11 ,"$1,216.80 ","$1,014.00 ",$665.18 ,"$1,189.76 ",$665.18 ,"$1,014.00 ","$1,014.00 ","$1,149.20 ","$1,149.20 ",$665.18 ,"$1,149.20 ",$665.18 ,"$1,068.08 ","$1,068.08 ","$1,068.08 ","$1,216.80 ","$1,352.00 ","$1,216.80 ",$665.18 ,"$1,352.00 ",$885.56 ,$665.18 ,$586.77 , N/A ,$696.24 ,"$1,216.80 ","$1,441.54 ",$853.11 ,$811.20 ,"$1,216.80 ",$665.18 ,"$1,216.80 ","$1,216.80 ",$665.18 ,$878.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92000001,59020,HC TEST STRESS FETAL,920,1 ,"$1,200.00 ",$780.00 ,$173.14 ,"$1,200.00 ",$894.00 ,$786.00 ,$173.14 ,$632.40 ,$173.14 ,$757.20 ,$757.20 ,$757.20 ,$757.20 ,"$1,080.00 ",$900.00 ,$173.14 ,"$1,056.00 ",$173.14 ,$900.00 ,$900.00 ,"$1,020.00 ","$1,020.00 ",$173.14 ,"$1,020.00 ",$173.14 ,$948.00 ,$948.00 ,$948.00 ,"$1,080.00 ",$415.64 ,"$1,080.00 ",$173.14 ,"$1,200.00 ",$786.00 ,$173.14 ,$520.80 , N/A ,$181.23 ,"$1,080.00 ",$375.22 ,$757.20 ,$720.00 ,"$1,080.00 ",$173.14 ,"$1,080.00 ","$1,080.00 ",$173.14 ,$780.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92000002,59025,HC TEST NON STRESS FETAL,920,1 ,$894.00 ,$581.10 ,$173.14 ,$894.00 ,$666.03 ,$585.57 ,$173.14 ,$471.14 ,$173.14 ,$564.11 ,$564.11 ,$564.11 ,$564.11 ,$804.60 ,$670.50 ,$173.14 ,$786.72 ,$173.14 ,$670.50 ,$670.50 ,$759.90 ,$759.90 ,$173.14 ,$759.90 ,$173.14 ,$706.26 ,$706.26 ,$706.26 ,$804.60 ,$415.64 ,$804.60 ,$173.14 ,$894.00 ,$585.57 ,$173.14 ,$388.00 , N/A ,$181.23 ,$804.60 ,$375.22 ,$564.11 ,$536.40 ,$804.60 ,$173.14 ,$804.60 ,$804.60 ,$173.14 ,$581.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92000012,93788,HC AMBUL BLOOD PRESS MONITR W/REPORT,920,1 ,$135.00 ,$87.75 ,$58.59 ,$246.63 ,$100.58 ,$88.43 ,$113.81 ,$71.15 ,$113.81 ,$85.19 ,$85.19 ,$85.19 ,$85.19 ,$121.50 ,$101.25 ,$113.81 ,$118.80 ,$113.81 ,$101.25 ,$101.25 ,$114.75 ,$114.75 ,$113.81 ,$114.75 ,$113.81 ,$106.65 ,$106.65 ,$106.65 ,$121.50 ,$135.00 ,$121.50 ,$113.81 ,$135.00 ,$88.43 ,$113.81 ,$58.59 , N/A ,$119.12 ,$121.50 ,$246.63 ,$85.19 ,$81.00 ,$121.50 ,$113.81 ,$121.50 ,$121.50 ,$113.81 ,$87.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92000030,59020,HC TEST STRESS FETAL EXTENDED,920,1 ,"$1,800.00 ","$1,170.00 ",$173.14 ,"$1,800.00 ","$1,341.00 ","$1,179.00 ",$173.14 ,$948.60 ,$173.14 ,"$1,135.80 ","$1,135.80 ","$1,135.80 ","$1,135.80 ","$1,620.00 ","$1,350.00 ",$173.14 ,"$1,584.00 ",$173.14 ,"$1,350.00 ","$1,350.00 ","$1,530.00 ","$1,530.00 ",$173.14 ,"$1,530.00 ",$173.14 ,"$1,422.00 ","$1,422.00 ","$1,422.00 ","$1,620.00 ",$415.64 ,"$1,620.00 ",$173.14 ,"$1,800.00 ","$1,179.00 ",$173.14 ,$781.20 , N/A ,$181.23 ,"$1,620.00 ",$375.22 ,"$1,135.80 ","$1,080.00 ","$1,620.00 ",$173.14 ,"$1,620.00 ","$1,620.00 ",$173.14 ,"$1,170.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92000031,59025,HC TEST NON STRESS FETAL EXTENDED,920,1 ,"$1,340.00 ",$871.00 ,$173.14 ,"$1,340.00 ",$998.30 ,$877.70 ,$173.14 ,$706.18 ,$173.14 ,$845.54 ,$845.54 ,$845.54 ,$845.54 ,"$1,206.00 ","$1,005.00 ",$173.14 ,"$1,179.20 ",$173.14 ,"$1,005.00 ","$1,005.00 ","$1,139.00 ","$1,139.00 ",$173.14 ,"$1,139.00 ",$173.14 ,"$1,058.60 ","$1,058.60 ","$1,058.60 ","$1,206.00 ",$415.64 ,"$1,206.00 ",$173.14 ,"$1,340.00 ",$877.70 ,$173.14 ,$581.56 , N/A ,$181.23 ,"$1,206.00 ",$375.22 ,$845.54 ,$804.00 ,"$1,206.00 ",$173.14 ,"$1,206.00 ","$1,206.00 ",$173.14 ,$871.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100002,93880,HC DUPLEX CAROTID BILAT,921,1 ,"$1,049.00 ",$681.85 ,$233.94 ,"$1,049.00 ",$781.51 ,$687.10 ,$233.94 ,$552.82 ,$233.94 ,$661.92 ,$661.92 ,$661.92 ,$661.92 ,$944.10 ,$786.75 ,$233.94 ,$923.12 ,$233.94 ,$786.75 ,$786.75 ,$891.65 ,$891.65 ,$233.94 ,$891.65 ,$233.94 ,$828.71 ,$828.71 ,$828.71 ,$944.10 ,$561.60 ,$944.10 ,$233.94 ,"$1,049.00 ",$687.10 ,$233.94 ,$455.27 , N/A ,$244.87 ,$944.10 ,$506.99 ,$661.92 ,$629.40 ,$944.10 ,$233.94 ,$944.10 ,$944.10 ,$233.94 ,$681.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100003,93882,HC DUPLEX CAROTID UNI,921,1 ,$775.00 ,$503.75 ,$110.78 ,$775.00 ,$577.38 ,$507.63 ,$110.78 ,$408.43 ,$110.78 ,$489.03 ,$489.03 ,$489.03 ,$489.03 ,$697.50 ,$581.25 ,$110.78 ,$682.00 ,$110.78 ,$581.25 ,$581.25 ,$658.75 ,$658.75 ,$110.78 ,$658.75 ,$110.78 ,$612.25 ,$612.25 ,$612.25 ,$697.50 ,$265.92 ,$697.50 ,$110.78 ,$775.00 ,$507.63 ,$110.78 ,$336.35 , N/A ,$115.95 ,$697.50 ,$240.07 ,$489.03 ,$465.00 ,$697.50 ,$110.78 ,$697.50 ,$697.50 ,$110.78 ,$503.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100005,93922,HC ABI/PPG SINGLE LEVEL,921,1 ,$587.00 ,$381.55 ,$113.81 ,$587.00 ,$437.32 ,$384.49 ,$113.81 ,$309.35 ,$113.81 ,$370.40 ,$370.40 ,$370.40 ,$370.40 ,$528.30 ,$440.25 ,$113.81 ,$516.56 ,$113.81 ,$440.25 ,$440.25 ,$498.95 ,$498.95 ,$113.81 ,$498.95 ,$113.81 ,$463.73 ,$463.73 ,$463.73 ,$528.30 ,$273.20 ,$528.30 ,$113.81 ,$587.00 ,$384.49 ,$113.81 ,$254.76 , N/A ,$119.12 ,$528.30 ,$246.63 ,$370.40 ,$352.20 ,$528.30 ,$113.81 ,$528.30 ,$528.30 ,$113.81 ,$381.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100011,93922,HC TCPO2 UNLIATERAL 1-2 LEVEL - 93922-52,921,1 ,$587.00 ,$381.55 ,$113.81 ,$587.00 ,$437.32 ,$384.49 ,$113.81 ,$309.35 ,$113.81 ,$370.40 ,$370.40 ,$370.40 ,$370.40 ,$528.30 ,$440.25 ,$113.81 ,$516.56 ,$113.81 ,$440.25 ,$440.25 ,$498.95 ,$498.95 ,$113.81 ,$498.95 ,$113.81 ,$463.73 ,$463.73 ,$463.73 ,$528.30 ,$273.20 ,$528.30 ,$113.81 ,$587.00 ,$384.49 ,$113.81 ,$254.76 , N/A ,$119.12 ,$528.30 ,$246.63 ,$370.40 ,$352.20 ,$528.30 ,$113.81 ,$528.30 ,$528.30 ,$113.81 ,$381.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100030,93923,HC RESTING ARTERIAL LOWER BILATERAL,921,1 ,"$1,132.00 ",$735.80 ,$141.86 ,"$1,132.00 ",$843.34 ,$741.46 ,$141.86 ,$596.56 ,$141.86 ,$714.29 ,$714.29 ,$714.29 ,$714.29 ,"$1,018.80 ",$849.00 ,$141.86 ,$996.16 ,$141.86 ,$849.00 ,$849.00 ,$962.20 ,$962.20 ,$141.86 ,$962.20 ,$141.86 ,$894.28 ,$894.28 ,$894.28 ,"$1,018.80 ",$340.55 ,"$1,018.80 ",$141.86 ,"$1,132.00 ",$741.46 ,$141.86 ,$491.29 , N/A ,$148.49 ,"$1,018.80 ",$307.44 ,$714.29 ,$679.20 ,"$1,018.80 ",$141.86 ,"$1,018.80 ","$1,018.80 ",$141.86 ,$735.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100031,93923,HC RESTING ARTERIAL UPPER BILATERAL,921,1 ,"$1,132.00 ",$735.80 ,$141.86 ,"$1,132.00 ",$843.34 ,$741.46 ,$141.86 ,$596.56 ,$141.86 ,$714.29 ,$714.29 ,$714.29 ,$714.29 ,"$1,018.80 ",$849.00 ,$141.86 ,$996.16 ,$141.86 ,$849.00 ,$849.00 ,$962.20 ,$962.20 ,$141.86 ,$962.20 ,$141.86 ,$894.28 ,$894.28 ,$894.28 ,"$1,018.80 ",$340.55 ,"$1,018.80 ",$141.86 ,"$1,132.00 ",$741.46 ,$141.86 ,$491.29 , N/A ,$148.49 ,"$1,018.80 ",$307.44 ,$714.29 ,$679.20 ,"$1,018.80 ",$141.86 ,"$1,018.80 ","$1,018.80 ",$141.86 ,$735.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100032,93924,HC DOPPLER ARTERY LWR EXT STRESS,921,1 ,"$1,387.00 ",$901.55 ,$268.83 ,"$1,387.00 ","$1,033.32 ",$908.49 ,$268.83 ,$730.95 ,$268.83 ,$875.20 ,$875.20 ,$875.20 ,$875.20 ,"$1,248.30 ","$1,040.25 ",$268.83 ,"$1,220.56 ",$268.83 ,"$1,040.25 ","$1,040.25 ","$1,178.95 ","$1,178.95 ",$268.83 ,"$1,178.95 ",$268.83 ,"$1,095.73 ","$1,095.73 ","$1,095.73 ","$1,248.30 ",$645.35 ,"$1,248.30 ",$268.83 ,"$1,387.00 ",$908.49 ,$268.83 ,$601.96 , N/A ,$281.38 ,"$1,248.30 ",$582.60 ,$875.20 ,$832.20 ,"$1,248.30 ",$268.83 ,"$1,248.30 ","$1,248.30 ",$268.83 ,$901.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100034,93925,HC DUPLEX ARTERIAL LWR EXT BI,921,1 ,"$2,564.00 ","$1,666.60 ",$233.94 ,"$2,564.00 ","$1,910.18 ","$1,679.42 ",$233.94 ,"$1,351.23 ",$233.94 ,"$1,617.88 ","$1,617.88 ","$1,617.88 ","$1,617.88 ","$2,307.60 ","$1,923.00 ",$233.94 ,"$2,256.32 ",$233.94 ,"$1,923.00 ","$1,923.00 ","$2,179.40 ","$2,179.40 ",$233.94 ,"$2,179.40 ",$233.94 ,"$2,025.56 ","$2,025.56 ","$2,025.56 ","$2,307.60 ",$561.60 ,"$2,307.60 ",$233.94 ,"$2,564.00 ","$1,679.42 ",$233.94 ,"$1,112.78 ", N/A ,$244.87 ,"$2,307.60 ",$506.99 ,"$1,617.88 ","$1,538.40 ","$2,307.60 ",$233.94 ,"$2,307.60 ","$2,307.60 ",$233.94 ,"$1,666.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100035,93926,HC DUPLEX ARTRL LWR EXT UNI/LMT,921,1 ,"$1,163.00 ",$755.95 ,$110.78 ,"$1,163.00 ",$866.44 ,$761.77 ,$110.78 ,$612.90 ,$110.78 ,$733.85 ,$733.85 ,$733.85 ,$733.85 ,"$1,046.70 ",$872.25 ,$110.78 ,"$1,023.44 ",$110.78 ,$872.25 ,$872.25 ,$988.55 ,$988.55 ,$110.78 ,$988.55 ,$110.78 ,$918.77 ,$918.77 ,$918.77 ,"$1,046.70 ",$265.92 ,"$1,046.70 ",$110.78 ,"$1,163.00 ",$761.77 ,$110.78 ,$504.74 , N/A ,$115.95 ,"$1,046.70 ",$240.07 ,$733.85 ,$697.80 ,"$1,046.70 ",$110.78 ,"$1,046.70 ","$1,046.70 ",$110.78 ,$755.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100037,93930,HC DUPLEX ARTERIAL UPR EXT BI,921,1 ,"$1,390.00 ",$903.50 ,$233.94 ,"$1,390.00 ","$1,035.55 ",$910.45 ,$233.94 ,$732.53 ,$233.94 ,$877.09 ,$877.09 ,$877.09 ,$877.09 ,"$1,251.00 ","$1,042.50 ",$233.94 ,"$1,223.20 ",$233.94 ,"$1,042.50 ","$1,042.50 ","$1,181.50 ","$1,181.50 ",$233.94 ,"$1,181.50 ",$233.94 ,"$1,098.10 ","$1,098.10 ","$1,098.10 ","$1,251.00 ",$561.60 ,"$1,251.00 ",$233.94 ,"$1,390.00 ",$910.45 ,$233.94 ,$603.26 , N/A ,$244.87 ,"$1,251.00 ",$506.99 ,$877.09 ,$834.00 ,"$1,251.00 ",$233.94 ,"$1,251.00 ","$1,251.00 ",$233.94 ,$903.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100038,93931,HC DUPLEX ARTRL UPR EXT UNI/LMT,921,1 ,"$1,030.00 ",$669.50 ,$110.78 ,"$1,030.00 ",$767.35 ,$674.65 ,$110.78 ,$542.81 ,$110.78 ,$649.93 ,$649.93 ,$649.93 ,$649.93 ,$927.00 ,$772.50 ,$110.78 ,$906.40 ,$110.78 ,$772.50 ,$772.50 ,$875.50 ,$875.50 ,$110.78 ,$875.50 ,$110.78 ,$813.70 ,$813.70 ,$813.70 ,$927.00 ,$265.92 ,$927.00 ,$110.78 ,"$1,030.00 ",$674.65 ,$110.78 ,$447.02 , N/A ,$115.95 ,$927.00 ,$240.07 ,$649.93 ,$618.00 ,$927.00 ,$110.78 ,$927.00 ,$927.00 ,$110.78 ,$669.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100039,93931,HC DUPLEX ARTRL UPR EXT PSEUD ONLY,921,1 ,"$1,030.00 ",$669.50 ,$110.78 ,"$1,030.00 ",$767.35 ,$674.65 ,$110.78 ,$542.81 ,$110.78 ,$649.93 ,$649.93 ,$649.93 ,$649.93 ,$927.00 ,$772.50 ,$110.78 ,$906.40 ,$110.78 ,$772.50 ,$772.50 ,$875.50 ,$875.50 ,$110.78 ,$875.50 ,$110.78 ,$813.70 ,$813.70 ,$813.70 ,$927.00 ,$265.92 ,$927.00 ,$110.78 ,"$1,030.00 ",$674.65 ,$110.78 ,$447.02 , N/A ,$115.95 ,$927.00 ,$240.07 ,$649.93 ,$618.00 ,$927.00 ,$110.78 ,$927.00 ,$927.00 ,$110.78 ,$669.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100041,93970,HC DUPLEX VENOUS EXT BI,921,1 ,"$1,354.00 ",$880.10 ,$233.94 ,"$1,354.00 ","$1,008.73 ",$886.87 ,$233.94 ,$713.56 ,$233.94 ,$854.37 ,$854.37 ,$854.37 ,$854.37 ,"$1,218.60 ","$1,015.50 ",$233.94 ,"$1,191.52 ",$233.94 ,"$1,015.50 ","$1,015.50 ","$1,150.90 ","$1,150.90 ",$233.94 ,"$1,150.90 ",$233.94 ,"$1,069.66 ","$1,069.66 ","$1,069.66 ","$1,218.60 ",$561.60 ,"$1,218.60 ",$233.94 ,"$1,354.00 ",$886.87 ,$233.94 ,$587.64 , N/A ,$244.87 ,"$1,218.60 ",$506.99 ,$854.37 ,$812.40 ,"$1,218.60 ",$233.94 ,"$1,218.60 ","$1,218.60 ",$233.94 ,$880.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100043,93971,HC DUPLEX VENOUS EXT UNI/LMTD,921,1 ,"$1,061.00 ",$689.65 ,$110.78 ,"$1,061.00 ",$790.45 ,$694.96 ,$110.78 ,$559.15 ,$110.78 ,$669.49 ,$669.49 ,$669.49 ,$669.49 ,$954.90 ,$795.75 ,$110.78 ,$933.68 ,$110.78 ,$795.75 ,$795.75 ,$901.85 ,$901.85 ,$110.78 ,$901.85 ,$110.78 ,$838.19 ,$838.19 ,$838.19 ,$954.90 ,$265.92 ,$954.90 ,$110.78 ,"$1,061.00 ",$694.96 ,$110.78 ,$460.47 , N/A ,$115.95 ,$954.90 ,$240.07 ,$669.49 ,$636.60 ,$954.90 ,$110.78 ,$954.90 ,$954.90 ,$110.78 ,$689.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100046,93990,HC DUPLEX HEMODIALYSIS ACCESS,921,1 ,$573.00 ,$372.45 ,$110.78 ,$573.00 ,$426.89 ,$375.32 ,$110.78 ,$301.97 ,$110.78 ,$361.56 ,$361.56 ,$361.56 ,$361.56 ,$515.70 ,$429.75 ,$110.78 ,$504.24 ,$110.78 ,$429.75 ,$429.75 ,$487.05 ,$487.05 ,$110.78 ,$487.05 ,$110.78 ,$452.67 ,$452.67 ,$452.67 ,$515.70 ,$265.92 ,$515.70 ,$110.78 ,$573.00 ,$375.32 ,$110.78 ,$248.68 , N/A ,$115.95 ,$515.70 ,$240.07 ,$361.56 ,$343.80 ,$515.70 ,$110.78 ,$515.70 ,$515.70 ,$110.78 ,$372.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100049,93923,HC RESTING ARTERIAL EXTREMITY COMP -52,921,1 ,"$1,132.00 ",$735.80 ,$141.86 ,"$1,132.00 ",$843.34 ,$741.46 ,$141.86 ,$596.56 ,$141.86 ,$714.29 ,$714.29 ,$714.29 ,$714.29 ,"$1,018.80 ",$849.00 ,$141.86 ,$996.16 ,$141.86 ,$849.00 ,$849.00 ,$962.20 ,$962.20 ,$141.86 ,$962.20 ,$141.86 ,$894.28 ,$894.28 ,$894.28 ,"$1,018.80 ",$340.55 ,"$1,018.80 ",$141.86 ,"$1,132.00 ",$741.46 ,$141.86 ,$491.29 , N/A ,$148.49 ,"$1,018.80 ",$307.44 ,$714.29 ,$679.20 ,"$1,018.80 ",$141.86 ,"$1,018.80 ","$1,018.80 ",$141.86 ,$735.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100051,93701,HC BIOIMPEDANCE DERIVED PHYSIO CV ANALYSIS,921,1 ,$295.00 ,$191.75 ,$113.81 ,$295.00 ,$219.78 ,$193.23 ,$113.81 ,$155.47 ,$113.81 ,$186.15 ,$186.15 ,$186.15 ,$186.15 ,$265.50 ,$221.25 ,$113.81 ,$259.60 ,$113.81 ,$221.25 ,$221.25 ,$250.75 ,$250.75 ,$113.81 ,$250.75 ,$113.81 ,$233.05 ,$233.05 ,$233.05 ,$265.50 ,$273.20 ,$265.50 ,$113.81 ,$295.00 ,$193.23 ,$113.81 ,$128.03 , N/A ,$119.12 ,$265.50 ,$246.63 ,$186.15 ,$177.00 ,$265.50 ,$113.81 ,$265.50 ,$265.50 ,$113.81 ,$191.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100053,93985,HC DUPLEX SCAN ARTERIAL/VENOUS HEMO ACCESS COMPL BILATERAL STUDY,921,1 ,"$1,059.00 ",$688.35 ,$233.94 ,"$1,059.00 ",$788.96 ,$693.65 ,$233.94 ,$558.09 ,$233.94 ,$668.23 ,$668.23 ,$668.23 ,$668.23 ,$953.10 ,$794.25 ,$233.94 ,$931.92 ,$233.94 ,$794.25 ,$794.25 ,$900.15 ,$900.15 ,$233.94 ,$900.15 ,$233.94 ,$836.61 ,$836.61 ,$836.61 ,$953.10 ,$561.60 ,$953.10 ,$233.94 ,"$1,059.00 ",$693.65 ,$233.94 ,$459.61 , N/A ,$244.87 ,$953.10 ,$506.99 ,$668.23 ,$635.40 ,$953.10 ,$233.94 ,$953.10 ,$953.10 ,$233.94 ,$688.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92100054,93986,HC DUPLEX SCAN ARTERIAL/VENOUS HEMO ACCESS COMPL UNILATERAL STUDY,921,1 ,$530.00 ,$344.50 ,$110.78 ,$530.00 ,$394.85 ,$347.15 ,$110.78 ,$279.31 ,$110.78 ,$334.43 ,$334.43 ,$334.43 ,$334.43 ,$477.00 ,$397.50 ,$110.78 ,$466.40 ,$110.78 ,$397.50 ,$397.50 ,$450.50 ,$450.50 ,$110.78 ,$450.50 ,$110.78 ,$418.70 ,$418.70 ,$418.70 ,$477.00 ,$265.92 ,$477.00 ,$110.78 ,$530.00 ,$347.15 ,$110.78 ,$230.02 , N/A ,$115.95 ,$477.00 ,$240.07 ,$334.43 ,$318.00 ,$477.00 ,$110.78 ,$477.00 ,$477.00 ,$110.78 ,$344.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200000,95860,HC EMG ONE EXTREMITY,922,1 ,$297.00 ,$193.05 ,$113.81 ,$297.00 ,$221.27 ,$194.54 ,$113.81 ,$156.52 ,$113.81 ,$187.41 ,$187.41 ,$187.41 ,$187.41 ,$267.30 ,$222.75 ,$113.81 ,$261.36 ,$113.81 ,$222.75 ,$222.75 ,$252.45 ,$252.45 ,$113.81 ,$252.45 ,$113.81 ,$234.63 ,$234.63 ,$234.63 ,$267.30 ,$273.20 ,$267.30 ,$113.81 ,$297.00 ,$194.54 ,$113.81 ,$128.90 , N/A ,$119.12 ,$267.30 ,$246.63 ,$187.41 ,$178.20 ,$267.30 ,$113.81 ,$267.30 ,$267.30 ,$113.81 ,$193.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200001,95861,HC EMG TWO EXTREMITIES,922,1 ,$324.00 ,$210.60 ,$113.81 ,$324.00 ,$241.38 ,$212.22 ,$113.81 ,$170.75 ,$113.81 ,$204.44 ,$204.44 ,$204.44 ,$204.44 ,$291.60 ,$243.00 ,$113.81 ,$285.12 ,$113.81 ,$243.00 ,$243.00 ,$275.40 ,$275.40 ,$113.81 ,$275.40 ,$113.81 ,$255.96 ,$255.96 ,$255.96 ,$291.60 ,$273.20 ,$291.60 ,$113.81 ,$324.00 ,$212.22 ,$113.81 ,$140.62 , N/A ,$119.12 ,$291.60 ,$246.63 ,$204.44 ,$194.40 ,$291.60 ,$113.81 ,$291.60 ,$291.60 ,$113.81 ,$210.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200002,95863,HC EMG THREE EXTREMITIES,922,1 ,$252.00 ,$163.80 ,$109.37 ,$307.44 ,$187.74 ,$165.06 ,$141.86 ,$132.80 ,$141.86 ,$159.01 ,$159.01 ,$159.01 ,$159.01 ,$226.80 ,$189.00 ,$141.86 ,$221.76 ,$141.86 ,$189.00 ,$189.00 ,$214.20 ,$214.20 ,$141.86 ,$214.20 ,$141.86 ,$199.08 ,$199.08 ,$199.08 ,$226.80 ,$252.00 ,$226.80 ,$141.86 ,$252.00 ,$165.06 ,$141.86 ,$109.37 , N/A ,$148.49 ,$226.80 ,$307.44 ,$159.01 ,$151.20 ,$226.80 ,$141.86 ,$226.80 ,$226.80 ,$141.86 ,$163.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200008,95925,HC SSEP UPPER LIMBS,922,1 ,$603.00 ,$391.95 ,$261.70 ,$603.00 ,$449.24 ,$394.97 ,$268.83 ,$317.78 ,$268.83 ,$380.49 ,$380.49 ,$380.49 ,$380.49 ,$542.70 ,$452.25 ,$268.83 ,$530.64 ,$268.83 ,$452.25 ,$452.25 ,$512.55 ,$512.55 ,$268.83 ,$512.55 ,$268.83 ,$476.37 ,$476.37 ,$476.37 ,$542.70 ,$603.00 ,$542.70 ,$268.83 ,$603.00 ,$394.97 ,$268.83 ,$261.70 , N/A ,$281.38 ,$542.70 ,$582.60 ,$380.49 ,$361.80 ,$542.70 ,$268.83 ,$542.70 ,$542.70 ,$268.83 ,$391.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200009,95926,HC SSEP LOWER LIMBS,922,1 ,$603.00 ,$391.95 ,$261.70 ,$603.00 ,$449.24 ,$394.97 ,$268.83 ,$317.78 ,$268.83 ,$380.49 ,$380.49 ,$380.49 ,$380.49 ,$542.70 ,$452.25 ,$268.83 ,$530.64 ,$268.83 ,$452.25 ,$452.25 ,$512.55 ,$512.55 ,$268.83 ,$512.55 ,$268.83 ,$476.37 ,$476.37 ,$476.37 ,$542.70 ,$603.00 ,$542.70 ,$268.83 ,$603.00 ,$394.97 ,$268.83 ,$261.70 , N/A ,$281.38 ,$542.70 ,$582.60 ,$380.49 ,$361.80 ,$542.70 ,$268.83 ,$542.70 ,$542.70 ,$268.83 ,$391.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200011,95886,HC EMG ADD ON >5 MUSCLES,922,1 ,"$1,715.00 ","$1,114.75 ",$744.31 ,"$1,715.00 ","$1,277.68 ","$1,123.33 ", N/A ,$903.81 , N/A ,"$1,082.17 ","$1,082.17 ","$1,082.17 ","$1,082.17 ","$1,543.50 ","$1,286.25 ", N/A ,"$1,509.20 ", N/A ,"$1,286.25 ","$1,286.25 ","$1,457.75 ","$1,457.75 ", N/A ,"$1,457.75 ", N/A ,"$1,354.85 ","$1,354.85 ","$1,354.85 ","$1,543.50 ", N/A ,"$1,543.50 ", N/A ,"$1,715.00 ","$1,123.33 ", N/A ,$744.31 , N/A , N/A ,"$1,543.50 ", N/A ,"$1,082.17 ","$1,029.00 ","$1,543.50 ", N/A ,"$1,543.50 ","$1,543.50 ", N/A ,"$1,114.75 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200012,95864,HC EMG 4 EXTREMITIES,922,1 ,$435.00 ,$282.75 ,$141.86 ,$435.00 ,$324.08 ,$284.93 ,$141.86 ,$229.25 ,$141.86 ,$274.49 ,$274.49 ,$274.49 ,$274.49 ,$391.50 ,$326.25 ,$141.86 ,$382.80 ,$141.86 ,$326.25 ,$326.25 ,$369.75 ,$369.75 ,$141.86 ,$369.75 ,$141.86 ,$343.65 ,$343.65 ,$343.65 ,$391.50 ,$340.55 ,$391.50 ,$141.86 ,$435.00 ,$284.93 ,$141.86 ,$188.79 , N/A ,$148.49 ,$391.50 ,$307.44 ,$274.49 ,$261.00 ,$391.50 ,$141.86 ,$391.50 ,$391.50 ,$141.86 ,$282.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200015,95938,HC SSEP UPPER AND LOWER,922,1 ,"$2,762.00 ","$1,795.30 ",$495.86 ,"$2,762.00 ","$2,057.69 ","$1,809.11 ",$495.86 ,"$1,455.57 ",$495.86 ,"$1,742.82 ","$1,742.82 ","$1,742.82 ","$1,742.82 ","$2,485.80 ","$2,071.50 ",$495.86 ,"$2,430.56 ",$495.86 ,"$2,071.50 ","$2,071.50 ","$2,347.70 ","$2,347.70 ",$495.86 ,"$2,347.70 ",$495.86 ,"$2,181.98 ","$2,181.98 ","$2,181.98 ","$2,485.80 ","$1,190.35 ","$2,485.80 ",$495.86 ,"$2,762.00 ","$1,809.11 ",$495.86 ,"$1,198.71 ", N/A ,$519.01 ,"$2,485.80 ","$1,074.60 ","$1,742.82 ","$1,657.20 ","$2,485.80 ",$495.86 ,"$2,485.80 ","$2,485.80 ",$495.86 ,"$1,795.30 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200016,95885,HC EMG ADD ON <5 MUSCLES,922,1 ,$349.00 ,$226.85 ,$151.47 ,$349.00 ,$260.01 ,$228.60 , N/A ,$183.92 , N/A ,$220.22 ,$220.22 ,$220.22 ,$220.22 ,$314.10 ,$261.75 , N/A ,$307.12 , N/A ,$261.75 ,$261.75 ,$296.65 ,$296.65 , N/A ,$296.65 , N/A ,$275.71 ,$275.71 ,$275.71 ,$314.10 , N/A ,$314.10 , N/A ,$349.00 ,$228.60 , N/A ,$151.47 , N/A , N/A ,$314.10 , N/A ,$220.22 ,$209.40 ,$314.10 , N/A ,$314.10 ,$314.10 , N/A ,$226.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200017,95887,HC EMG ADD ON CRANIAL,922,1 ,$242.00 ,$157.30 ,$105.03 ,$242.00 ,$180.29 ,$158.51 , N/A ,$127.53 , N/A ,$152.70 ,$152.70 ,$152.70 ,$152.70 ,$217.80 ,$181.50 , N/A ,$212.96 , N/A ,$181.50 ,$181.50 ,$205.70 ,$205.70 , N/A ,$205.70 , N/A ,$191.18 ,$191.18 ,$191.18 ,$217.80 , N/A ,$217.80 , N/A ,$242.00 ,$158.51 , N/A ,$105.03 , N/A , N/A ,$217.80 , N/A ,$152.70 ,$145.20 ,$217.80 , N/A ,$217.80 ,$217.80 , N/A ,$157.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200021,95907,HC NVR CNDJ TST 1-2 STUDIES,922,1 ,"$1,195.00 ",$776.75 ,$141.86 ,"$1,195.00 ",$890.28 ,$782.73 ,$141.86 ,$629.77 ,$141.86 ,$754.05 ,$754.05 ,$754.05 ,$754.05 ,"$1,075.50 ",$896.25 ,$141.86 ,"$1,051.60 ",$141.86 ,$896.25 ,$896.25 ,"$1,015.75 ","$1,015.75 ",$141.86 ,"$1,015.75 ",$141.86 ,$944.05 ,$944.05 ,$944.05 ,"$1,075.50 ",$340.55 ,"$1,075.50 ",$141.86 ,"$1,195.00 ",$782.73 ,$141.86 ,$518.63 , N/A ,$148.49 ,"$1,075.50 ",$307.44 ,$754.05 ,$717.00 ,"$1,075.50 ",$141.86 ,"$1,075.50 ","$1,075.50 ",$141.86 ,$776.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200022,95908,HC NVR CNDJ TST 3-4 STUDIES,922,1 ,"$2,389.00 ","$1,552.85 ",$268.83 ,"$2,389.00 ","$1,779.81 ","$1,564.80 ",$268.83 ,"$1,259.00 ",$268.83 ,"$1,507.46 ","$1,507.46 ","$1,507.46 ","$1,507.46 ","$2,150.10 ","$1,791.75 ",$268.83 ,"$2,102.32 ",$268.83 ,"$1,791.75 ","$1,791.75 ","$2,030.65 ","$2,030.65 ",$268.83 ,"$2,030.65 ",$268.83 ,"$1,887.31 ","$1,887.31 ","$1,887.31 ","$2,150.10 ",$645.35 ,"$2,150.10 ",$268.83 ,"$2,389.00 ","$1,564.80 ",$268.83 ,"$1,036.83 ", N/A ,$281.38 ,"$2,150.10 ",$582.60 ,"$1,507.46 ","$1,433.40 ","$2,150.10 ",$268.83 ,"$2,150.10 ","$2,150.10 ",$268.83 ,"$1,552.85 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200023,95909,HC NVR CNDJ TST 5-6 STUDIES,922,1 ,"$3,584.00 ","$2,329.60 ",$268.83 ,"$3,584.00 ","$2,670.08 ","$2,347.52 ",$268.83 ,"$1,888.77 ",$268.83 ,"$2,261.50 ","$2,261.50 ","$2,261.50 ","$2,261.50 ","$3,225.60 ","$2,688.00 ",$268.83 ,"$3,153.92 ",$268.83 ,"$2,688.00 ","$2,688.00 ","$3,046.40 ","$3,046.40 ",$268.83 ,"$3,046.40 ",$268.83 ,"$2,831.36 ","$2,831.36 ","$2,831.36 ","$3,225.60 ",$645.35 ,"$3,225.60 ",$268.83 ,"$3,584.00 ","$2,347.52 ",$268.83 ,"$1,555.46 ", N/A ,$281.38 ,"$3,225.60 ",$582.60 ,"$2,261.50 ","$2,150.40 ","$3,225.60 ",$268.83 ,"$3,225.60 ","$3,225.60 ",$268.83 ,"$2,329.60 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200024,95910,HC NVR CNDJ TST 7-8 STUDIES,922,1 ,"$4,779.00 ","$3,106.35 ",$268.83 ,"$4,779.00 ","$3,560.36 ","$3,130.25 ",$268.83 ,"$2,518.53 ",$268.83 ,"$3,015.55 ","$3,015.55 ","$3,015.55 ","$3,015.55 ","$4,301.10 ","$3,584.25 ",$268.83 ,"$4,205.52 ",$268.83 ,"$3,584.25 ","$3,584.25 ","$4,062.15 ","$4,062.15 ",$268.83 ,"$4,062.15 ",$268.83 ,"$3,775.41 ","$3,775.41 ","$3,775.41 ","$4,301.10 ",$645.35 ,"$4,301.10 ",$268.83 ,"$4,779.00 ","$3,130.25 ",$268.83 ,"$2,074.09 ", N/A ,$281.38 ,"$4,301.10 ",$582.60 ,"$3,015.55 ","$2,867.40 ","$4,301.10 ",$268.83 ,"$4,301.10 ","$4,301.10 ",$268.83 ,"$3,106.35 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200025,95911,HC NVR CNDJ TST 9-10 STUDIES,922,1 ,"$5,973.00 ","$3,882.45 ",$495.86 ,"$5,973.00 ","$4,449.89 ","$3,912.32 ",$495.86 ,"$3,147.77 ",$495.86 ,"$3,768.96 ","$3,768.96 ","$3,768.96 ","$3,768.96 ","$5,375.70 ","$4,479.75 ",$495.86 ,"$5,256.24 ",$495.86 ,"$4,479.75 ","$4,479.75 ","$5,077.05 ","$5,077.05 ",$495.86 ,"$5,077.05 ",$495.86 ,"$4,718.67 ","$4,718.67 ","$4,718.67 ","$5,375.70 ","$1,190.35 ","$5,375.70 ",$495.86 ,"$5,973.00 ","$3,912.32 ",$495.86 ,"$2,592.28 ", N/A ,$519.01 ,"$5,375.70 ","$1,074.60 ","$3,768.96 ","$3,583.80 ","$5,375.70 ",$495.86 ,"$5,375.70 ","$5,375.70 ",$495.86 ,"$3,882.45 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200026,95912,HC NVR CNDJ TST 11-12 STUDIES,922,1 ,"$7,167.00 ","$4,658.55 ",$495.86 ,"$7,167.00 ","$5,339.42 ","$4,694.39 ",$495.86 ,"$3,777.01 ",$495.86 ,"$4,522.38 ","$4,522.38 ","$4,522.38 ","$4,522.38 ","$6,450.30 ","$5,375.25 ",$495.86 ,"$6,306.96 ",$495.86 ,"$5,375.25 ","$5,375.25 ","$6,091.95 ","$6,091.95 ",$495.86 ,"$6,091.95 ",$495.86 ,"$5,661.93 ","$5,661.93 ","$5,661.93 ","$6,450.30 ","$1,190.35 ","$6,450.30 ",$495.86 ,"$7,167.00 ","$4,694.39 ",$495.86 ,"$3,110.48 ", N/A ,$519.01 ,"$6,450.30 ","$1,074.60 ","$4,522.38 ","$4,300.20 ","$6,450.30 ",$495.86 ,"$6,450.30 ","$6,450.30 ",$495.86 ,"$4,658.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200027,95913,HC NVR CNDJ TST 13 AND > STUDIES,922,1 ,"$8,361.00 ","$5,434.65 ",$495.86 ,"$8,361.00 ","$6,228.95 ","$5,476.46 ",$495.86 ,"$4,406.25 ",$495.86 ,"$5,275.79 ","$5,275.79 ","$5,275.79 ","$5,275.79 ","$7,524.90 ","$6,270.75 ",$495.86 ,"$7,357.68 ",$495.86 ,"$6,270.75 ","$6,270.75 ","$7,106.85 ","$7,106.85 ",$495.86 ,"$7,106.85 ",$495.86 ,"$6,605.19 ","$6,605.19 ","$6,605.19 ","$7,524.90 ","$1,190.35 ","$7,524.90 ",$495.86 ,"$8,361.00 ","$5,476.46 ",$495.86 ,"$3,628.67 ", N/A ,$519.01 ,"$7,524.90 ","$1,074.60 ","$5,275.79 ","$5,016.60 ","$7,524.90 ",$495.86 ,"$7,524.90 ","$7,524.90 ",$495.86 ,"$5,434.65 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200029,95870,HC EMG NON LIMB,922,1 ,$272.00 ,$176.80 ,$113.81 ,$272.00 ,$202.64 ,$178.16 ,$113.81 ,$143.34 ,$113.81 ,$171.63 ,$171.63 ,$171.63 ,$171.63 ,$244.80 ,$204.00 ,$113.81 ,$239.36 ,$113.81 ,$204.00 ,$204.00 ,$231.20 ,$231.20 ,$113.81 ,$231.20 ,$113.81 ,$214.88 ,$214.88 ,$214.88 ,$244.80 ,$272.00 ,$244.80 ,$113.81 ,$272.00 ,$178.16 ,$113.81 ,$118.05 , N/A ,$119.12 ,$244.80 ,$246.63 ,$171.63 ,$163.20 ,$244.80 ,$113.81 ,$244.80 ,$244.80 ,$113.81 ,$176.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),92200031,95927,HC SSEP TRUNK/HEAD,922,1 ,$993.00 ,$645.45 ,$268.83 ,$993.00 ,$739.79 ,$650.42 ,$268.83 ,$523.31 ,$268.83 ,$626.58 ,$626.58 ,$626.58 ,$626.58 ,$893.70 ,$744.75 ,$268.83 ,$873.84 ,$268.83 ,$744.75 ,$744.75 ,$844.05 ,$844.05 ,$268.83 ,$844.05 ,$268.83 ,$784.47 ,$784.47 ,$784.47 ,$893.70 ,$645.35 ,$893.70 ,$268.83 ,$993.00 ,$650.42 ,$268.83 ,$430.96 , N/A ,$281.38 ,$893.70 ,$582.60 ,$626.58 ,$595.80 ,$893.70 ,$268.83 ,$893.70 ,$893.70 ,$268.83 ,$645.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),94000101,99195,HC PHLEBOTOMY THERAPEUTIC,940,1 ,$154.00 ,$100.10 ,$66.84 ,$246.63 ,$114.73 ,$100.87 ,$113.81 ,$81.16 ,$113.81 ,$97.17 ,$97.17 ,$97.17 ,$97.17 ,$138.60 ,$115.50 ,$113.81 ,$135.52 ,$113.81 ,$115.50 ,$115.50 ,$130.90 ,$130.90 ,$113.81 ,$130.90 ,$113.81 ,$121.66 ,$121.66 ,$121.66 ,$138.60 ,$154.00 ,$138.60 ,$113.81 ,$154.00 ,$100.87 ,$113.81 ,$66.84 , N/A ,$119.12 ,$138.60 ,$246.63 ,$97.17 ,$92.40 ,$138.60 ,$113.81 ,$138.60 ,$138.60 ,$113.81 ,$100.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),94000103,E0202,HC PHOTO THERAPY INITIATE,940,1 ,$108.00 ,$70.20 ,$23.13 ,$108.00 ,$80.46 ,$70.74 ,$23.13 ,$56.92 ,$23.13 ,$68.15 ,$68.15 ,$68.15 ,$68.15 ,$97.20 ,$81.00 ,$23.13 ,$95.04 ,$23.13 ,$81.00 ,$81.00 ,$91.80 ,$91.80 ,$23.13 ,$91.80 ,$23.13 ,$85.32 ,$85.32 ,$85.32 ,$97.20 ,$55.53 ,$97.20 ,$23.13 ,$108.00 ,$70.74 ,$23.13 ,$46.87 , N/A ,$24.21 ,$97.20 ,$50.13 ,$68.15 ,$64.80 ,$97.20 ,$23.13 ,$97.20 ,$97.20 ,$23.13 ,$70.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),94000104,96372,HC INJECTION IM/SUBQ,940,1 ,$233.00 ,$151.45 ,$63.00 ,$233.00 ,$173.59 ,$152.62 ,$63.00 ,$122.79 ,$63.00 ,$147.02 ,$147.02 ,$147.02 ,$147.02 ,$209.70 ,$174.75 ,$63.00 ,$205.04 ,$63.00 ,$174.75 ,$174.75 ,$198.05 ,$198.05 ,$63.00 ,$198.05 ,$63.00 ,$184.07 ,$184.07 ,$184.07 ,$209.70 ,$151.23 ,$209.70 ,$63.00 ,$233.00 ,$152.62 ,$63.00 ,$101.12 , N/A ,$65.94 ,$209.70 ,$136.52 ,$147.02 ,$139.80 ,$209.70 ,$63.00 ,$209.70 ,$209.70 ,$63.00 ,$151.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),94000105,96374,HC INJ IV PUSH SINGL/INITIAL,940,1 ,$175.00 ,$113.75 ,$75.95 ,$448.32 ,$130.38 ,$114.63 ,$175.00 ,$92.23 ,$175.00 ,$110.43 ,$110.43 ,$110.43 ,$110.43 ,$157.50 ,$131.25 ,$175.00 ,$154.00 ,$175.00 ,$131.25 ,$131.25 ,$148.75 ,$148.75 ,$175.00 ,$148.75 ,$175.00 ,$138.25 ,$138.25 ,$138.25 ,$157.50 ,$175.00 ,$157.50 ,$175.00 ,$175.00 ,$114.63 ,$175.00 ,$75.95 , N/A ,$175.00 ,$157.50 ,$448.32 ,$110.43 ,$105.00 ,$157.50 ,$175.00 ,$157.50 ,$157.50 ,$175.00 ,$113.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),94000114,20560,HC NEEDLE INSERTION W/O INJECTION 1-2 MUSCLES,940,1 ,$142.00 ,$92.30 ,$25.08 ,$142.00 ,$105.79 ,$93.01 ,$25.08 ,$74.83 ,$25.08 ,$89.60 ,$89.60 ,$89.60 ,$89.60 ,$127.80 ,$106.50 ,$25.08 ,$124.96 ,$25.08 ,$106.50 ,$106.50 ,$120.70 ,$120.70 ,$25.08 ,$120.70 ,$25.08 ,$112.18 ,$112.18 ,$112.18 ,$127.80 ,$60.20 ,$127.80 ,$25.08 ,$142.00 ,$93.01 ,$25.08 ,$61.63 , N/A ,$26.25 ,$127.80 ,$54.35 ,$89.60 ,$85.20 ,$127.80 ,$25.08 ,$127.80 ,$127.80 ,$25.08 ,$92.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),94000115,20561,HC NEEDLE INSERTION W/O INJECTION 3+ MUSCLES,940,1 ,$142.00 ,$92.30 ,$25.08 ,$142.00 ,$105.79 ,$93.01 ,$25.08 ,$74.83 ,$25.08 ,$89.60 ,$89.60 ,$89.60 ,$89.60 ,$127.80 ,$106.50 ,$25.08 ,$124.96 ,$25.08 ,$106.50 ,$106.50 ,$120.70 ,$120.70 ,$25.08 ,$120.70 ,$25.08 ,$112.18 ,$112.18 ,$112.18 ,$127.80 ,$60.20 ,$127.80 ,$25.08 ,$142.00 ,$93.01 ,$25.08 ,$61.63 , N/A ,$26.25 ,$127.80 ,$54.35 ,$89.60 ,$85.20 ,$127.80 ,$25.08 ,$127.80 ,$127.80 ,$25.08 ,$92.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),94200005,97802,HC NUTRITION THRPY EVAL 15 MIN,942,1 ,$56.00 ,$36.40 ,$24.30 ,$56.00 ,$41.72 ,$36.68 ,$30.75 ,$29.51 ,$30.75 ,$35.34 ,$35.34 ,$35.34 ,$35.34 ,$50.40 ,$42.00 ,$30.75 ,$49.28 ,$30.75 ,$42.00 ,$42.00 ,$47.60 ,$47.60 ,$30.75 ,$47.60 ,$30.75 ,$44.24 ,$44.24 ,$44.24 ,$50.40 ,$30.75 ,$50.40 ,$30.75 ,$56.00 ,$36.68 ,$30.75 ,$24.30 , N/A ,$30.75 ,$50.40 ,$30.75 ,$35.34 ,$33.60 ,$50.40 ,$30.75 ,$50.40 ,$50.40 ,$30.75 ,$36.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),94200006,97803,HC NUTRITION THRPY RE-EVAL 15 MIN,942,1 ,$47.00 ,$30.55 ,$20.40 ,$47.00 ,$35.02 ,$30.79 ,$26.49 ,$24.77 ,$26.49 ,$29.66 ,$29.66 ,$29.66 ,$29.66 ,$42.30 ,$35.25 ,$26.49 ,$41.36 ,$26.49 ,$35.25 ,$35.25 ,$39.95 ,$39.95 ,$26.49 ,$39.95 ,$26.49 ,$37.13 ,$37.13 ,$37.13 ,$42.30 ,$26.49 ,$42.30 ,$26.49 ,$47.00 ,$30.79 ,$26.49 ,$20.40 , N/A ,$26.49 ,$42.30 ,$26.49 ,$29.66 ,$28.20 ,$42.30 ,$26.49 ,$42.30 ,$42.30 ,$26.49 ,$30.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),94200007,97804,HC MNT GROUP INIT 30 MIN,942,1 ,$60.00 ,$39.00 ,$13.98 ,$60.00 ,$44.70 ,$39.30 ,$13.98 ,$31.62 ,$13.98 ,$37.86 ,$37.86 ,$37.86 ,$37.86 ,$54.00 ,$45.00 ,$13.98 ,$52.80 ,$13.98 ,$45.00 ,$45.00 ,$51.00 ,$51.00 ,$13.98 ,$51.00 ,$13.98 ,$47.40 ,$47.40 ,$47.40 ,$54.00 ,$13.98 ,$54.00 ,$13.98 ,$60.00 ,$39.30 ,$13.98 ,$26.04 , N/A ,$13.98 ,$54.00 ,$13.98 ,$37.86 ,$36.00 ,$54.00 ,$13.98 ,$54.00 ,$54.00 ,$13.98 ,$39.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),94200011,G0108,HC DIABETES SELF MGT ED 30 MIN,942,1 ,$106.00 ,$68.90 ,$46.00 ,$126.42 ,$78.97 ,$69.43 ,$58.34 ,$55.86 ,$58.34 ,$66.89 ,$66.89 ,$66.89 ,$66.89 ,$95.40 ,$79.50 ,$58.34 ,$93.28 ,$58.34 ,$79.50 ,$79.50 ,$90.10 ,$90.10 ,$58.34 ,$90.10 ,$58.34 ,$83.74 ,$83.74 ,$83.74 ,$95.40 ,$106.00 ,$95.40 ,$58.34 ,$106.00 ,$69.43 ,$58.34 ,$46.00 , N/A ,$61.06 ,$95.40 ,$126.42 ,$66.89 ,$63.60 ,$95.40 ,$58.34 ,$95.40 ,$95.40 ,$58.34 ,$68.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),94200013,G0109,HC DIABETES SELF MGT GROUP 30MIN,942,1 ,$53.00 ,$34.45 ,$16.26 ,$53.00 ,$39.49 ,$34.72 ,$16.26 ,$27.93 ,$16.26 ,$33.44 ,$33.44 ,$33.44 ,$33.44 ,$47.70 ,$39.75 ,$16.26 ,$46.64 ,$16.26 ,$39.75 ,$39.75 ,$45.05 ,$45.05 ,$16.26 ,$45.05 ,$16.26 ,$41.87 ,$41.87 ,$41.87 ,$47.70 ,$39.03 ,$47.70 ,$16.26 ,$53.00 ,$34.72 ,$16.26 ,$23.00 , N/A ,$17.02 ,$47.70 ,$35.23 ,$33.44 ,$31.80 ,$47.70 ,$16.26 ,$47.70 ,$47.70 ,$16.26 ,$34.45 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),94300004,93797,HC CARDIAC REHAB W/O EKG SESSION,943,1 ,$180.00 ,$117.00 ,$78.12 ,$255.69 ,$134.10 ,$117.90 ,$117.98 ,$94.86 ,$117.98 ,$113.58 ,$113.58 ,$113.58 ,$113.58 ,$162.00 ,$135.00 ,$117.98 ,$158.40 ,$117.98 ,$135.00 ,$135.00 ,$153.00 ,$153.00 ,$117.98 ,$153.00 ,$117.98 ,$142.20 ,$142.20 ,$142.20 ,$162.00 ,$180.00 ,$162.00 ,$117.98 ,$180.00 ,$117.90 ,$117.98 ,$78.12 , N/A ,$123.49 ,$162.00 ,$255.69 ,$113.58 ,$108.00 ,$162.00 ,$117.98 ,$162.00 ,$162.00 ,$117.98 ,$117.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),94300006,93798,HC CARDIAC REHAB W/EKG SESSION (LV1),943,1 ,$215.00 ,$139.75 ,$93.31 ,$255.69 ,$160.18 ,$140.83 ,$117.98 ,$113.31 ,$117.98 ,$135.67 ,$135.67 ,$135.67 ,$135.67 ,$193.50 ,$161.25 ,$117.98 ,$189.20 ,$117.98 ,$161.25 ,$161.25 ,$182.75 ,$182.75 ,$117.98 ,$182.75 ,$117.98 ,$169.85 ,$169.85 ,$169.85 ,$193.50 ,$215.00 ,$193.50 ,$117.98 ,$215.00 ,$140.83 ,$117.98 ,$93.31 , N/A ,$123.49 ,$193.50 ,$255.69 ,$135.67 ,$129.00 ,$193.50 ,$117.98 ,$193.50 ,$193.50 ,$117.98 ,$139.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),94300008,G0424,HC PULMONARY REHAB PER HOUR,948,1 ,$149.00 ,$96.85 ,$56.58 ,$149.00 ,$111.01 ,$97.60 ,$56.58 ,$78.52 ,$56.58 ,$94.02 ,$94.02 ,$94.02 ,$94.02 ,$134.10 ,$111.75 ,$56.58 ,$131.12 ,$56.58 ,$111.75 ,$111.75 ,$126.65 ,$126.65 ,$56.58 ,$126.65 ,$56.58 ,$117.71 ,$117.71 ,$117.71 ,$134.10 ,$135.83 ,$134.10 ,$56.58 ,$149.00 ,$97.60 ,$56.58 ,$64.67 , N/A ,$59.22 ,$134.10 ,$122.62 ,$94.02 ,$89.40 ,$134.10 ,$56.58 ,$134.10 ,$134.10 ,$56.58 ,$96.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),94300012,G0424,HC PULMONARY REHAB PER HOUR-KX,948,1 ,$149.00 ,$96.85 ,$56.58 ,$149.00 ,$111.01 ,$97.60 ,$56.58 ,$78.52 ,$56.58 ,$94.02 ,$94.02 ,$94.02 ,$94.02 ,$134.10 ,$111.75 ,$56.58 ,$131.12 ,$56.58 ,$111.75 ,$111.75 ,$126.65 ,$126.65 ,$56.58 ,$126.65 ,$56.58 ,$117.71 ,$117.71 ,$117.71 ,$134.10 ,$135.83 ,$134.10 ,$56.58 ,$149.00 ,$97.60 ,$56.58 ,$64.67 , N/A ,$59.22 ,$134.10 ,$122.62 ,$94.02 ,$89.40 ,$134.10 ,$56.58 ,$134.10 ,$134.10 ,$56.58 ,$96.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),94300014,93798,HC CARD REHAB W/EKG SESS (PH2)-KX,943,1 ,$215.00 ,$139.75 ,$93.31 ,$255.69 ,$160.18 ,$140.83 ,$117.98 ,$113.31 ,$117.98 ,$135.67 ,$135.67 ,$135.67 ,$135.67 ,$193.50 ,$161.25 ,$117.98 ,$189.20 ,$117.98 ,$161.25 ,$161.25 ,$182.75 ,$182.75 ,$117.98 ,$182.75 ,$117.98 ,$169.85 ,$169.85 ,$169.85 ,$193.50 ,$215.00 ,$193.50 ,$117.98 ,$215.00 ,$140.83 ,$117.98 ,$93.31 , N/A ,$123.49 ,$193.50 ,$255.69 ,$135.67 ,$129.00 ,$193.50 ,$117.98 ,$193.50 ,$193.50 ,$117.98 ,$139.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),94300019,N/A,HC CARDIAC REHAB PHASE 3 FULL MONTH,943,1 ,$62.00 ,$40.30 ,$26.91 ,$62.00 ,$46.19 ,$40.61 , N/A ,$32.67 , N/A ,$39.12 ,$39.12 ,$39.12 ,$39.12 ,$55.80 ,$46.50 , N/A ,$54.56 , N/A ,$46.50 ,$46.50 ,$52.70 ,$52.70 , N/A ,$52.70 , N/A ,$48.98 ,$48.98 ,$48.98 ,$55.80 , N/A ,$55.80 , N/A ,$62.00 ,$40.61 , N/A ,$26.91 , N/A , N/A ,$55.80 , N/A ,$39.12 ,$37.20 ,$55.80 , N/A ,$55.80 ,$55.80 , N/A ,$40.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),94300021,N/A,HC CARDIAC REHAB EXERCISE PER VISIT,943,1 ,$16.00 ,$10.40 ,$6.94 ,$16.00 ,$11.92 ,$10.48 , N/A ,$8.43 , N/A ,$10.10 ,$10.10 ,$10.10 ,$10.10 ,$14.40 ,$12.00 , N/A ,$14.08 , N/A ,$12.00 ,$12.00 ,$13.60 ,$13.60 , N/A ,$13.60 , N/A ,$12.64 ,$12.64 ,$12.64 ,$14.40 , N/A ,$14.40 , N/A ,$16.00 ,$10.48 , N/A ,$6.94 , N/A , N/A ,$14.40 , N/A ,$10.10 ,$9.60 ,$14.40 , N/A ,$14.40 ,$14.40 , N/A ,$10.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),96000010,32550,PC INSERT CATH PLEURAL INDWELL W/CUFF,960,1 ,$650.00 ,$422.50 ,$342.55 ,"$7,013.20 ",$484.25 ,$425.75 ,$650.00 ,$342.55 ,$650.00 ,$410.15 ,$410.15 ,$410.15 ,$410.15 ,$585.00 ,$487.50 ,$650.00 ,$572.00 ,$650.00 ,$487.50 ,$487.50 ,$552.50 ,$552.50 ,$650.00 ,$552.50 ,$650.00 ,$513.50 ,$513.50 ,$513.50 ,$585.00 ,$650.00 ,$585.00 ,$650.00 ,$650.00 ,$425.75 ,$650.00 ,$367.38 , N/A ,$650.00 ,$585.00 ,"$7,013.20 ",$410.15 ,$390.00 ,$585.00 ,$650.00 , N/A , N/A ,$650.00 ,$422.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),96000011,32556,PC PLEURAL DRAINAGE W/O IMAGING,960,1 ,$384.00 ,$249.60 ,$202.37 ,"$3,580.00 ",$286.08 ,$251.52 ,$384.00 ,$202.37 ,$384.00 ,$242.30 ,$242.30 ,$242.30 ,$242.30 ,$345.60 ,$288.00 ,$384.00 ,$337.92 ,$384.00 ,$288.00 ,$288.00 ,$326.40 ,$326.40 ,$384.00 ,$326.40 ,$384.00 ,$303.36 ,$303.36 ,$303.36 ,$345.60 ,$384.00 ,$345.60 ,$384.00 ,$384.00 ,$251.52 ,$384.00 ,$219.29 , N/A ,$384.00 ,$345.60 ,"$3,580.00 ",$242.30 ,$230.40 ,$345.60 ,$384.00 , N/A , N/A ,$384.00 ,$249.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),96000012,36660,PC CATHERIZATION UMBILICAL ARTERY NEWBORN,960,1 ,$228.00 ,$148.20 ,$120.16 ,$228.00 ,$169.86 ,$149.34 , N/A ,$120.16 , N/A ,$143.87 ,$143.87 ,$143.87 ,$143.87 ,$205.20 ,$171.00 , N/A ,$200.64 , N/A ,$171.00 ,$171.00 ,$193.80 ,$193.80 , N/A ,$193.80 , N/A ,$180.12 ,$180.12 ,$180.12 ,$205.20 , N/A ,$205.20 , N/A ,$228.00 ,$149.34 , N/A ,$120.32 , N/A , N/A ,$205.20 , N/A ,$143.87 ,$136.80 ,$205.20 , N/A , N/A , N/A , N/A ,$148.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),96000013,54150,PC CIRCUMCISION W/DEVICE,960,1 ,$303.00 ,$196.95 ,$159.68 ,"$3,950.04 ",$225.74 ,$198.47 ,$303.00 ,$159.68 ,$303.00 ,$191.19 ,$191.19 ,$191.19 ,$191.19 ,$272.70 ,$227.25 ,$303.00 ,$266.64 ,$303.00 ,$227.25 ,$227.25 ,$257.55 ,$257.55 ,$303.00 ,$257.55 ,$303.00 ,$239.37 ,$239.37 ,$239.37 ,$272.70 ,$303.00 ,$272.70 ,$303.00 ,$303.00 ,$198.47 ,$303.00 ,$174.91 , N/A ,$303.00 ,$272.70 ,"$3,950.04 ",$191.19 ,$181.80 ,$272.70 ,$303.00 , N/A , N/A ,$303.00 ,$196.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),96000014,36510,PC UMBILICAL CATHETER INSERTION NEWBORN,960,1 ,$174.00 ,$113.10 ,$91.70 ,$174.00 ,$129.63 ,$113.97 , N/A ,$91.70 , N/A ,$109.79 ,$109.79 ,$109.79 ,$109.79 ,$156.60 ,$130.50 , N/A ,$153.12 , N/A ,$130.50 ,$130.50 ,$147.90 ,$147.90 , N/A ,$147.90 , N/A ,$137.46 ,$137.46 ,$137.46 ,$156.60 , N/A ,$156.60 , N/A ,$174.00 ,$113.97 , N/A ,$94.76 , N/A , N/A ,$156.60 , N/A ,$109.79 ,$104.40 ,$156.60 , N/A , N/A , N/A , N/A ,$113.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),96000015,76936,PC US GUIDED COMPRESSION RPR -26,960,1 ,$151.75 ,$98.64 ,$79.97 ,$582.60 ,$113.05 ,$99.40 ,$151.75 ,$79.97 ,$151.75 ,$95.75 ,$95.75 ,$95.75 ,$95.75 ,$136.58 ,$113.81 ,$151.75 ,$133.54 ,$151.75 ,$113.81 ,$113.81 ,$128.99 ,$128.99 ,$151.75 ,$128.99 ,$151.75 ,$119.88 ,$119.88 ,$119.88 ,$136.58 ,$151.75 ,$136.58 ,$151.75 ,$151.75 ,$99.40 ,$151.75 ,$151.75 , N/A ,$151.75 ,$136.58 ,$582.60 ,$95.75 ,$91.05 ,$136.58 ,$151.75 , N/A , N/A ,$151.75 ,$98.64 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),96000044,G2061,PC NON PHYSICIAN EST PT 5-10 MIN,960,1 ,$37.47 ,$24.36 ,$15.49 ,$37.47 ,$27.92 ,$24.54 , N/A ,$19.75 , N/A ,$23.64 ,$23.64 ,$23.64 ,$23.64 ,$33.72 ,$28.10 , N/A ,$32.97 , N/A ,$28.10 ,$28.10 ,$31.85 ,$31.85 , N/A ,$31.85 , N/A ,$29.60 ,$29.60 ,$29.60 ,$33.72 , N/A ,$33.72 , N/A ,$37.47 ,$24.54 , N/A ,$15.49 , N/A , N/A ,$33.72 , N/A ,$23.64 ,$22.48 ,$33.72 , N/A , N/A , N/A , N/A ,$24.36 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),96000045,G2062,PC NON PHYSICIAN EST PT 11-20 MIN,960,1 ,$66.27 ,$43.08 ,$27.35 ,$66.27 ,$49.37 ,$43.41 , N/A ,$34.92 , N/A ,$41.82 ,$41.82 ,$41.82 ,$41.82 ,$59.64 ,$49.70 , N/A ,$58.32 , N/A ,$49.70 ,$49.70 ,$56.33 ,$56.33 , N/A ,$56.33 , N/A ,$52.35 ,$52.35 ,$52.35 ,$59.64 , N/A ,$59.64 , N/A ,$66.27 ,$43.41 , N/A ,$27.35 , N/A , N/A ,$59.64 , N/A ,$41.82 ,$39.76 ,$59.64 , N/A , N/A , N/A , N/A ,$43.08 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),96000046,G2063,PC NON PHYSICIAN EST PT > 21 MIN,960,1 ,$103.74 ,$67.43 ,$42.42 ,$103.74 ,$77.29 ,$67.95 , N/A ,$54.67 , N/A ,$65.46 ,$65.46 ,$65.46 ,$65.46 ,$93.37 ,$77.81 , N/A ,$91.29 , N/A ,$77.81 ,$77.81 ,$88.18 ,$88.18 , N/A ,$88.18 , N/A ,$81.95 ,$81.95 ,$81.95 ,$93.37 , N/A ,$93.37 , N/A ,$103.74 ,$67.95 , N/A ,$42.42 , N/A , N/A ,$93.37 , N/A ,$65.46 ,$62.24 ,$93.37 , N/A , N/A , N/A , N/A ,$67.43 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),96100001,90791,PC EVAL PSYCH DIAG MD,961,1 ,$424.00 ,$275.60 ,$135.84 ,$424.00 ,$315.88 ,$277.72 ,$135.84 ,$223.45 ,$135.84 ,$267.54 ,$267.54 ,$267.54 ,$267.54 ,$381.60 ,$318.00 ,$135.84 ,$373.12 ,$135.84 ,$318.00 ,$318.00 ,$360.40 ,$360.40 ,$135.84 ,$360.40 ,$135.84 ,$334.96 ,$334.96 ,$334.96 ,$381.60 ,$326.10 ,$381.60 ,$135.84 ,$424.00 ,$277.72 ,$135.84 ,$175.57 , N/A ,$142.19 ,$381.60 ,$294.39 ,$267.54 ,$254.40 ,$381.60 ,$135.84 , N/A , N/A ,$135.84 ,$275.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),96100002,90791,PC EVAL PSYCH DIAG PHD,961,1 ,$424.00 ,$275.60 ,$135.84 ,$424.00 ,$315.88 ,$277.72 ,$135.84 ,$223.45 ,$135.84 ,$267.54 ,$267.54 ,$267.54 ,$267.54 ,$381.60 ,$318.00 ,$135.84 ,$373.12 ,$135.84 ,$318.00 ,$318.00 ,$360.40 ,$360.40 ,$135.84 ,$360.40 ,$135.84 ,$334.96 ,$334.96 ,$334.96 ,$381.60 ,$326.10 ,$381.60 ,$135.84 ,$424.00 ,$277.72 ,$135.84 ,$175.57 , N/A ,$142.19 ,$381.60 ,$294.39 ,$267.54 ,$254.40 ,$381.60 ,$135.84 , N/A , N/A ,$135.84 ,$275.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),96100004,90832,PC THERAPY INDIVIDUAL PSYCH 30MIN,961,1 ,$189.00 ,$122.85 ,$87.86 ,$294.39 ,$140.81 ,$123.80 ,$135.84 ,$99.60 ,$135.84 ,$119.26 ,$119.26 ,$119.26 ,$119.26 ,$170.10 ,$141.75 ,$135.84 ,$166.32 ,$135.84 ,$141.75 ,$141.75 ,$160.65 ,$160.65 ,$135.84 ,$160.65 ,$135.84 ,$149.31 ,$149.31 ,$149.31 ,$170.10 ,$189.00 ,$170.10 ,$135.84 ,$189.00 ,$123.80 ,$135.84 ,$87.86 , N/A ,$142.19 ,$170.10 ,$294.39 ,$119.26 ,$113.40 ,$170.10 ,$135.84 , N/A , N/A ,$135.84 ,$122.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),96100005,90833,PC THERAPY INDIVIDUAL PSYCH W/MED EVAL 30MIN,961,1 ,$195.00 ,$126.75 ,$91.05 ,$195.00 ,$145.28 ,$127.73 , N/A ,$102.77 , N/A ,$123.05 ,$123.05 ,$123.05 ,$123.05 ,$175.50 ,$146.25 , N/A ,$171.60 , N/A ,$146.25 ,$146.25 ,$165.75 ,$165.75 , N/A ,$165.75 , N/A ,$154.05 ,$154.05 ,$154.05 ,$175.50 , N/A ,$175.50 , N/A ,$195.00 ,$127.73 , N/A ,$91.05 , N/A , N/A ,$175.50 , N/A ,$123.05 ,$117.00 ,$175.50 , N/A , N/A , N/A , N/A ,$126.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),96100006,90834,PC THERAPY INDIVIDUAL PSYCH 45MIN,961,1 ,$249.00 ,$161.85 ,$117.14 ,$294.39 ,$185.51 ,$163.10 ,$135.84 ,$131.22 ,$135.84 ,$157.12 ,$157.12 ,$157.12 ,$157.12 ,$224.10 ,$186.75 ,$135.84 ,$219.12 ,$135.84 ,$186.75 ,$186.75 ,$211.65 ,$211.65 ,$135.84 ,$211.65 ,$135.84 ,$196.71 ,$196.71 ,$196.71 ,$224.10 ,$249.00 ,$224.10 ,$135.84 ,$249.00 ,$163.10 ,$135.84 ,$117.14 , N/A ,$142.19 ,$224.10 ,$294.39 ,$157.12 ,$149.40 ,$224.10 ,$135.84 , N/A , N/A ,$135.84 ,$161.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),96100007,90836,PC THERAPY INDIVIDUAL PSYCH W/MED EVAL 45MIN,961,1 ,$246.00 ,$159.90 ,$115.36 ,$246.00 ,$183.27 ,$161.13 , N/A ,$129.64 , N/A ,$155.23 ,$155.23 ,$155.23 ,$155.23 ,$221.40 ,$184.50 , N/A ,$216.48 , N/A ,$184.50 ,$184.50 ,$209.10 ,$209.10 , N/A ,$209.10 , N/A ,$194.34 ,$194.34 ,$194.34 ,$221.40 , N/A ,$221.40 , N/A ,$246.00 ,$161.13 , N/A ,$115.36 , N/A , N/A ,$221.40 , N/A ,$155.23 ,$147.60 ,$221.40 , N/A , N/A , N/A , N/A ,$159.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),96100008,90837,PC THERAPY INDIVIDUAL PSYCH PHD 60MIN,961,1 ,$375.00 ,$243.75 ,$135.84 ,$375.00 ,$279.38 ,$245.63 ,$135.84 ,$197.63 ,$135.84 ,$236.63 ,$236.63 ,$236.63 ,$236.63 ,$337.50 ,$281.25 ,$135.84 ,$330.00 ,$135.84 ,$281.25 ,$281.25 ,$318.75 ,$318.75 ,$135.84 ,$318.75 ,$135.84 ,$296.25 ,$296.25 ,$296.25 ,$337.50 ,$326.10 ,$337.50 ,$135.84 ,$375.00 ,$245.63 ,$135.84 ,$175.12 , N/A ,$142.19 ,$337.50 ,$294.39 ,$236.63 ,$225.00 ,$337.50 ,$135.84 , N/A , N/A ,$135.84 ,$243.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),96100011,90838,PC PSYCH THERAPY INDIV W/MED EVAL 60MIN,961,1 ,$324.00 ,$210.60 ,$151.31 ,$324.00 ,$241.38 ,$212.22 , N/A ,$170.75 , N/A ,$204.44 ,$204.44 ,$204.44 ,$204.44 ,$291.60 ,$243.00 , N/A ,$285.12 , N/A ,$243.00 ,$243.00 ,$275.40 ,$275.40 , N/A ,$275.40 , N/A ,$255.96 ,$255.96 ,$255.96 ,$291.60 , N/A ,$291.60 , N/A ,$324.00 ,$212.22 , N/A ,$151.31 , N/A , N/A ,$291.60 , N/A ,$204.44 ,$194.40 ,$291.60 , N/A , N/A , N/A , N/A ,$210.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),97280006,76706,PC US ABDOMINAL AORTA SCREENING-26,972,1 ,$126.00 ,$81.90 ,$66.40 ,$240.07 ,$93.87 ,$82.53 ,$110.78 ,$66.40 ,$110.78 ,$79.51 ,$79.51 ,$79.51 ,$79.51 ,$113.40 ,$94.50 ,$110.78 ,$110.88 ,$110.78 ,$94.50 ,$94.50 ,$107.10 ,$107.10 ,$110.78 ,$107.10 ,$110.78 ,$99.54 ,$99.54 ,$99.54 ,$113.40 ,$126.00 ,$113.40 ,$110.78 ,$126.00 ,$82.53 ,$110.78 ,$126.00 , N/A ,$115.95 ,$113.40 ,$240.07 ,$79.51 ,$75.60 ,$113.40 ,$110.78 , N/A , N/A ,$110.78 ,$81.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),97400001,78472,PC MUGA RESTING SINGLE -26,974,1 ,$288.00 ,$187.20 ,$151.78 ,$830.81 ,$214.56 ,$188.64 ,$288.00 ,$151.78 ,$288.00 ,$181.73 ,$181.73 ,$181.73 ,$181.73 ,$259.20 ,$216.00 ,$288.00 ,$253.44 ,$288.00 ,$216.00 ,$216.00 ,$244.80 ,$244.80 ,$288.00 ,$244.80 ,$288.00 ,$227.52 ,$227.52 ,$227.52 ,$259.20 ,$288.00 ,$259.20 ,$288.00 ,$288.00 ,$188.64 ,$288.00 ,$288.00 , N/A ,$288.00 ,$259.20 ,$830.81 ,$181.73 ,$172.80 ,$259.20 ,$288.00 , N/A , N/A ,$288.00 ,$187.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),97400002,78451,PC HT MUSCLE IMAGE SPECT SINGLE -26,974,1 ,$688.22 ,$447.34 ,$362.69 ,"$2,877.05 ",$512.72 ,$450.78 ,$688.22 ,$362.69 ,$688.22 ,$434.27 ,$434.27 ,$434.27 ,$434.27 ,$619.40 ,$516.17 ,$688.22 ,$605.63 ,$688.22 ,$516.17 ,$516.17 ,$584.99 ,$584.99 ,$688.22 ,$584.99 ,$688.22 ,$543.69 ,$543.69 ,$543.69 ,$619.40 ,$688.22 ,$619.40 ,$688.22 ,$688.22 ,$450.78 ,$688.22 ,$688.22 , N/A ,$688.22 ,$619.40 ,"$2,877.05 ",$434.27 ,$412.93 ,$619.40 ,$688.22 , N/A , N/A ,$688.22 ,$447.34 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),97400003,78452,PC HT MUSCLE IMAGE SPECT MULTI -26,974,1 ,$866.20 ,$563.03 ,$456.49 ,"$2,877.05 ",$645.32 ,$567.36 ,$866.20 ,$456.49 ,$866.20 ,$546.57 ,$546.57 ,$546.57 ,$546.57 ,$779.58 ,$649.65 ,$866.20 ,$762.26 ,$866.20 ,$649.65 ,$649.65 ,$736.27 ,$736.27 ,$866.20 ,$736.27 ,$866.20 ,$684.30 ,$684.30 ,$684.30 ,$779.58 ,$866.20 ,$779.58 ,$866.20 ,$866.20 ,$567.36 ,$866.20 ,$866.20 , N/A ,$866.20 ,$779.58 ,"$2,877.05 ",$546.57 ,$519.72 ,$779.58 ,$866.20 , N/A , N/A ,$866.20 ,$563.03 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),97600002,94010,PC SPIROMETRY PACKAGE-26,976,1 ,$19.44 ,$12.64 ,$10.24 ,$307.44 ,$14.48 ,$12.73 ,$19.44 ,$10.24 ,$19.44 ,$12.27 ,$12.27 ,$12.27 ,$12.27 ,$17.50 ,$14.58 ,$19.44 ,$17.11 ,$19.44 ,$14.58 ,$14.58 ,$16.52 ,$16.52 ,$19.44 ,$16.52 ,$19.44 ,$15.36 ,$15.36 ,$15.36 ,$17.50 ,$19.44 ,$17.50 ,$19.44 ,$19.44 ,$12.73 ,$19.44 ,$19.44 , N/A ,$19.44 ,$17.50 ,$307.44 ,$12.27 ,$11.66 ,$17.50 ,$19.44 , N/A , N/A ,$19.44 ,$12.64 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),97600003,94070,PC SPIROMETRY PFT COMPLEX -26,976,1 ,$82.19 ,$53.42 ,$43.31 ,$582.60 ,$61.23 ,$53.83 ,$82.19 ,$43.31 ,$82.19 ,$51.86 ,$51.86 ,$51.86 ,$51.86 ,$73.97 ,$61.64 ,$82.19 ,$72.33 ,$82.19 ,$61.64 ,$61.64 ,$69.86 ,$69.86 ,$82.19 ,$69.86 ,$82.19 ,$64.93 ,$64.93 ,$64.93 ,$73.97 ,$82.19 ,$73.97 ,$82.19 ,$82.19 ,$53.83 ,$82.19 ,$82.19 , N/A ,$82.19 ,$73.97 ,$582.60 ,$51.86 ,$49.31 ,$73.97 ,$82.19 , N/A , N/A ,$82.19 ,$53.42 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),97600004,94060,PC SPIROMETRY/PFT PRE AND POST -26,976,1 ,$54.78 ,$35.61 ,$28.87 ,$582.60 ,$40.81 ,$35.88 ,$54.78 ,$28.87 ,$54.78 ,$34.57 ,$34.57 ,$34.57 ,$34.57 ,$49.30 ,$41.09 ,$54.78 ,$48.21 ,$54.78 ,$41.09 ,$41.09 ,$46.56 ,$46.56 ,$54.78 ,$46.56 ,$54.78 ,$43.28 ,$43.28 ,$43.28 ,$49.30 ,$54.78 ,$49.30 ,$54.78 ,$54.78 ,$35.88 ,$54.78 ,$54.78 , N/A ,$54.78 ,$49.30 ,$582.60 ,$34.57 ,$32.87 ,$49.30 ,$54.78 , N/A , N/A ,$54.78 ,$35.61 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),97600006,94726,PC PLETHYSMOGRAPHY -26,976,1 ,$79.87 ,$51.92 ,$42.09 ,$582.60 ,$59.50 ,$52.31 ,$79.87 ,$42.09 ,$79.87 ,$50.40 ,$50.40 ,$50.40 ,$50.40 ,$71.88 ,$59.90 ,$79.87 ,$70.29 ,$79.87 ,$59.90 ,$59.90 ,$67.89 ,$67.89 ,$79.87 ,$67.89 ,$79.87 ,$63.10 ,$63.10 ,$63.10 ,$71.88 ,$79.87 ,$71.88 ,$79.87 ,$79.87 ,$52.31 ,$79.87 ,$79.87 , N/A ,$79.87 ,$71.88 ,$582.60 ,$50.40 ,$47.92 ,$71.88 ,$79.87 , N/A , N/A ,$79.87 ,$51.92 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),97600008,94729,PC DIFFUSING CAPACITY -26,976,1 ,$39.93 ,$25.95 ,$21.04 ,$39.93 ,$29.75 ,$26.15 , N/A ,$21.04 , N/A ,$25.20 ,$25.20 ,$25.20 ,$25.20 ,$35.94 ,$29.95 , N/A ,$35.14 , N/A ,$29.95 ,$29.95 ,$33.94 ,$33.94 , N/A ,$33.94 , N/A ,$31.54 ,$31.54 ,$31.54 ,$35.94 , N/A ,$35.94 , N/A ,$39.93 ,$26.15 , N/A ,$39.93 , N/A , N/A ,$35.94 , N/A ,$25.20 ,$23.96 ,$35.94 , N/A , N/A , N/A , N/A ,$25.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),97600009,94002,PC VENT MANGMNT INPT/OBS INIT DAY,976,1 ,$282.00 ,$183.30 ,$148.61 ,"$1,069.05 ",$210.09 ,$184.71 ,$282.00 ,$148.61 ,$282.00 ,$177.94 ,$177.94 ,$177.94 ,$177.94 ,$253.80 ,$211.50 ,$282.00 ,$248.16 ,$282.00 ,$211.50 ,$211.50 ,$239.70 ,$239.70 ,$282.00 ,$239.70 ,$282.00 ,$222.78 ,$222.78 ,$222.78 ,$253.80 ,$282.00 ,$253.80 ,$282.00 ,$282.00 ,$184.71 ,$282.00 ,$173.95 , N/A ,$282.00 ,$253.80 ,"$1,069.05 ",$177.94 ,$169.20 ,$253.80 ,$282.00 , N/A , N/A ,$282.00 ,$183.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),97600010,94003,PC VENT MANGMENT INPT/OBS SUBS DAY,976,1 ,$204.00 ,$132.60 ,$107.51 ,"$1,069.05 ",$151.98 ,$133.62 ,$204.00 ,$107.51 ,$204.00 ,$128.72 ,$128.72 ,$128.72 ,$128.72 ,$183.60 ,$153.00 ,$204.00 ,$179.52 ,$204.00 ,$153.00 ,$153.00 ,$173.40 ,$173.40 ,$204.00 ,$173.40 ,$204.00 ,$161.16 ,$161.16 ,$161.16 ,$183.60 ,$204.00 ,$183.60 ,$204.00 ,$204.00 ,$133.62 ,$204.00 ,$125.32 , N/A ,$204.00 ,$183.60 ,"$1,069.05 ",$128.72 ,$122.40 ,$183.60 ,$204.00 , N/A , N/A ,$204.00 ,$132.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),97600011,94610,PC INTRAPULM SURFACTANT ADMIN W/ENDOTRACH TUBE,976,1 ,$171.00 ,$111.15 ,$90.12 ,$413.91 ,$127.40 ,$112.01 ,$171.00 ,$90.12 ,$171.00 ,$107.90 ,$107.90 ,$107.90 ,$107.90 ,$153.90 ,$128.25 ,$171.00 ,$150.48 ,$171.00 ,$128.25 ,$128.25 ,$145.35 ,$145.35 ,$171.00 ,$145.35 ,$171.00 ,$135.09 ,$135.09 ,$135.09 ,$153.90 ,$171.00 ,$153.90 ,$171.00 ,$171.00 ,$112.01 ,$171.00 ,$104.91 , N/A ,$171.00 ,$153.90 ,$413.91 ,$107.90 ,$102.60 ,$153.90 ,$171.00 , N/A , N/A ,$171.00 ,$111.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),97600012,94660,PC CPAP/BIPAP VENT NONINVAS INIT AND MGMT,976,1 ,$117.00 ,$76.05 ,$61.66 ,$413.91 ,$87.17 ,$76.64 ,$117.00 ,$61.66 ,$117.00 ,$73.83 ,$73.83 ,$73.83 ,$73.83 ,$105.30 ,$87.75 ,$117.00 ,$102.96 ,$117.00 ,$87.75 ,$87.75 ,$99.45 ,$99.45 ,$117.00 ,$99.45 ,$117.00 ,$92.43 ,$92.43 ,$92.43 ,$105.30 ,$117.00 ,$105.30 ,$117.00 ,$117.00 ,$76.64 ,$117.00 ,$71.69 , N/A ,$117.00 ,$105.30 ,$413.91 ,$73.83 ,$70.20 ,$105.30 ,$117.00 , N/A , N/A ,$117.00 ,$76.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180003,10061,PC DRAIN SKIN ABSCESS COMPLIC,981,1 ,$496.25 ,$322.56 ,$261.52 ,$761.90 ,$369.71 ,$325.04 ,$351.57 ,$261.52 ,$351.57 ,$313.13 ,$313.13 ,$313.13 ,$313.13 ,$446.63 ,$372.19 ,$351.57 ,$436.70 ,$351.57 ,$372.19 ,$372.19 ,$421.81 ,$421.81 ,$351.57 ,$421.81 ,$351.57 ,$392.04 ,$392.04 ,$392.04 ,$446.63 ,$496.25 ,$446.63 ,$351.57 ,$496.25 ,$325.04 ,$351.57 ,$313.11 , N/A ,$367.98 ,$446.63 ,$761.90 ,$313.13 ,$297.75 ,$446.63 ,$351.57 , N/A , N/A ,$351.57 ,$322.56 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180029,11750,PC REMOVAL OF NAIL BED,981,1 ,$631.44 ,$410.44 ,$174.97 ,$761.90 ,$470.42 ,$413.59 ,$351.57 ,$332.77 ,$351.57 ,$398.44 ,$398.44 ,$398.44 ,$398.44 ,$568.30 ,$473.58 ,$351.57 ,$555.67 ,$351.57 ,$473.58 ,$473.58 ,$536.72 ,$536.72 ,$351.57 ,$536.72 ,$351.57 ,$498.84 ,$498.84 ,$498.84 ,$568.30 ,$631.44 ,$568.30 ,$351.57 ,$631.44 ,$413.59 ,$351.57 ,$174.97 , N/A ,$367.98 ,$568.30 ,$761.90 ,$398.44 ,$378.86 ,$568.30 ,$351.57 , N/A , N/A ,$351.57 ,$410.44 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180329,31500,PC INSERT EMERGENCY ENDOTRACH AIRWAY,981,1 ,$441.00 ,$286.65 ,$215.11 ,$466.16 ,$328.55 ,$288.86 ,$215.11 ,$232.41 ,$215.11 ,$278.27 ,$278.27 ,$278.27 ,$278.27 ,$396.90 ,$330.75 ,$215.11 ,$388.08 ,$215.11 ,$330.75 ,$330.75 ,$374.85 ,$374.85 ,$215.11 ,$374.85 ,$215.11 ,$348.39 ,$348.39 ,$348.39 ,$396.90 ,$441.00 ,$396.90 ,$215.11 ,$441.00 ,$288.86 ,$215.11 ,$257.30 , N/A ,$225.15 ,$396.90 ,$466.16 ,$278.27 ,$264.60 ,$396.90 ,$215.11 , N/A , N/A ,$215.11 ,$286.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180340,32554,PC THORACENTESIS ASPIRATION WO IMAGING,981,1 ,$279.00 ,$181.35 ,$147.03 ,"$1,193.21 ",$207.86 ,$182.75 ,$279.00 ,$147.03 ,$279.00 ,$176.05 ,$176.05 ,$176.05 ,$176.05 ,$251.10 ,$209.25 ,$279.00 ,$245.52 ,$279.00 ,$209.25 ,$209.25 ,$237.15 ,$237.15 ,$279.00 ,$237.15 ,$279.00 ,$220.41 ,$220.41 ,$220.41 ,$251.10 ,$279.00 ,$251.10 ,$279.00 ,$279.00 ,$182.75 ,$279.00 ,$159.31 , N/A ,$279.00 ,$251.10 ,"$1,193.21 ",$176.05 ,$167.40 ,$251.10 ,$279.00 , N/A , N/A ,$279.00 ,$181.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180345,32551,PC CHEST TUBE INSERTION,981,1 ,$495.00 ,$321.75 ,$260.87 ,"$3,097.79 ",$368.78 ,$324.23 ,$495.00 ,$260.87 ,$495.00 ,$312.35 ,$312.35 ,$312.35 ,$312.35 ,$445.50 ,$371.25 ,$495.00 ,$435.60 ,$495.00 ,$371.25 ,$371.25 ,$420.75 ,$420.75 ,$495.00 ,$420.75 ,$495.00 ,$391.05 ,$391.05 ,$391.05 ,$445.50 ,$495.00 ,$445.50 ,$495.00 ,$495.00 ,$324.23 ,$495.00 ,$283.01 , N/A ,$495.00 ,$445.50 ,"$3,097.79 ",$312.35 ,$297.00 ,$445.50 ,$495.00 , N/A , N/A ,$495.00 ,$321.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180355,62270,"PC SPINAL PUNCTURE,LUMBAR,DIAGNOSTIC",981,1 ,$240.00 ,$156.00 ,$110.40 ,"$1,398.03 ",$178.80 ,$157.20 ,$240.00 ,$126.48 ,$240.00 ,$151.44 ,$151.44 ,$151.44 ,$151.44 ,$216.00 ,$180.00 ,$240.00 ,$211.20 ,$240.00 ,$180.00 ,$180.00 ,$204.00 ,$204.00 ,$240.00 ,$204.00 ,$240.00 ,$189.60 ,$189.60 ,$189.60 ,$216.00 ,$240.00 ,$216.00 ,$240.00 ,$240.00 ,$157.20 ,$240.00 ,$110.40 , N/A ,$240.00 ,$216.00 ,"$1,398.03 ",$151.44 ,$144.00 ,$216.00 ,$240.00 , N/A , N/A ,$240.00 ,$156.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180471,99471,PC INIT.PEDIATRIC CRITICAL CARE,981,1 ,"$2,607.00 ","$1,694.55 ","$1,026.93 ","$2,607.00 ","$1,942.22 ","$1,707.59 ", N/A ,"$1,373.89 ", N/A ,"$1,645.02 ","$1,645.02 ","$1,645.02 ","$1,645.02 ","$2,346.30 ","$1,955.25 ", N/A ,"$2,294.16 ", N/A ,"$1,955.25 ","$1,955.25 ","$2,215.95 ","$2,215.95 ", N/A ,"$2,215.95 ", N/A ,"$2,059.53 ","$2,059.53 ","$2,059.53 ","$2,346.30 ", N/A ,"$2,346.30 ", N/A ,"$2,607.00 ","$1,707.59 ", N/A ,"$1,026.93 ", N/A , N/A ,"$2,346.30 ", N/A ,"$1,645.02 ","$1,564.20 ","$2,346.30 ", N/A , N/A , N/A , N/A ,"$1,694.55 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180472,99472,PC SUBSQ.PEDIATRIC CRIT.CARE,981,1 ,"$1,245.00 ",$809.25 ,$519.08 ,"$1,245.00 ",$927.53 ,$815.48 , N/A ,$656.12 , N/A ,$785.60 ,$785.60 ,$785.60 ,$785.60 ,"$1,120.50 ",$933.75 , N/A ,"$1,095.60 ", N/A ,$933.75 ,$933.75 ,"$1,058.25 ","$1,058.25 ", N/A ,"$1,058.25 ", N/A ,$983.55 ,$983.55 ,$983.55 ,"$1,120.50 ", N/A ,"$1,120.50 ", N/A ,"$1,245.00 ",$815.48 , N/A ,$519.08 , N/A , N/A ,"$1,120.50 ", N/A ,$785.60 ,$747.00 ,"$1,120.50 ", N/A , N/A , N/A , N/A ,$809.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180473,99464,"PC ATTENDANCE, BIRTH/INITIAL STABILIZE",981,1 ,$231.00 ,$150.15 ,$96.26 ,$231.00 ,$172.10 ,$151.31 , N/A ,$121.74 , N/A ,$145.76 ,$145.76 ,$145.76 ,$145.76 ,$207.90 ,$173.25 , N/A ,$203.28 , N/A ,$173.25 ,$173.25 ,$196.35 ,$196.35 , N/A ,$196.35 , N/A ,$182.49 ,$182.49 ,$182.49 ,$207.90 , N/A ,$207.90 , N/A ,$231.00 ,$151.31 , N/A ,$96.26 , N/A , N/A ,$207.90 , N/A ,$145.76 ,$138.60 ,$207.90 , N/A , N/A , N/A , N/A ,$150.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180474,99465,PC NEWBORN RESUSCITATION,981,1 ,$459.00 ,$298.35 ,$188.58 ,"$1,237.91 ",$341.96 ,$300.65 ,$459.00 ,$241.89 ,$459.00 ,$289.63 ,$289.63 ,$289.63 ,$289.63 ,$413.10 ,$344.25 ,$459.00 ,$403.92 ,$459.00 ,$344.25 ,$344.25 ,$390.15 ,$390.15 ,$459.00 ,$390.15 ,$459.00 ,$362.61 ,$362.61 ,$362.61 ,$413.10 ,$459.00 ,$413.10 ,$459.00 ,$459.00 ,$300.65 ,$459.00 ,$188.58 , N/A ,$459.00 ,$413.10 ,"$1,237.91 ",$289.63 ,$275.40 ,$413.10 ,$459.00 , N/A , N/A ,$459.00 ,$298.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180480,11055,PC PARING LESION BENIGN SINGLE,981,1 ,$128.49 ,$83.52 ,$28.37 ,$395.56 ,$95.73 ,$84.16 ,$128.49 ,$67.71 ,$128.49 ,$81.08 ,$81.08 ,$81.08 ,$81.08 ,$115.64 ,$96.37 ,$128.49 ,$113.07 ,$128.49 ,$96.37 ,$96.37 ,$109.22 ,$109.22 ,$128.49 ,$109.22 ,$128.49 ,$101.51 ,$101.51 ,$101.51 ,$115.64 ,$128.49 ,$115.64 ,$128.49 ,$128.49 ,$84.16 ,$128.49 ,$28.37 , N/A ,$128.49 ,$115.64 ,$395.56 ,$81.08 ,$77.09 ,$115.64 ,$128.49 , N/A , N/A ,$128.49 ,$83.52 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180481,11056,PC PARING LESION BENIGN 2-4 LESIONS,981,1 ,$153.97 ,$100.08 ,$41.38 ,$395.56 ,$114.71 ,$100.85 ,$153.97 ,$81.14 ,$153.97 ,$97.16 ,$97.16 ,$97.16 ,$97.16 ,$138.57 ,$115.48 ,$153.97 ,$135.49 ,$153.97 ,$115.48 ,$115.48 ,$130.87 ,$130.87 ,$153.97 ,$130.87 ,$153.97 ,$121.64 ,$121.64 ,$121.64 ,$138.57 ,$153.97 ,$138.57 ,$153.97 ,$153.97 ,$100.85 ,$153.97 ,$41.38 , N/A ,$153.97 ,$138.57 ,$395.56 ,$97.16 ,$92.38 ,$138.57 ,$153.97 , N/A , N/A ,$153.97 ,$100.08 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180482,11057,PC PARING LESION BENIGN 4+ LESIONS,981,1 ,$182.77 ,$118.80 ,$52.34 ,$395.56 ,$136.16 ,$119.71 ,$182.53 ,$96.32 ,$182.53 ,$115.33 ,$115.33 ,$115.33 ,$115.33 ,$164.49 ,$137.08 ,$182.53 ,$160.84 ,$182.53 ,$137.08 ,$137.08 ,$155.35 ,$155.35 ,$182.53 ,$155.35 ,$182.53 ,$144.39 ,$144.39 ,$144.39 ,$164.49 ,$182.77 ,$164.49 ,$182.53 ,$182.77 ,$119.71 ,$182.53 ,$52.34 , N/A ,$182.77 ,$164.49 ,$395.56 ,$115.33 ,$109.66 ,$164.49 ,$182.53 , N/A , N/A ,$182.53 ,$118.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180497,11732,PC AVULSION NAIL PLATE EA ADDL,981,1 ,$116.31 ,$75.60 ,$30.79 ,$116.31 ,$86.65 ,$76.18 , N/A ,$61.30 , N/A ,$73.39 ,$73.39 ,$73.39 ,$73.39 ,$104.68 ,$87.23 , N/A ,$102.35 , N/A ,$87.23 ,$87.23 ,$98.86 ,$98.86 , N/A ,$98.86 , N/A ,$91.88 ,$91.88 ,$91.88 ,$104.68 , N/A ,$104.68 , N/A ,$116.31 ,$76.18 , N/A ,$30.79 , N/A , N/A ,$104.68 , N/A ,$73.39 ,$69.79 ,$104.68 , N/A , N/A , N/A , N/A ,$75.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180524,36400,PC IV START < 3 YEARS OLD,981,1 ,$57.00 ,$37.05 ,$30.04 ,$57.00 ,$42.47 ,$37.34 , N/A ,$30.04 , N/A ,$35.97 ,$35.97 ,$35.97 ,$35.97 ,$51.30 ,$42.75 , N/A ,$50.16 , N/A ,$42.75 ,$42.75 ,$48.45 ,$48.45 , N/A ,$48.45 , N/A ,$45.03 ,$45.03 ,$45.03 ,$51.30 , N/A ,$51.30 , N/A ,$57.00 ,$37.34 , N/A ,$33.05 , N/A , N/A ,$51.30 , N/A ,$35.97 ,$34.20 ,$51.30 , N/A , N/A , N/A , N/A ,$37.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180525,36405,PC IV START < 3 YEARS OLD SCALP VEIN,981,1 ,$51.00 ,$33.15 ,$26.86 ,$51.00 ,$38.00 ,$33.41 , N/A ,$26.88 , N/A ,$32.18 ,$32.18 ,$32.18 ,$32.18 ,$45.90 ,$38.25 , N/A ,$44.88 , N/A ,$38.25 ,$38.25 ,$43.35 ,$43.35 , N/A ,$43.35 , N/A ,$40.29 ,$40.29 ,$40.29 ,$45.90 , N/A ,$45.90 , N/A ,$51.00 ,$33.41 , N/A ,$26.86 , N/A , N/A ,$45.90 , N/A ,$32.18 ,$30.60 ,$45.90 , N/A , N/A , N/A , N/A ,$33.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180526,36406,PC IV START < 3 YEARS OLD OTHER VEIN,981,1 ,$27.00 ,$17.55 ,$14.23 ,$27.00 ,$20.12 ,$17.69 , N/A ,$14.23 , N/A ,$17.04 ,$17.04 ,$17.04 ,$17.04 ,$24.30 ,$20.25 , N/A ,$23.76 , N/A ,$20.25 ,$20.25 ,$22.95 ,$22.95 , N/A ,$22.95 , N/A ,$21.33 ,$21.33 ,$21.33 ,$24.30 , N/A ,$24.30 , N/A ,$27.00 ,$17.69 , N/A ,$15.26 , N/A , N/A ,$24.30 , N/A ,$17.04 ,$16.20 ,$24.30 , N/A , N/A , N/A , N/A ,$17.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180527,36410,PC VENIPUNCTURE > AGE 3,981,1 ,$30.00 ,$19.50 ,$15.81 ,$30.00 ,$22.35 ,$19.65 , N/A ,$15.81 , N/A ,$18.93 ,$18.93 ,$18.93 ,$18.93 ,$27.00 ,$22.50 , N/A ,$26.40 , N/A ,$22.50 ,$22.50 ,$25.50 ,$25.50 , N/A ,$25.50 , N/A ,$23.70 ,$23.70 ,$23.70 ,$27.00 , N/A ,$27.00 , N/A ,$30.00 ,$19.65 , N/A ,$16.56 , N/A , N/A ,$27.00 , N/A ,$18.93 ,$18.00 ,$27.00 , N/A , N/A , N/A , N/A ,$19.50 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180530,36600,PC ARTERIAL PUNCTURE,981,1 ,$48.00 ,$31.20 ,$25.30 ,$246.63 ,$35.76 ,$31.44 ,$48.00 ,$25.30 ,$48.00 ,$30.29 ,$30.29 ,$30.29 ,$30.29 ,$43.20 ,$36.00 ,$48.00 ,$42.24 ,$48.00 ,$36.00 ,$36.00 ,$40.80 ,$40.80 ,$48.00 ,$40.80 ,$48.00 ,$37.92 ,$37.92 ,$37.92 ,$43.20 ,$48.00 ,$43.20 ,$48.00 ,$48.00 ,$31.44 ,$48.00 ,$27.65 , N/A ,$48.00 ,$43.20 ,$246.63 ,$30.29 ,$28.80 ,$43.20 ,$48.00 , N/A , N/A ,$48.00 ,$31.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180532,36680,PC PLACE NDL INFS INTRAOSSEOUS,981,1 ,$183.00 ,$118.95 ,$96.44 ,$595.31 ,$136.34 ,$119.87 ,$183.00 ,$96.44 ,$183.00 ,$115.47 ,$115.47 ,$115.47 ,$115.47 ,$164.70 ,$137.25 ,$183.00 ,$161.04 ,$183.00 ,$137.25 ,$137.25 ,$155.55 ,$155.55 ,$183.00 ,$155.55 ,$183.00 ,$144.57 ,$144.57 ,$144.57 ,$164.70 ,$183.00 ,$164.70 ,$183.00 ,$183.00 ,$119.87 ,$183.00 ,$108.68 , N/A ,$183.00 ,$164.70 ,$595.31 ,$115.47 ,$109.80 ,$164.70 ,$183.00 , N/A , N/A ,$183.00 ,$118.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180603,69210,PC REMOVE CERUMEN IMPACTED W/INSTRUMENT,981,1 ,$142.00 ,$92.30 ,$56.58 ,$142.00 ,$105.79 ,$93.01 ,$56.58 ,$74.83 ,$56.58 ,$89.60 ,$89.60 ,$89.60 ,$89.60 ,$127.80 ,$106.50 ,$56.58 ,$124.96 ,$56.58 ,$106.50 ,$106.50 ,$120.70 ,$120.70 ,$56.58 ,$120.70 ,$56.58 ,$112.18 ,$112.18 ,$112.18 ,$127.80 ,$135.83 ,$127.80 ,$56.58 ,$142.00 ,$93.01 ,$56.58 ,$59.05 , N/A ,$59.22 ,$127.80 ,$122.62 ,$89.60 ,$85.20 ,$127.80 ,$56.58 , N/A , N/A ,$56.58 ,$92.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180861,36000,PC IV START > 3YR OLD,981,1 ,$28.00 ,$18.20 ,$14.76 ,$28.00 ,$20.86 ,$18.34 , N/A ,$14.76 , N/A ,$17.67 ,$17.67 ,$17.67 ,$17.67 ,$25.20 ,$21.00 , N/A ,$24.64 , N/A ,$21.00 ,$21.00 ,$23.80 ,$23.80 , N/A ,$23.80 , N/A ,$22.12 ,$22.12 ,$22.12 ,$25.20 , N/A ,$25.20 , N/A ,$28.00 ,$18.34 , N/A ,$15.82 , N/A , N/A ,$25.20 , N/A ,$17.67 ,$16.80 ,$25.20 , N/A , N/A , N/A , N/A ,$18.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180864,51702,PC INSERT CATH BLADDER SIMPLE,981,1 ,$78.00 ,$50.70 ,$41.11 ,$246.63 ,$58.11 ,$51.09 ,$78.00 ,$41.11 ,$78.00 ,$49.22 ,$49.22 ,$49.22 ,$49.22 ,$70.20 ,$58.50 ,$78.00 ,$68.64 ,$78.00 ,$58.50 ,$58.50 ,$66.30 ,$66.30 ,$78.00 ,$66.30 ,$78.00 ,$61.62 ,$61.62 ,$61.62 ,$70.20 ,$78.00 ,$70.20 ,$78.00 ,$78.00 ,$51.09 ,$78.00 ,$45.51 , N/A ,$78.00 ,$70.20 ,$246.63 ,$49.22 ,$46.80 ,$70.20 ,$78.00 , N/A , N/A ,$78.00 ,$50.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180944,69210,PC REMOVE CERUMEN IMPACTED W/INSTRUMENT-LT,981,1 ,$142.00 ,$92.30 ,$56.58 ,$142.00 ,$105.79 ,$93.01 ,$56.58 ,$74.83 ,$56.58 ,$89.60 ,$89.60 ,$89.60 ,$89.60 ,$127.80 ,$106.50 ,$56.58 ,$124.96 ,$56.58 ,$106.50 ,$106.50 ,$120.70 ,$120.70 ,$56.58 ,$120.70 ,$56.58 ,$112.18 ,$112.18 ,$112.18 ,$127.80 ,$135.83 ,$127.80 ,$56.58 ,$142.00 ,$93.01 ,$56.58 ,$59.05 , N/A ,$59.22 ,$127.80 ,$122.62 ,$89.60 ,$85.20 ,$127.80 ,$56.58 , N/A , N/A ,$56.58 ,$92.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180945,69210,PC REMOVE CERUMEN IMPACTED W/INSTRUMENT-RT,981,1 ,$142.00 ,$92.30 ,$56.58 ,$142.00 ,$105.79 ,$93.01 ,$56.58 ,$74.83 ,$56.58 ,$89.60 ,$89.60 ,$89.60 ,$89.60 ,$127.80 ,$106.50 ,$56.58 ,$124.96 ,$56.58 ,$106.50 ,$106.50 ,$120.70 ,$120.70 ,$56.58 ,$120.70 ,$56.58 ,$112.18 ,$112.18 ,$112.18 ,$127.80 ,$135.83 ,$127.80 ,$56.58 ,$142.00 ,$93.01 ,$56.58 ,$59.05 , N/A ,$59.22 ,$127.80 ,$122.62 ,$89.60 ,$85.20 ,$127.80 ,$56.58 , N/A , N/A ,$56.58 ,$92.30 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180960,11105,PC BIOPSY SKIN PUNCH ADDL LESN,981,1 ,$88.62 ,$57.60 ,$46.21 ,$88.62 ,$66.02 ,$58.05 , N/A ,$46.70 , N/A ,$55.92 ,$55.92 ,$55.92 ,$55.92 ,$79.76 ,$66.47 , N/A ,$77.99 , N/A ,$66.47 ,$66.47 ,$75.33 ,$75.33 , N/A ,$75.33 , N/A ,$70.01 ,$70.01 ,$70.01 ,$79.76 , N/A ,$79.76 , N/A ,$88.62 ,$58.05 , N/A ,$46.21 , N/A , N/A ,$79.76 , N/A ,$55.92 ,$53.17 ,$79.76 , N/A , N/A , N/A , N/A ,$57.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98180963,11104,PC BIOPSY SKIN PUNCH INIT LESN,981,1 ,$342.24 ,$222.46 ,$85.10 ,$761.90 ,$254.97 ,$224.17 ,$342.24 ,$180.36 ,$342.24 ,$215.95 ,$215.95 ,$215.95 ,$215.95 ,$308.02 ,$256.68 ,$342.24 ,$301.17 ,$342.24 ,$256.68 ,$256.68 ,$290.90 ,$290.90 ,$342.24 ,$290.90 ,$342.24 ,$270.37 ,$270.37 ,$270.37 ,$308.02 ,$342.24 ,$308.02 ,$342.24 ,$342.24 ,$224.17 ,$342.24 ,$85.10 , N/A ,$342.24 ,$308.02 ,$761.90 ,$215.95 ,$205.34 ,$308.02 ,$342.24 , N/A , N/A ,$342.24 ,$222.46 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200001,99201,PC CLINIC VISIT BRIEF NEW PRO,982,1 ,$94.00 ,$61.10 ,$34.24 ,$94.00 ,$70.03 ,$61.57 , N/A ,$49.54 , N/A ,$59.31 ,$59.31 ,$59.31 ,$59.31 ,$84.60 ,$70.50 , N/A ,$82.72 , N/A ,$70.50 ,$70.50 ,$79.90 ,$79.90 , N/A ,$79.90 , N/A ,$74.26 ,$74.26 ,$74.26 ,$84.60 , N/A ,$84.60 , N/A ,$94.00 ,$61.57 , N/A ,$34.24 , N/A , N/A ,$84.60 , N/A ,$59.31 ,$56.40 ,$84.60 , N/A , N/A , N/A , N/A ,$61.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200002,99202,PC CLINIC VISIT LIMITED NEW PRO,982,1 ,$152.57 ,$99.17 ,$65.28 ,$152.57 ,$113.66 ,$99.93 , N/A ,$80.40 , N/A ,$96.27 ,$96.27 ,$96.27 ,$96.27 ,$137.31 ,$114.43 , N/A ,$134.26 , N/A ,$114.43 ,$114.43 ,$129.68 ,$129.68 , N/A ,$129.68 , N/A ,$120.53 ,$120.53 ,$120.53 ,$137.31 , N/A ,$137.31 , N/A ,$78.75 ,$99.93 , N/A ,$65.28 , N/A , N/A ,$137.31 , N/A ,$96.27 ,$91.54 ,$137.31 , N/A , N/A , N/A , N/A ,$99.17 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200003,99203,PC CLINIC VISIT INTERM NEW PRO,982,1 ,$233.45 ,$151.74 ,$97.74 ,$233.45 ,$173.92 ,$152.91 , N/A ,$123.03 , N/A ,$147.31 ,$147.31 ,$147.31 ,$147.31 ,$210.11 ,$175.09 , N/A ,$205.44 , N/A ,$175.09 ,$175.09 ,$198.43 ,$198.43 , N/A ,$198.43 , N/A ,$184.43 ,$184.43 ,$184.43 ,$210.11 , N/A ,$210.11 , N/A ,$121.24 ,$152.91 , N/A ,$97.74 , N/A , N/A ,$210.11 , N/A ,$147.31 ,$140.07 ,$210.11 , N/A , N/A , N/A , N/A ,$151.74 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200004,99204,PC CLINIC VISIT COMPLEX NEW PRO,982,1 ,$315.11 ,$204.82 ,$166.06 ,$315.11 ,$234.76 ,$206.40 , N/A ,$166.06 , N/A ,$198.83 ,$198.83 ,$198.83 ,$198.83 ,$283.60 ,$236.33 , N/A ,$277.30 , N/A ,$236.33 ,$236.33 ,$267.84 ,$267.84 , N/A ,$267.84 , N/A ,$248.94 ,$248.94 ,$248.94 ,$283.60 , N/A ,$283.60 , N/A ,$181.05 ,$206.40 , N/A ,$167.14 , N/A , N/A ,$283.60 , N/A ,$198.83 ,$189.07 ,$283.60 , N/A , N/A , N/A , N/A ,$204.82 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200005,99205,PC CLINIC VISIT COMPREH NEW PRO,982,1 ,$414.00 ,$269.10 ,$218.17 ,$414.00 ,$308.43 ,$271.17 , N/A ,$218.18 , N/A ,$261.23 ,$261.23 ,$261.23 ,$261.23 ,$372.60 ,$310.50 , N/A ,$364.32 , N/A ,$310.50 ,$310.50 ,$351.90 ,$351.90 , N/A ,$351.90 , N/A ,$327.06 ,$327.06 ,$327.06 ,$372.60 , N/A ,$372.60 , N/A ,$239.15 ,$271.17 , N/A ,$218.17 , N/A , N/A ,$372.60 , N/A ,$261.23 ,$248.40 ,$372.60 , N/A , N/A , N/A , N/A ,$269.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200006,99211,PC CLINIC VISIT BRIEF EST PRO,982,1 ,$52.90 ,$34.39 ,$11.83 ,$52.90 ,$39.41 ,$34.65 , N/A ,$27.88 , N/A ,$33.38 ,$33.38 ,$33.38 ,$33.38 ,$47.61 ,$39.68 , N/A ,$46.55 , N/A ,$39.68 ,$39.68 ,$44.97 ,$44.97 , N/A ,$44.97 , N/A ,$41.79 ,$41.79 ,$41.79 ,$47.61 , N/A ,$47.61 , N/A ,$52.90 ,$34.65 , N/A ,$11.83 , N/A , N/A ,$47.61 , N/A ,$33.38 ,$31.74 ,$47.61 , N/A , N/A , N/A , N/A ,$34.39 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200007,99212,PC CLINIC VISIT LIMIT EST PRO,982,1 ,$112.70 ,$73.26 ,$33.40 ,$112.70 ,$83.96 ,$73.82 , N/A ,$59.39 , N/A ,$71.11 ,$71.11 ,$71.11 ,$71.11 ,$101.43 ,$84.53 , N/A ,$99.18 , N/A ,$84.53 ,$84.53 ,$95.80 ,$95.80 , N/A ,$95.80 , N/A ,$89.03 ,$89.03 ,$89.03 ,$101.43 , N/A ,$101.43 , N/A ,$60.02 ,$73.82 , N/A ,$33.40 , N/A , N/A ,$101.43 , N/A ,$71.11 ,$67.62 ,$101.43 , N/A , N/A , N/A , N/A ,$73.26 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200008,99213,PC CLINIC VISIT INTERM EST PRO,982,1 ,$186.30 ,$121.10 ,$66.15 ,$186.30 ,$138.79 ,$122.03 , N/A ,$98.18 , N/A ,$117.56 ,$117.56 ,$117.56 ,$117.56 ,$167.67 ,$139.73 , N/A ,$163.94 , N/A ,$139.73 ,$139.73 ,$158.36 ,$158.36 , N/A ,$158.36 , N/A ,$147.18 ,$147.18 ,$147.18 ,$167.67 , N/A ,$167.67 , N/A ,$97.92 ,$122.03 , N/A ,$66.15 , N/A , N/A ,$167.67 , N/A ,$117.56 ,$111.78 ,$167.67 , N/A , N/A , N/A , N/A ,$121.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200009,99214,PC CLINIC VISIT COMPLX EST PRO,982,1 ,$278.30 ,$180.90 ,$101.60 ,$278.30 ,$207.33 ,$182.29 , N/A ,$146.66 , N/A ,$175.61 ,$175.61 ,$175.61 ,$175.61 ,$250.47 ,$208.73 , N/A ,$244.90 , N/A ,$208.73 ,$208.73 ,$236.56 ,$236.56 , N/A ,$236.56 , N/A ,$219.86 ,$219.86 ,$219.86 ,$250.47 , N/A ,$250.47 , N/A ,$278.30 ,$182.29 , N/A ,$101.60 , N/A , N/A ,$250.47 , N/A ,$175.61 ,$166.98 ,$250.47 , N/A , N/A , N/A , N/A ,$180.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200010,99215,PC CLINIC VISIT COMPRH EST PRO,982,1 ,$334.92 ,$217.70 ,$143.41 ,$334.92 ,$249.52 ,$219.37 , N/A ,$176.50 , N/A ,$211.33 ,$211.33 ,$211.33 ,$211.33 ,$301.43 ,$251.19 , N/A ,$294.73 , N/A ,$251.19 ,$251.19 ,$284.68 ,$284.68 , N/A ,$284.68 , N/A ,$264.59 ,$264.59 ,$264.59 ,$301.43 , N/A ,$301.43 , N/A ,$334.92 ,$219.37 , N/A ,$143.41 , N/A , N/A ,$301.43 , N/A ,$211.33 ,$200.95 ,$301.43 , N/A , N/A , N/A , N/A ,$217.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200011,93922,PC DOPPLER ARTERIAL EXTREMITY LIMITED- 26,982,1 ,$67.00 ,$43.55 ,$35.31 ,$246.63 ,$49.92 ,$43.89 ,$67.00 ,$35.31 ,$67.00 ,$42.28 ,$42.28 ,$42.28 ,$42.28 ,$60.30 ,$50.25 ,$67.00 ,$58.96 ,$67.00 ,$50.25 ,$50.25 ,$56.95 ,$56.95 ,$67.00 ,$56.95 ,$67.00 ,$52.93 ,$52.93 ,$52.93 ,$60.30 ,$67.00 ,$60.30 ,$67.00 ,$67.00 ,$43.89 ,$67.00 ,$67.00 , N/A ,$67.00 ,$60.30 ,$246.63 ,$42.28 ,$40.20 ,$60.30 ,$67.00 , N/A , N/A ,$67.00 ,$43.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200012,93923,PC DOPPLER ARTERIAL EXTREMITY COMPLETE - 26,982,1 ,$94.00 ,$61.10 ,$49.54 ,$307.44 ,$70.03 ,$61.57 ,$94.00 ,$49.54 ,$94.00 ,$59.31 ,$59.31 ,$59.31 ,$59.31 ,$84.60 ,$70.50 ,$94.00 ,$82.72 ,$94.00 ,$70.50 ,$70.50 ,$79.90 ,$79.90 ,$94.00 ,$79.90 ,$94.00 ,$74.26 ,$74.26 ,$74.26 ,$84.60 ,$94.00 ,$84.60 ,$94.00 ,$94.00 ,$61.57 ,$94.00 ,$94.00 , N/A ,$94.00 ,$84.60 ,$307.44 ,$59.31 ,$56.40 ,$84.60 ,$94.00 , N/A , N/A ,$94.00 ,$61.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200013,93922,"PC DOPPLER ARTERIAL EXTREMITY LIMITED - 26,52",982,1 ,$67.00 ,$43.55 ,$35.31 ,$246.63 ,$49.92 ,$43.89 ,$67.00 ,$35.31 ,$67.00 ,$42.28 ,$42.28 ,$42.28 ,$42.28 ,$60.30 ,$50.25 ,$67.00 ,$58.96 ,$67.00 ,$50.25 ,$50.25 ,$56.95 ,$56.95 ,$67.00 ,$56.95 ,$67.00 ,$52.93 ,$52.93 ,$52.93 ,$60.30 ,$67.00 ,$60.30 ,$67.00 ,$67.00 ,$43.89 ,$67.00 ,$67.00 , N/A ,$67.00 ,$60.30 ,$246.63 ,$42.28 ,$40.20 ,$60.30 ,$67.00 , N/A , N/A ,$67.00 ,$43.55 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200014,93880,PC DUPLEX CAROTID BILAT COMPLETE-26,982,1 ,$53.67 ,$34.89 ,$28.28 ,$506.99 ,$39.98 ,$35.15 ,$53.67 ,$28.28 ,$53.67 ,$33.87 ,$33.87 ,$33.87 ,$33.87 ,$48.30 ,$40.25 ,$53.67 ,$47.23 ,$53.67 ,$40.25 ,$40.25 ,$45.62 ,$45.62 ,$53.67 ,$45.62 ,$53.67 ,$42.40 ,$42.40 ,$42.40 ,$48.30 ,$53.67 ,$48.30 ,$53.67 ,$53.67 ,$35.15 ,$53.67 ,$53.67 , N/A ,$53.67 ,$48.30 ,$506.99 ,$33.87 ,$32.20 ,$48.30 ,$53.67 , N/A , N/A ,$53.67 ,$34.89 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200015,93924,PC DOPPLER ARTERY LWR EXT STRESS-26,982,1 ,$30.85 ,$20.05 ,$16.26 ,$582.60 ,$22.98 ,$20.21 ,$30.85 ,$16.26 ,$30.85 ,$19.47 ,$19.47 ,$19.47 ,$19.47 ,$27.77 ,$23.14 ,$30.85 ,$27.15 ,$30.85 ,$23.14 ,$23.14 ,$26.22 ,$26.22 ,$30.85 ,$26.22 ,$30.85 ,$24.37 ,$24.37 ,$24.37 ,$27.77 ,$30.85 ,$27.77 ,$30.85 ,$30.85 ,$20.21 ,$30.85 ,$30.85 , N/A ,$30.85 ,$27.77 ,$582.60 ,$19.47 ,$18.51 ,$27.77 ,$30.85 , N/A , N/A ,$30.85 ,$20.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200016,93925,PC DUPLEX ARTERIAL LWR EXT CMPL BILAT-26,982,1 ,$73.62 ,$47.85 ,$38.80 ,$506.99 ,$54.85 ,$48.22 ,$73.62 ,$38.80 ,$73.62 ,$46.45 ,$46.45 ,$46.45 ,$46.45 ,$66.26 ,$55.22 ,$73.62 ,$64.79 ,$73.62 ,$55.22 ,$55.22 ,$62.58 ,$62.58 ,$73.62 ,$62.58 ,$73.62 ,$58.16 ,$58.16 ,$58.16 ,$66.26 ,$73.62 ,$66.26 ,$73.62 ,$73.62 ,$48.22 ,$73.62 ,$73.62 , N/A ,$73.62 ,$66.26 ,$506.99 ,$46.45 ,$44.17 ,$66.26 ,$73.62 , N/A , N/A ,$73.62 ,$47.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200017,93926,PC DUPLEX ARTERIAL LWR EXT UNILAT/LIMITED-26,982,1 ,$32.66 ,$21.23 ,$17.21 ,$240.07 ,$24.33 ,$21.39 ,$32.66 ,$17.21 ,$32.66 ,$20.61 ,$20.61 ,$20.61 ,$20.61 ,$29.39 ,$24.50 ,$32.66 ,$28.74 ,$32.66 ,$24.50 ,$24.50 ,$27.76 ,$27.76 ,$32.66 ,$27.76 ,$32.66 ,$25.80 ,$25.80 ,$25.80 ,$29.39 ,$32.66 ,$29.39 ,$32.66 ,$32.66 ,$21.39 ,$32.66 ,$32.66 , N/A ,$32.66 ,$29.39 ,$240.07 ,$20.61 ,$19.60 ,$29.39 ,$32.66 , N/A , N/A ,$32.66 ,$21.23 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200018,93930,PC DUPLEX ARTERIAL UPR EXT CMPL BILAT-26,982,1 ,$64.11 ,$41.67 ,$33.79 ,$506.99 ,$47.76 ,$41.99 ,$64.11 ,$33.79 ,$64.11 ,$40.45 ,$40.45 ,$40.45 ,$40.45 ,$57.70 ,$48.08 ,$64.11 ,$56.42 ,$64.11 ,$48.08 ,$48.08 ,$54.49 ,$54.49 ,$64.11 ,$54.49 ,$64.11 ,$50.65 ,$50.65 ,$50.65 ,$57.70 ,$64.11 ,$57.70 ,$64.11 ,$64.11 ,$41.99 ,$64.11 ,$64.11 , N/A ,$64.11 ,$57.70 ,$506.99 ,$40.45 ,$38.47 ,$57.70 ,$64.11 , N/A , N/A ,$64.11 ,$41.67 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200019,93931,PC DUPLEX ARTERIAL UPR EXT UNILAT/LIMITED-26,982,1 ,$28.51 ,$18.53 ,$15.02 ,$240.07 ,$21.24 ,$18.67 ,$28.51 ,$15.02 ,$28.51 ,$17.99 ,$17.99 ,$17.99 ,$17.99 ,$25.66 ,$21.38 ,$28.51 ,$25.09 ,$28.51 ,$21.38 ,$21.38 ,$24.23 ,$24.23 ,$28.51 ,$24.23 ,$28.51 ,$22.52 ,$22.52 ,$22.52 ,$25.66 ,$28.51 ,$25.66 ,$28.51 ,$28.51 ,$18.67 ,$28.51 ,$28.51 , N/A ,$28.51 ,$25.66 ,$240.07 ,$17.99 ,$17.11 ,$25.66 ,$28.51 , N/A , N/A ,$28.51 ,$18.53 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200020,93970,PC DUPLEX VENOUS EXT CMPL BILAT-26,982,1 ,$83.69 ,$54.40 ,$44.10 ,$506.99 ,$62.35 ,$54.82 ,$83.69 ,$44.10 ,$83.69 ,$52.81 ,$52.81 ,$52.81 ,$52.81 ,$75.32 ,$62.77 ,$83.69 ,$73.65 ,$83.69 ,$62.77 ,$62.77 ,$71.14 ,$71.14 ,$83.69 ,$71.14 ,$83.69 ,$66.12 ,$66.12 ,$66.12 ,$75.32 ,$83.69 ,$75.32 ,$83.69 ,$83.69 ,$54.82 ,$83.69 ,$83.69 , N/A ,$83.69 ,$75.32 ,$506.99 ,$52.81 ,$50.21 ,$75.32 ,$83.69 , N/A , N/A ,$83.69 ,$54.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200021,93971,PC DUPLEX VENOUS EXT UNILAT/LIMITED-26,982,1 ,$45.10 ,$29.32 ,$23.77 ,$240.07 ,$33.60 ,$29.54 ,$45.10 ,$23.77 ,$45.10 ,$28.46 ,$28.46 ,$28.46 ,$28.46 ,$40.59 ,$33.83 ,$45.10 ,$39.69 ,$45.10 ,$33.83 ,$33.83 ,$38.34 ,$38.34 ,$45.10 ,$38.34 ,$45.10 ,$35.63 ,$35.63 ,$35.63 ,$40.59 ,$45.10 ,$40.59 ,$45.10 ,$45.10 ,$29.54 ,$45.10 ,$45.10 , N/A ,$45.10 ,$40.59 ,$240.07 ,$28.46 ,$27.06 ,$40.59 ,$45.10 , N/A , N/A ,$45.10 ,$29.32 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200022,93975,PC DUPLEX ABD/PEL/RETRO CMPL-26,982,1 ,$115.20 ,$74.88 ,$60.71 ,$506.99 ,$85.82 ,$75.46 ,$115.20 ,$60.71 ,$115.20 ,$72.69 ,$72.69 ,$72.69 ,$72.69 ,$103.68 ,$86.40 ,$115.20 ,$101.38 ,$115.20 ,$86.40 ,$86.40 ,$97.92 ,$97.92 ,$115.20 ,$97.92 ,$115.20 ,$91.01 ,$91.01 ,$91.01 ,$103.68 ,$115.20 ,$103.68 ,$115.20 ,$115.20 ,$75.46 ,$115.20 ,$115.20 , N/A ,$115.20 ,$103.68 ,$506.99 ,$72.69 ,$69.12 ,$103.68 ,$115.20 , N/A , N/A ,$115.20 ,$74.88 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200023,93976,PC DUPLEX ABD/PEL/RETRO LIMITED-26,982,1 ,$86.40 ,$56.16 ,$45.53 ,$240.07 ,$64.37 ,$56.59 ,$86.40 ,$45.53 ,$86.40 ,$54.52 ,$54.52 ,$54.52 ,$54.52 ,$77.76 ,$64.80 ,$86.40 ,$76.03 ,$86.40 ,$64.80 ,$64.80 ,$73.44 ,$73.44 ,$86.40 ,$73.44 ,$86.40 ,$68.26 ,$68.26 ,$68.26 ,$77.76 ,$86.40 ,$77.76 ,$86.40 ,$86.40 ,$56.59 ,$86.40 ,$86.40 , N/A ,$86.40 ,$77.76 ,$240.07 ,$54.52 ,$51.84 ,$77.76 ,$86.40 , N/A , N/A ,$86.40 ,$56.16 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200024,93978,PC DUPLEX AORTA/IVC/GRAFT CMPL-26,982,1 ,$251.45 ,$163.44 ,$132.51 ,$506.99 ,$187.33 ,$164.70 ,$233.94 ,$132.51 ,$233.94 ,$158.67 ,$158.67 ,$158.67 ,$158.67 ,$226.31 ,$188.59 ,$233.94 ,$221.28 ,$233.94 ,$188.59 ,$188.59 ,$213.73 ,$213.73 ,$233.94 ,$213.73 ,$233.94 ,$198.65 ,$198.65 ,$198.65 ,$226.31 ,$251.45 ,$226.31 ,$233.94 ,$251.45 ,$164.70 ,$233.94 ,$251.45 , N/A ,$244.87 ,$226.31 ,$506.99 ,$158.67 ,$150.87 ,$226.31 ,$233.94 , N/A , N/A ,$233.94 ,$163.44 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200025,93979,PC DUPLEX AORTA/IVC/GRAFT LIMITED-26,982,1 ,$172.80 ,$112.32 ,$91.07 ,$240.07 ,$128.74 ,$113.18 ,$110.78 ,$91.07 ,$110.78 ,$109.04 ,$109.04 ,$109.04 ,$109.04 ,$155.52 ,$129.60 ,$110.78 ,$152.06 ,$110.78 ,$129.60 ,$129.60 ,$146.88 ,$146.88 ,$110.78 ,$146.88 ,$110.78 ,$136.51 ,$136.51 ,$136.51 ,$155.52 ,$172.80 ,$155.52 ,$110.78 ,$172.80 ,$113.18 ,$110.78 ,$172.80 , N/A ,$115.95 ,$155.52 ,$240.07 ,$109.04 ,$103.68 ,$155.52 ,$110.78 , N/A , N/A ,$110.78 ,$112.32 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200026,93990,PC DUPLEX HEMODIALYSIS ACCESS-26,982,1 ,$27.97 ,$18.18 ,$14.74 ,$240.07 ,$20.84 ,$18.32 ,$27.97 ,$14.74 ,$27.97 ,$17.65 ,$17.65 ,$17.65 ,$17.65 ,$25.17 ,$20.98 ,$27.97 ,$24.61 ,$27.97 ,$20.98 ,$20.98 ,$23.77 ,$23.77 ,$27.97 ,$23.77 ,$27.97 ,$22.10 ,$22.10 ,$22.10 ,$25.17 ,$27.97 ,$25.17 ,$27.97 ,$27.97 ,$18.32 ,$27.97 ,$27.97 , N/A ,$27.97 ,$25.17 ,$240.07 ,$17.65 ,$16.78 ,$25.17 ,$27.97 , N/A , N/A ,$27.97 ,$18.18 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98200027,93882,PC DUPLEX CAROTID UNI-26,975,1 ,$57.05 ,$37.08 ,$30.07 ,$240.07 ,$42.50 ,$37.37 ,$57.05 ,$30.07 ,$57.05 ,$36.00 ,$36.00 ,$36.00 ,$36.00 ,$51.35 ,$42.79 ,$57.05 ,$50.20 ,$57.05 ,$42.79 ,$42.79 ,$48.49 ,$48.49 ,$57.05 ,$48.49 ,$57.05 ,$45.07 ,$45.07 ,$45.07 ,$51.35 ,$57.05 ,$51.35 ,$57.05 ,$57.05 ,$37.37 ,$57.05 ,$57.05 , N/A ,$57.05 ,$51.35 ,$240.07 ,$36.00 ,$34.23 ,$51.35 ,$57.05 , N/A , N/A ,$57.05 ,$37.08 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300001,10060,PC I AND D ABSC SMP PRO,983,1 ,$323.04 ,$209.98 ,$170.24 ,$395.56 ,$240.66 ,$211.59 ,$182.53 ,$170.24 ,$182.53 ,$203.84 ,$203.84 ,$203.84 ,$203.84 ,$290.74 ,$242.28 ,$182.53 ,$284.28 ,$182.53 ,$242.28 ,$242.28 ,$274.58 ,$274.58 ,$182.53 ,$274.58 ,$182.53 ,$255.20 ,$255.20 ,$255.20 ,$290.74 ,$323.04 ,$290.74 ,$182.53 ,$323.04 ,$211.59 ,$182.53 ,$171.01 , N/A ,$191.05 ,$290.74 ,$395.56 ,$203.84 ,$193.82 ,$290.74 ,$182.53 , N/A , N/A ,$182.53 ,$209.98 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300004,11042,PC DEBR SKIN/SUBQ TISS INIT 20CM PRO,983,1 ,$291.18 ,$189.27 ,$106.36 ,$761.90 ,$216.93 ,$190.72 ,$291.18 ,$153.45 ,$291.18 ,$183.73 ,$183.73 ,$183.73 ,$183.73 ,$262.06 ,$218.39 ,$291.18 ,$256.24 ,$291.18 ,$218.39 ,$218.39 ,$247.50 ,$247.50 ,$291.18 ,$247.50 ,$291.18 ,$230.03 ,$230.03 ,$230.03 ,$262.06 ,$291.18 ,$262.06 ,$291.18 ,$291.18 ,$190.72 ,$291.18 ,$106.36 , N/A ,$291.18 ,$262.06 ,$761.90 ,$183.73 ,$174.71 ,$262.06 ,$291.18 , N/A , N/A ,$291.18 ,$189.27 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300006,11043,PC DEBR SKIN/SUBQ TISSUE/MUSCLE PRO,983,1 ,$570.49 ,$370.82 ,$274.25 ,"$1,154.77 ",$425.02 ,$373.67 ,$532.86 ,$300.65 ,$532.86 ,$359.98 ,$359.98 ,$359.98 ,$359.98 ,$513.44 ,$427.87 ,$532.86 ,$502.03 ,$532.86 ,$427.87 ,$427.87 ,$484.92 ,$484.92 ,$532.86 ,$484.92 ,$532.86 ,$450.69 ,$450.69 ,$450.69 ,$513.44 ,$570.49 ,$513.44 ,$532.86 ,$570.49 ,$373.67 ,$532.86 ,$274.25 , N/A ,$557.73 ,$513.44 ,"$1,154.77 ",$359.98 ,$342.29 ,$513.44 ,$532.86 , N/A , N/A ,$532.86 ,$370.82 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300008,11044,PC DEBR SKIN/SUB TIS/MUS/BONE INT 20 PRO,983,1 ,$993.60 ,$645.84 ,$403.60 ,"$3,099.69 ",$740.23 ,$650.81 ,$993.60 ,$523.63 ,$993.60 ,$626.96 ,$626.96 ,$626.96 ,$626.96 ,$894.24 ,$745.20 ,$993.60 ,$874.37 ,$993.60 ,$745.20 ,$745.20 ,$844.56 ,$844.56 ,$993.60 ,$844.56 ,$993.60 ,$784.94 ,$784.94 ,$784.94 ,$894.24 ,$993.60 ,$894.24 ,$993.60 ,$993.60 ,$650.81 ,$993.60 ,$403.60 , N/A ,$993.60 ,$894.24 ,"$3,099.69 ",$626.96 ,$596.16 ,$894.24 ,$993.60 , N/A , N/A ,$993.60 ,$645.84 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300010,11045,PC DEBR SKIN/SUBQ TIS EA ADL 20CM PRO,983,1 ,$104.88 ,$68.17 ,$47.73 ,$104.88 ,$78.14 ,$68.70 , N/A ,$55.27 , N/A ,$66.18 ,$66.18 ,$66.18 ,$66.18 ,$94.39 ,$78.66 , N/A ,$92.29 , N/A ,$78.66 ,$78.66 ,$89.15 ,$89.15 , N/A ,$89.15 , N/A ,$82.86 ,$82.86 ,$82.86 ,$94.39 , N/A ,$94.39 , N/A ,$104.88 ,$68.70 , N/A ,$47.73 , N/A , N/A ,$94.39 , N/A ,$66.18 ,$62.93 ,$94.39 , N/A , N/A , N/A , N/A ,$68.17 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300011,11046,PC DEBR SKIN/SUBQ MUS/FAS ADL 20C PRO,983,1 ,$147.32 ,$95.76 ,$77.64 ,$147.32 ,$109.75 ,$96.49 , N/A ,$77.64 , N/A ,$92.96 ,$92.96 ,$92.96 ,$92.96 ,$132.59 ,$110.49 , N/A ,$129.64 , N/A ,$110.49 ,$110.49 ,$125.22 ,$125.22 , N/A ,$125.22 , N/A ,$116.38 ,$116.38 ,$116.38 ,$132.59 , N/A ,$132.59 , N/A ,$147.32 ,$96.49 , N/A ,$100.31 , N/A , N/A ,$132.59 , N/A ,$92.96 ,$88.39 ,$132.59 , N/A , N/A , N/A , N/A ,$95.76 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300012,11047,PC DEBR SKIN/SUB TIS/MUS/BN ADL 20C PRO,983,1 ,$275.88 ,$179.32 ,$145.39 ,$275.88 ,$205.53 ,$180.70 , N/A ,$145.39 , N/A ,$174.08 ,$174.08 ,$174.08 ,$174.08 ,$248.29 ,$206.91 , N/A ,$242.77 , N/A ,$206.91 ,$206.91 ,$234.50 ,$234.50 , N/A ,$234.50 , N/A ,$217.95 ,$217.95 ,$217.95 ,$248.29 , N/A ,$248.29 , N/A ,$275.88 ,$180.70 , N/A ,$177.25 , N/A , N/A ,$248.29 , N/A ,$174.08 ,$165.53 ,$248.29 , N/A , N/A , N/A , N/A ,$179.32 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300015,11100,PC BX LESN SKIN/SUBQ/MUCOUS SGL PRO,983,1 ,$342.24 ,$222.46 ,$180.36 ,$342.24 ,$254.97 ,$224.17 , N/A ,$180.36 , N/A ,$215.95 ,$215.95 ,$215.95 ,$215.95 ,$308.02 ,$256.68 , N/A ,$301.17 , N/A ,$256.68 ,$256.68 ,$290.90 ,$290.90 , N/A ,$290.90 , N/A ,$270.37 ,$270.37 ,$270.37 ,$308.02 , N/A ,$308.02 , N/A ,$342.24 ,$224.17 , N/A ,$239.57 , N/A , N/A ,$308.02 , N/A ,$215.95 ,$205.34 ,$308.02 , N/A , N/A , N/A , N/A ,$222.46 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300017,11101,PC PUNCH BIOPSY EA ADD PRO,983,1 ,$88.62 ,$57.60 ,$46.70 ,$88.62 ,$66.02 ,$58.05 , N/A ,$46.70 , N/A ,$55.92 ,$55.92 ,$55.92 ,$55.92 ,$79.76 ,$66.47 , N/A ,$77.99 , N/A ,$66.47 ,$66.47 ,$75.33 ,$75.33 , N/A ,$75.33 , N/A ,$70.01 ,$70.01 ,$70.01 ,$79.76 , N/A ,$79.76 , N/A ,$88.62 ,$58.05 , N/A ,$62.03 , N/A , N/A ,$79.76 , N/A ,$55.92 ,$53.17 ,$79.76 , N/A , N/A , N/A , N/A ,$57.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300018,11719,PC TRIM NAILS NONDYSTROPHIC PRO,983,1 ,$9.01 ,$5.86 ,$4.75 ,$122.62 ,$6.71 ,$5.90 ,$9.01 ,$4.75 ,$9.01 ,$5.69 ,$5.69 ,$5.69 ,$5.69 ,$8.11 ,$6.76 ,$9.01 ,$7.93 ,$9.01 ,$6.76 ,$6.76 ,$7.66 ,$7.66 ,$9.01 ,$7.66 ,$9.01 ,$7.12 ,$7.12 ,$7.12 ,$8.11 ,$9.01 ,$8.11 ,$9.01 ,$9.01 ,$5.90 ,$9.01 ,$9.01 , N/A ,$9.01 ,$8.11 ,$122.62 ,$5.69 ,$5.41 ,$8.11 ,$9.01 , N/A , N/A ,$9.01 ,$5.86 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300028,16020,PC BURN DRESS AND /OR DEBRIDE PRO <5%,983,1 ,$212.00 ,$137.80 ,$93.88 ,$395.56 ,$157.94 ,$138.86 ,$182.53 ,$111.72 ,$182.53 ,$133.77 ,$133.77 ,$133.77 ,$133.77 ,$190.80 ,$159.00 ,$182.53 ,$186.56 ,$182.53 ,$159.00 ,$159.00 ,$180.20 ,$180.20 ,$182.53 ,$180.20 ,$182.53 ,$167.48 ,$167.48 ,$167.48 ,$190.80 ,$212.00 ,$190.80 ,$182.53 ,$212.00 ,$138.86 ,$182.53 ,$93.88 , N/A ,$191.05 ,$190.80 ,$395.56 ,$133.77 ,$127.20 ,$190.80 ,$182.53 , N/A , N/A ,$182.53 ,$137.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300031,17250,PC CHEM CAUTERY PRO,983,1 ,$199.39 ,$129.60 ,$64.71 ,$395.56 ,$148.55 ,$130.60 ,$182.53 ,$105.08 ,$182.53 ,$125.82 ,$125.82 ,$125.82 ,$125.82 ,$179.45 ,$149.54 ,$182.53 ,$175.46 ,$182.53 ,$149.54 ,$149.54 ,$169.48 ,$169.48 ,$182.53 ,$169.48 ,$182.53 ,$157.52 ,$157.52 ,$157.52 ,$179.45 ,$199.39 ,$179.45 ,$182.53 ,$199.39 ,$130.60 ,$182.53 ,$64.71 , N/A ,$191.05 ,$179.45 ,$395.56 ,$125.82 ,$119.63 ,$179.45 ,$182.53 , N/A , N/A ,$182.53 ,$129.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300043,97597,PC DEBR SKIN INTL 20CM PRO,983,1 ,$191.82 ,$124.68 ,$64.46 ,$395.56 ,$142.91 ,$125.64 ,$182.53 ,$101.09 ,$182.53 ,$121.04 ,$121.04 ,$121.04 ,$121.04 ,$172.64 ,$143.87 ,$182.53 ,$168.80 ,$182.53 ,$143.87 ,$143.87 ,$163.05 ,$163.05 ,$182.53 ,$163.05 ,$182.53 ,$151.54 ,$151.54 ,$151.54 ,$172.64 ,$191.82 ,$172.64 ,$182.53 ,$191.82 ,$125.64 ,$182.53 ,$64.46 , N/A ,$191.05 ,$172.64 ,$395.56 ,$121.04 ,$115.09 ,$172.64 ,$182.53 , N/A , N/A ,$182.53 ,$124.68 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300049,97598,PC DEBR SKIN PART THICKNESS EA ADDN>20CM PRO,983,1 ,$202.50 ,$131.63 ,$45.51 ,$202.50 ,$150.86 ,$132.64 , N/A ,$106.72 , N/A ,$127.78 ,$127.78 ,$127.78 ,$127.78 ,$182.25 ,$151.88 , N/A ,$178.20 , N/A ,$151.88 ,$151.88 ,$172.13 ,$172.13 , N/A ,$172.13 , N/A ,$159.98 ,$159.98 ,$159.98 ,$182.25 , N/A ,$182.25 , N/A ,$202.50 ,$132.64 , N/A ,$45.51 , N/A , N/A ,$182.25 , N/A ,$127.78 ,$121.50 ,$182.25 , N/A , N/A , N/A , N/A ,$131.63 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300050,97605,PC NWPT <50 SQ CM PRO,983,1 ,$95.08 ,$61.80 ,$48.48 ,$395.56 ,$70.83 ,$62.28 ,$95.08 ,$50.11 ,$95.08 ,$60.00 ,$60.00 ,$60.00 ,$60.00 ,$85.57 ,$71.31 ,$95.08 ,$83.67 ,$95.08 ,$71.31 ,$71.31 ,$80.82 ,$80.82 ,$95.08 ,$80.82 ,$95.08 ,$75.11 ,$75.11 ,$75.11 ,$85.57 ,$95.08 ,$85.57 ,$95.08 ,$95.08 ,$62.28 ,$95.08 ,$48.48 , N/A ,$95.08 ,$85.57 ,$395.56 ,$60.00 ,$57.05 ,$85.57 ,$95.08 , N/A , N/A ,$95.08 ,$61.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300051,97606,PC NWPT >50 SQ CM PRO,983,1 ,$93.05 ,$60.48 ,$49.04 ,$761.90 ,$69.32 ,$60.95 ,$93.05 ,$49.04 ,$93.05 ,$58.71 ,$58.71 ,$58.71 ,$58.71 ,$83.75 ,$69.79 ,$93.05 ,$81.88 ,$93.05 ,$69.79 ,$69.79 ,$79.09 ,$79.09 ,$93.05 ,$79.09 ,$93.05 ,$73.51 ,$73.51 ,$73.51 ,$83.75 ,$93.05 ,$83.75 ,$93.05 ,$93.05 ,$60.95 ,$93.05 ,$52.41 , N/A ,$93.05 ,$83.75 ,$761.90 ,$58.71 ,$55.83 ,$83.75 ,$93.05 , N/A , N/A ,$93.05 ,$60.48 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300075,99183,PC HYPERBARIC 02 NP PRO FEE,983,1 ,$450.83 ,$293.04 ,$209.10 ,$450.83 ,$335.87 ,$295.29 , N/A ,$237.59 , N/A ,$284.47 ,$284.47 ,$284.47 ,$284.47 ,$405.75 ,$338.12 , N/A ,$396.73 , N/A ,$338.12 ,$338.12 ,$383.21 ,$383.21 , N/A ,$383.21 , N/A ,$356.16 ,$356.16 ,$356.16 ,$405.75 , N/A ,$405.75 , N/A ,$450.83 ,$295.29 , N/A ,$209.10 , N/A , N/A ,$405.75 , N/A ,$284.47 ,$270.50 ,$405.75 , N/A , N/A , N/A , N/A ,$293.04 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300080,15271,PC APL SKIN SUB TAL<100 INT 25CM PRO,983,1 ,$805.60 ,$523.64 ,$150.42 ,"$3,779.02 ",$600.17 ,$527.67 ,$805.60 ,$424.55 ,$805.60 ,$508.33 ,$508.33 ,$508.33 ,$508.33 ,$725.04 ,$604.20 ,$805.60 ,$708.93 ,$805.60 ,$604.20 ,$604.20 ,$684.76 ,$684.76 ,$805.60 ,$684.76 ,$805.60 ,$636.42 ,$636.42 ,$636.42 ,$725.04 ,$805.60 ,$725.04 ,$805.60 ,$805.60 ,$527.67 ,$805.60 ,$150.42 , N/A ,$805.60 ,$725.04 ,"$3,779.02 ",$508.33 ,$483.36 ,$725.04 ,$805.60 , N/A , N/A ,$805.60 ,$523.64 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300082,15272,PC APL SKIN SUB TAL<100 ADL 25CM PRO,983,1 ,$137.75 ,$89.54 ,$31.61 ,$137.75 ,$102.62 ,$90.23 , N/A ,$72.59 , N/A ,$86.92 ,$86.92 ,$86.92 ,$86.92 ,$123.98 ,$103.31 , N/A ,$121.22 , N/A ,$103.31 ,$103.31 ,$117.09 ,$117.09 , N/A ,$117.09 , N/A ,$108.82 ,$108.82 ,$108.82 ,$123.98 , N/A ,$123.98 , N/A ,$137.75 ,$90.23 , N/A ,$31.61 , N/A , N/A ,$123.98 , N/A ,$86.92 ,$82.65 ,$123.98 , N/A , N/A , N/A , N/A ,$89.54 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300083,15273,PC APL SKIN SUB TAL>100 INT 100CM PRO,983,1 ,"$1,005.68 ",$653.69 ,$358.43 ,"$7,759.46 ",$749.23 ,$658.72 ,"$1,005.68 ",$529.99 ,"$1,005.68 ",$634.58 ,$634.58 ,$634.58 ,$634.58 ,$905.11 ,$754.26 ,"$1,005.68 ",$885.00 ,"$1,005.68 ",$754.26 ,$754.26 ,$854.83 ,$854.83 ,"$1,005.68 ",$854.83 ,"$1,005.68 ",$794.49 ,$794.49 ,$794.49 ,$905.11 ,"$1,005.68 ",$905.11 ,"$1,005.68 ","$1,005.68 ",$658.72 ,"$1,005.68 ",$358.43 , N/A ,"$1,005.68 ",$905.11 ,"$7,759.46 ",$634.58 ,$603.41 ,$905.11 ,"$1,005.68 ", N/A , N/A ,"$1,005.68 ",$653.69 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300085,15274,PC APL SKIN SUB TAL>100 ADL 100CM PRO,983,1 ,$210.46 ,$136.80 ,$81.62 ,$210.46 ,$156.79 ,$137.85 , N/A ,$110.91 , N/A ,$132.80 ,$132.80 ,$132.80 ,$132.80 ,$189.41 ,$157.85 , N/A ,$185.20 , N/A ,$157.85 ,$157.85 ,$178.89 ,$178.89 , N/A ,$178.89 , N/A ,$166.26 ,$166.26 ,$166.26 ,$189.41 , N/A ,$189.41 , N/A ,$210.46 ,$137.85 , N/A ,$81.62 , N/A , N/A ,$189.41 , N/A ,$132.80 ,$126.28 ,$189.41 , N/A , N/A , N/A , N/A ,$136.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300086,15275,PC APL SKIN SUB OTH<100 INT 25CM PRO,983,1 ,$805.60 ,$523.64 ,$168.42 ,"$3,779.02 ",$600.17 ,$527.67 ,$805.60 ,$424.55 ,$805.60 ,$508.33 ,$508.33 ,$508.33 ,$508.33 ,$725.04 ,$604.20 ,$805.60 ,$708.93 ,$805.60 ,$604.20 ,$604.20 ,$684.76 ,$684.76 ,$805.60 ,$684.76 ,$805.60 ,$636.42 ,$636.42 ,$636.42 ,$725.04 ,$805.60 ,$725.04 ,$805.60 ,$805.60 ,$527.67 ,$805.60 ,$168.42 , N/A ,$805.60 ,$725.04 ,"$3,779.02 ",$508.33 ,$483.36 ,$725.04 ,$805.60 , N/A , N/A ,$805.60 ,$523.64 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300088,15276,PC APL SKIN SUB OTH<100 ADL 25CM PRO,983,1 ,$125.17 ,$81.36 ,$46.42 ,$125.17 ,$93.25 ,$81.99 , N/A ,$65.96 , N/A ,$78.98 ,$78.98 ,$78.98 ,$78.98 ,$112.65 ,$93.88 , N/A ,$110.15 , N/A ,$93.88 ,$93.88 ,$106.39 ,$106.39 , N/A ,$106.39 , N/A ,$98.88 ,$98.88 ,$98.88 ,$112.65 , N/A ,$112.65 , N/A ,$125.17 ,$81.99 , N/A ,$46.42 , N/A , N/A ,$112.65 , N/A ,$78.98 ,$75.10 ,$112.65 , N/A , N/A , N/A , N/A ,$81.36 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300089,15277,PC APL SKIN SUB OTH>100 INT 100CM PRO,983,1 ,$913.85 ,$594.00 ,$406.38 ,"$3,779.02 ",$680.82 ,$598.57 ,$913.85 ,$481.60 ,$913.85 ,$576.64 ,$576.64 ,$576.64 ,$576.64 ,$822.47 ,$685.39 ,$913.85 ,$804.19 ,$913.85 ,$685.39 ,$685.39 ,$776.77 ,$776.77 ,$913.85 ,$776.77 ,$913.85 ,$721.94 ,$721.94 ,$721.94 ,$822.47 ,$913.85 ,$822.47 ,$913.85 ,$913.85 ,$598.57 ,$913.85 ,$406.38 , N/A ,$913.85 ,$822.47 ,"$3,779.02 ",$576.64 ,$548.31 ,$822.47 ,$913.85 , N/A , N/A ,$913.85 ,$594.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300091,15278,PC APL SKIN SUB OTH>100 ADL 100CM PRO,983,1 ,$210.46 ,$136.80 ,$103.33 ,$210.46 ,$156.79 ,$137.85 , N/A ,$110.91 , N/A ,$132.80 ,$132.80 ,$132.80 ,$132.80 ,$189.41 ,$157.85 , N/A ,$185.20 , N/A ,$157.85 ,$157.85 ,$178.89 ,$178.89 , N/A ,$178.89 , N/A ,$166.26 ,$166.26 ,$166.26 ,$189.41 , N/A ,$189.41 , N/A ,$210.46 ,$137.85 , N/A ,$103.33 , N/A , N/A ,$189.41 , N/A ,$132.80 ,$126.28 ,$189.41 , N/A , N/A , N/A , N/A ,$136.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300093,16030,PC BURN DRESS AND /OR DEBRIDE PRO >10%,983,1 ,$221.54 ,$144.00 ,$116.75 ,$761.90 ,$165.05 ,$145.11 ,$221.54 ,$116.75 ,$221.54 ,$139.79 ,$139.79 ,$139.79 ,$139.79 ,$199.39 ,$166.16 ,$221.54 ,$194.96 ,$221.54 ,$166.16 ,$166.16 ,$188.31 ,$188.31 ,$221.54 ,$188.31 ,$221.54 ,$175.02 ,$175.02 ,$175.02 ,$199.39 ,$221.54 ,$199.39 ,$221.54 ,$221.54 ,$145.11 ,$221.54 ,$221.54 , N/A ,$221.54 ,$199.39 ,$761.90 ,$139.79 ,$132.92 ,$199.39 ,$221.54 , N/A , N/A ,$221.54 ,$144.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300094,16025,PC BURN DRESS AND /OR DEBRIDE PRO 5-10%,983,1 ,$221.54 ,$144.00 ,$116.75 ,$395.56 ,$165.05 ,$145.11 ,$182.53 ,$116.75 ,$182.53 ,$139.79 ,$139.79 ,$139.79 ,$139.79 ,$199.39 ,$166.16 ,$182.53 ,$194.96 ,$182.53 ,$166.16 ,$166.16 ,$188.31 ,$188.31 ,$182.53 ,$188.31 ,$182.53 ,$175.02 ,$175.02 ,$175.02 ,$199.39 ,$221.54 ,$199.39 ,$182.53 ,$221.54 ,$145.11 ,$182.53 ,$193.84 , N/A ,$191.05 ,$199.39 ,$395.56 ,$139.79 ,$132.92 ,$199.39 ,$182.53 , N/A , N/A ,$182.53 ,$144.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300124,11730,PC AVULSION NAIL PLATE SINGLE PRO,983,1 ,$252.56 ,$164.16 ,$95.86 ,$395.56 ,$188.16 ,$165.43 ,$182.53 ,$133.10 ,$182.53 ,$159.37 ,$159.37 ,$159.37 ,$159.37 ,$227.30 ,$189.42 ,$182.53 ,$222.25 ,$182.53 ,$189.42 ,$189.42 ,$214.68 ,$214.68 ,$182.53 ,$214.68 ,$182.53 ,$199.52 ,$199.52 ,$199.52 ,$227.30 ,$252.56 ,$227.30 ,$182.53 ,$252.56 ,$165.43 ,$182.53 ,$95.86 , N/A ,$191.05 ,$227.30 ,$395.56 ,$159.37 ,$151.54 ,$227.30 ,$182.53 , N/A , N/A ,$182.53 ,$164.16 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300131,29445,PC APPL CAST LEG RIGID CONTACT -LT,983,1 ,$525.05 ,$341.28 ,$179.43 ,$531.31 ,$391.16 ,$343.91 ,$245.17 ,$276.70 ,$245.17 ,$331.31 ,$331.31 ,$331.31 ,$331.31 ,$472.55 ,$393.79 ,$245.17 ,$462.04 ,$245.17 ,$393.79 ,$393.79 ,$446.29 ,$446.29 ,$245.17 ,$446.29 ,$245.17 ,$414.79 ,$414.79 ,$414.79 ,$472.55 ,$525.05 ,$472.55 ,$245.17 ,$525.05 ,$343.91 ,$245.17 ,$179.43 , N/A ,$256.61 ,$472.55 ,$531.31 ,$331.31 ,$315.03 ,$472.55 ,$245.17 , N/A , N/A ,$245.17 ,$341.28 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300132,29445,PC APPL CAST LEG RIGID CONTACT -RT,983,1 ,$525.05 ,$341.28 ,$179.43 ,$531.31 ,$391.16 ,$343.91 ,$245.17 ,$276.70 ,$245.17 ,$331.31 ,$331.31 ,$331.31 ,$331.31 ,$472.55 ,$393.79 ,$245.17 ,$462.04 ,$245.17 ,$393.79 ,$393.79 ,$446.29 ,$446.29 ,$245.17 ,$446.29 ,$245.17 ,$414.79 ,$414.79 ,$414.79 ,$472.55 ,$525.05 ,$472.55 ,$245.17 ,$525.05 ,$343.91 ,$245.17 ,$179.43 , N/A ,$256.61 ,$472.55 ,$531.31 ,$331.31 ,$315.03 ,$472.55 ,$245.17 , N/A , N/A ,$245.17 ,$341.28 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300133,99201,PC CLINIC VISIT BRIEF NEW -25,983,1 ,$94.00 ,$61.10 ,$34.24 ,$94.00 ,$70.03 ,$61.57 , N/A ,$49.54 , N/A ,$59.31 ,$59.31 ,$59.31 ,$59.31 ,$84.60 ,$70.50 , N/A ,$82.72 , N/A ,$70.50 ,$70.50 ,$79.90 ,$79.90 , N/A ,$79.90 , N/A ,$74.26 ,$74.26 ,$74.26 ,$84.60 , N/A ,$84.60 , N/A ,$94.00 ,$61.57 , N/A ,$34.24 , N/A , N/A ,$84.60 , N/A ,$59.31 ,$56.40 ,$84.60 , N/A , N/A , N/A , N/A ,$61.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300134,99202,PC CLINIC VISIT LIMITED NEW -25,983,1 ,$152.57 ,$99.17 ,$65.28 ,$152.57 ,$113.66 ,$99.93 , N/A ,$80.40 , N/A ,$96.27 ,$96.27 ,$96.27 ,$96.27 ,$137.31 ,$114.43 , N/A ,$134.26 , N/A ,$114.43 ,$114.43 ,$129.68 ,$129.68 , N/A ,$129.68 , N/A ,$120.53 ,$120.53 ,$120.53 ,$137.31 , N/A ,$137.31 , N/A ,$78.75 ,$99.93 , N/A ,$65.28 , N/A , N/A ,$137.31 , N/A ,$96.27 ,$91.54 ,$137.31 , N/A , N/A , N/A , N/A ,$99.17 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300135,99203,PC CLINIC VISIT INTERM NEW -25,983,1 ,$233.45 ,$151.74 ,$97.74 ,$233.45 ,$173.92 ,$152.91 , N/A ,$123.03 , N/A ,$147.31 ,$147.31 ,$147.31 ,$147.31 ,$210.11 ,$175.09 , N/A ,$205.44 , N/A ,$175.09 ,$175.09 ,$198.43 ,$198.43 , N/A ,$198.43 , N/A ,$184.43 ,$184.43 ,$184.43 ,$210.11 , N/A ,$210.11 , N/A ,$121.24 ,$152.91 , N/A ,$97.74 , N/A , N/A ,$210.11 , N/A ,$147.31 ,$140.07 ,$210.11 , N/A , N/A , N/A , N/A ,$151.74 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300136,99204,PC CLINIC VISIT COMPLEX NEW -25,983,1 ,$315.11 ,$204.82 ,$166.06 ,$315.11 ,$234.76 ,$206.40 , N/A ,$166.06 , N/A ,$198.83 ,$198.83 ,$198.83 ,$198.83 ,$283.60 ,$236.33 , N/A ,$277.30 , N/A ,$236.33 ,$236.33 ,$267.84 ,$267.84 , N/A ,$267.84 , N/A ,$248.94 ,$248.94 ,$248.94 ,$283.60 , N/A ,$283.60 , N/A ,$181.05 ,$206.40 , N/A ,$167.14 , N/A , N/A ,$283.60 , N/A ,$198.83 ,$189.07 ,$283.60 , N/A , N/A , N/A , N/A ,$204.82 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300137,99205,PC CLINIC VISIT COMPREH NEW -25,983,1 ,$414.00 ,$269.10 ,$218.17 ,$414.00 ,$308.43 ,$271.17 , N/A ,$218.18 , N/A ,$261.23 ,$261.23 ,$261.23 ,$261.23 ,$372.60 ,$310.50 , N/A ,$364.32 , N/A ,$310.50 ,$310.50 ,$351.90 ,$351.90 , N/A ,$351.90 , N/A ,$327.06 ,$327.06 ,$327.06 ,$372.60 , N/A ,$372.60 , N/A ,$239.15 ,$271.17 , N/A ,$218.17 , N/A , N/A ,$372.60 , N/A ,$261.23 ,$248.40 ,$372.60 , N/A , N/A , N/A , N/A ,$269.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300138,99211,PC CLINIC VISIT BRIEF ESTAB -25,983,1 ,$52.90 ,$34.39 ,$11.83 ,$52.90 ,$39.41 ,$34.65 , N/A ,$27.88 , N/A ,$33.38 ,$33.38 ,$33.38 ,$33.38 ,$47.61 ,$39.68 , N/A ,$46.55 , N/A ,$39.68 ,$39.68 ,$44.97 ,$44.97 , N/A ,$44.97 , N/A ,$41.79 ,$41.79 ,$41.79 ,$47.61 , N/A ,$47.61 , N/A ,$52.90 ,$34.65 , N/A ,$11.83 , N/A , N/A ,$47.61 , N/A ,$33.38 ,$31.74 ,$47.61 , N/A , N/A , N/A , N/A ,$34.39 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300139,99212,PC CLINIC VISIT LIMITED ESTAB -25,983,1 ,$112.70 ,$73.26 ,$33.40 ,$112.70 ,$83.96 ,$73.82 , N/A ,$59.39 , N/A ,$71.11 ,$71.11 ,$71.11 ,$71.11 ,$101.43 ,$84.53 , N/A ,$99.18 , N/A ,$84.53 ,$84.53 ,$95.80 ,$95.80 , N/A ,$95.80 , N/A ,$89.03 ,$89.03 ,$89.03 ,$101.43 , N/A ,$101.43 , N/A ,$60.02 ,$73.82 , N/A ,$33.40 , N/A , N/A ,$101.43 , N/A ,$71.11 ,$67.62 ,$101.43 , N/A , N/A , N/A , N/A ,$73.26 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300140,99213,PC CLINIC VISIT INTERM ESTAB -25,983,1 ,$186.30 ,$121.10 ,$66.15 ,$186.30 ,$138.79 ,$122.03 , N/A ,$98.18 , N/A ,$117.56 ,$117.56 ,$117.56 ,$117.56 ,$167.67 ,$139.73 , N/A ,$163.94 , N/A ,$139.73 ,$139.73 ,$158.36 ,$158.36 , N/A ,$158.36 , N/A ,$147.18 ,$147.18 ,$147.18 ,$167.67 , N/A ,$167.67 , N/A ,$97.92 ,$122.03 , N/A ,$66.15 , N/A , N/A ,$167.67 , N/A ,$117.56 ,$111.78 ,$167.67 , N/A , N/A , N/A , N/A ,$121.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300141,99214,PC CLINIC VISIT COMPLEX ESTAB -25,983,1 ,$278.30 ,$180.90 ,$101.60 ,$278.30 ,$207.33 ,$182.29 , N/A ,$146.66 , N/A ,$175.61 ,$175.61 ,$175.61 ,$175.61 ,$250.47 ,$208.73 , N/A ,$244.90 , N/A ,$208.73 ,$208.73 ,$236.56 ,$236.56 , N/A ,$236.56 , N/A ,$219.86 ,$219.86 ,$219.86 ,$250.47 , N/A ,$250.47 , N/A ,$278.30 ,$182.29 , N/A ,$101.60 , N/A , N/A ,$250.47 , N/A ,$175.61 ,$166.98 ,$250.47 , N/A , N/A , N/A , N/A ,$180.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300142,99215,PC CLINIC VISIT COMPREH ESTAB -25,983,1 ,$334.92 ,$217.70 ,$143.41 ,$334.92 ,$249.52 ,$219.37 , N/A ,$176.50 , N/A ,$211.33 ,$211.33 ,$211.33 ,$211.33 ,$301.43 ,$251.19 , N/A ,$294.73 , N/A ,$251.19 ,$251.19 ,$284.68 ,$284.68 , N/A ,$284.68 , N/A ,$264.59 ,$264.59 ,$264.59 ,$301.43 , N/A ,$301.43 , N/A ,$334.92 ,$219.37 , N/A ,$143.41 , N/A , N/A ,$301.43 , N/A ,$211.33 ,$200.95 ,$301.43 , N/A , N/A , N/A , N/A ,$217.70 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300143,11721,PC DEBR NAIL(S) 6 OR MORE,983,1 ,$112.99 ,$73.44 ,$44.42 ,$122.62 ,$84.18 ,$74.01 ,$56.58 ,$59.55 ,$56.58 ,$71.30 ,$71.30 ,$71.30 ,$71.30 ,$101.69 ,$84.74 ,$56.58 ,$99.43 ,$56.58 ,$84.74 ,$84.74 ,$96.04 ,$96.04 ,$56.58 ,$96.04 ,$56.58 ,$89.26 ,$89.26 ,$89.26 ,$101.69 ,$112.99 ,$101.69 ,$56.58 ,$112.99 ,$74.01 ,$56.58 ,$44.42 , N/A ,$59.22 ,$101.69 ,$122.62 ,$71.30 ,$67.79 ,$101.69 ,$56.58 , N/A , N/A ,$56.58 ,$73.44 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300144,11720,PC DEBR NAIL(S) UP TO 5,983,1 ,$81.97 ,$53.28 ,$25.95 ,$122.62 ,$61.07 ,$53.69 ,$56.58 ,$43.20 ,$56.58 ,$51.72 ,$51.72 ,$51.72 ,$51.72 ,$73.77 ,$61.48 ,$56.58 ,$72.13 ,$56.58 ,$61.48 ,$61.48 ,$69.67 ,$69.67 ,$56.58 ,$69.67 ,$56.58 ,$64.76 ,$64.76 ,$64.76 ,$73.77 ,$81.97 ,$73.77 ,$56.58 ,$81.97 ,$53.69 ,$56.58 ,$25.95 , N/A ,$59.22 ,$73.77 ,$122.62 ,$51.72 ,$49.18 ,$73.77 ,$56.58 , N/A , N/A ,$56.58 ,$53.28 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300145,11102,PC BIOPSY SKIN TANGENTIAL INIT LESN,983,1 ,$342.24 ,$222.46 ,$68.20 ,$395.56 ,$254.97 ,$224.17 ,$182.53 ,$180.36 ,$182.53 ,$215.95 ,$215.95 ,$215.95 ,$215.95 ,$308.02 ,$256.68 ,$182.53 ,$301.17 ,$182.53 ,$256.68 ,$256.68 ,$290.90 ,$290.90 ,$182.53 ,$290.90 ,$182.53 ,$270.37 ,$270.37 ,$270.37 ,$308.02 ,$342.24 ,$308.02 ,$182.53 ,$342.24 ,$224.17 ,$182.53 ,$68.20 , N/A ,$191.05 ,$308.02 ,$395.56 ,$215.95 ,$205.34 ,$308.02 ,$182.53 , N/A , N/A ,$182.53 ,$222.46 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300147,11106,PC BIOPSY SKIN INCISIONAL INIT LESN,983,1 ,$342.24 ,$222.46 ,$102.45 ,"$1,154.77 ",$254.97 ,$224.17 ,$342.24 ,$180.36 ,$342.24 ,$215.95 ,$215.95 ,$215.95 ,$215.95 ,$308.02 ,$256.68 ,$342.24 ,$301.17 ,$342.24 ,$256.68 ,$256.68 ,$290.90 ,$290.90 ,$342.24 ,$290.90 ,$342.24 ,$270.37 ,$270.37 ,$270.37 ,$308.02 ,$342.24 ,$308.02 ,$342.24 ,$342.24 ,$224.17 ,$342.24 ,$102.45 , N/A ,$342.24 ,$308.02 ,"$1,154.77 ",$215.95 ,$205.34 ,$308.02 ,$342.24 , N/A , N/A ,$342.24 ,$222.46 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300148,11103,PC BIOPSY SKIN TANGENTIAL ADDL LESN,983,1 ,$88.62 ,$57.60 ,$39.62 ,$88.62 ,$66.02 ,$58.05 , N/A ,$46.70 , N/A ,$55.92 ,$55.92 ,$55.92 ,$55.92 ,$79.76 ,$66.47 , N/A ,$77.99 , N/A ,$66.47 ,$66.47 ,$75.33 ,$75.33 , N/A ,$75.33 , N/A ,$70.01 ,$70.01 ,$70.01 ,$79.76 , N/A ,$79.76 , N/A ,$88.62 ,$58.05 , N/A ,$39.62 , N/A , N/A ,$79.76 , N/A ,$55.92 ,$53.17 ,$79.76 , N/A , N/A , N/A , N/A ,$57.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98300150,11107,PC BIOPSY SKIN INCISIONAL ADDL LESN,983,1 ,$88.62 ,$57.60 ,$46.70 ,$88.62 ,$66.02 ,$58.05 , N/A ,$46.70 , N/A ,$55.92 ,$55.92 ,$55.92 ,$55.92 ,$79.76 ,$66.47 , N/A ,$77.99 , N/A ,$66.47 ,$66.47 ,$75.33 ,$75.33 , N/A ,$75.33 , N/A ,$70.01 ,$70.01 ,$70.01 ,$79.76 , N/A ,$79.76 , N/A ,$88.62 ,$58.05 , N/A ,$55.17 , N/A , N/A ,$79.76 , N/A ,$55.92 ,$53.17 ,$79.76 , N/A , N/A , N/A , N/A ,$57.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98500000,93010,PC EKG INTER AND REPORT PRO,985,1 ,$33.23 ,$21.60 ,$15.74 ,$33.23 ,$24.76 ,$21.77 , N/A ,$17.51 , N/A ,$20.97 ,$20.97 ,$20.97 ,$20.97 ,$29.91 ,$24.92 , N/A ,$29.24 , N/A ,$24.92 ,$24.92 ,$28.25 ,$28.25 , N/A ,$28.25 , N/A ,$26.25 ,$26.25 ,$26.25 ,$29.91 , N/A ,$29.91 , N/A ,$33.23 ,$21.77 , N/A ,$15.74 , N/A , N/A ,$29.91 , N/A ,$20.97 ,$19.94 ,$29.91 , N/A , N/A , N/A , N/A ,$21.60 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98500002,93016,PC CARDIAC STRESS TEST SUPERVISION,985,1 ,$171.14 ,$111.24 ,$41.22 ,$171.14 ,$127.50 ,$112.10 , N/A ,$90.19 , N/A ,$107.99 ,$107.99 ,$107.99 ,$107.99 ,$154.03 ,$128.36 , N/A ,$150.60 , N/A ,$128.36 ,$128.36 ,$145.47 ,$145.47 , N/A ,$145.47 , N/A ,$135.20 ,$135.20 ,$135.20 ,$154.03 , N/A ,$154.03 , N/A ,$171.14 ,$112.10 , N/A ,$41.22 , N/A , N/A ,$154.03 , N/A ,$107.99 ,$102.68 ,$154.03 , N/A , N/A , N/A , N/A ,$111.24 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98500003,93018,PC CARDIOVASCULAR STRESS TEST,985,1 ,$78.21 ,$50.84 ,$27.42 ,$78.21 ,$58.27 ,$51.23 , N/A ,$41.22 , N/A ,$49.35 ,$49.35 ,$49.35 ,$49.35 ,$70.39 ,$58.66 , N/A ,$68.82 , N/A ,$58.66 ,$58.66 ,$66.48 ,$66.48 , N/A ,$66.48 , N/A ,$61.79 ,$61.79 ,$61.79 ,$70.39 , N/A ,$70.39 , N/A ,$78.21 ,$51.23 , N/A ,$27.42 , N/A , N/A ,$70.39 , N/A ,$49.35 ,$46.93 ,$70.39 , N/A , N/A , N/A , N/A ,$50.84 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98500004,93306,PC ECHO/CARDIAC DOP/COLOR FLOW-26,985,1 ,$626.96 ,$407.52 ,$330.41 ,"$1,063.83 ",$467.09 ,$410.66 ,$490.89 ,$330.41 ,$490.89 ,$395.61 ,$395.61 ,$395.61 ,$395.61 ,$564.26 ,$470.22 ,$490.89 ,$551.72 ,$490.89 ,$470.22 ,$470.22 ,$532.92 ,$532.92 ,$490.89 ,$532.92 ,$490.89 ,$495.30 ,$495.30 ,$495.30 ,$564.26 ,$626.96 ,$564.26 ,$490.89 ,$626.96 ,$410.66 ,$490.89 ,$366.31 , N/A ,$513.81 ,$564.26 ,"$1,063.83 ",$395.61 ,$376.18 ,$564.26 ,$490.89 , N/A , N/A ,$490.89 ,$407.52 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98500005,93308,PC ECHO 2D W/W/O M-MODE LTD-26,985,1 ,$228.19 ,$148.32 ,$120.26 ,$506.99 ,$170.00 ,$149.46 ,$228.19 ,$120.26 ,$228.19 ,$143.99 ,$143.99 ,$143.99 ,$143.99 ,$205.37 ,$171.14 ,$228.19 ,$200.81 ,$228.19 ,$171.14 ,$171.14 ,$193.96 ,$193.96 ,$228.19 ,$193.96 ,$228.19 ,$180.27 ,$180.27 ,$180.27 ,$205.37 ,$228.19 ,$205.37 ,$228.19 ,$228.19 ,$149.46 ,$228.19 ,$173.31 , N/A ,$228.19 ,$205.37 ,$506.99 ,$143.99 ,$136.91 ,$205.37 ,$228.19 , N/A , N/A ,$228.19 ,$148.32 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98500007,93325,PC ECHO COLOR FLOW VELOCITY MAPPING-26,985,1 ,$77.54 ,$50.40 ,$40.86 ,$77.54 ,$57.77 ,$50.79 , N/A ,$40.86 , N/A ,$48.93 ,$48.93 ,$48.93 ,$48.93 ,$69.79 ,$58.16 , N/A ,$68.24 , N/A ,$58.16 ,$58.16 ,$65.91 ,$65.91 , N/A ,$65.91 , N/A ,$61.26 ,$61.26 ,$61.26 ,$69.79 , N/A ,$69.79 , N/A ,$77.54 ,$50.79 , N/A ,$42.99 , N/A , N/A ,$69.79 , N/A ,$48.93 ,$46.52 ,$69.79 , N/A , N/A , N/A , N/A ,$50.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98500008,93321,PC ECHO DOPPLER LIMITED-26,985,1 ,$77.54 ,$50.40 ,$40.86 ,$77.54 ,$57.77 ,$50.79 , N/A ,$40.86 , N/A ,$48.93 ,$48.93 ,$48.93 ,$48.93 ,$69.79 ,$58.16 , N/A ,$68.24 , N/A ,$58.16 ,$58.16 ,$65.91 ,$65.91 , N/A ,$65.91 , N/A ,$61.26 ,$61.26 ,$61.26 ,$69.79 , N/A ,$69.79 , N/A ,$77.54 ,$50.79 , N/A ,$46.67 , N/A , N/A ,$69.79 , N/A ,$48.93 ,$46.52 ,$69.79 , N/A , N/A , N/A , N/A ,$50.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98500009,93272,PC EVENT RECORDER 24HRS/30DAYS INTERP,985,1 ,$171.14 ,$111.24 ,$47.09 ,$171.14 ,$127.50 ,$112.10 , N/A ,$90.19 , N/A ,$107.99 ,$107.99 ,$107.99 ,$107.99 ,$154.03 ,$128.36 , N/A ,$150.60 , N/A ,$128.36 ,$128.36 ,$145.47 ,$145.47 , N/A ,$145.47 , N/A ,$135.20 ,$135.20 ,$135.20 ,$154.03 , N/A ,$154.03 , N/A ,$171.14 ,$112.10 , N/A ,$47.09 , N/A , N/A ,$154.03 , N/A ,$107.99 ,$102.68 ,$154.03 , N/A , N/A , N/A , N/A ,$111.24 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98500010,93227,PC HOLTER SCAN =< 48 HOURS,985,1 ,$94.15 ,$61.20 ,$48.92 ,$94.15 ,$70.14 ,$61.67 , N/A ,$49.62 , N/A ,$59.41 ,$59.41 ,$59.41 ,$59.41 ,$84.74 ,$70.61 , N/A ,$82.85 , N/A ,$70.61 ,$70.61 ,$80.03 ,$80.03 , N/A ,$80.03 , N/A ,$74.38 ,$74.38 ,$74.38 ,$84.74 , N/A ,$84.74 , N/A ,$94.15 ,$61.67 , N/A ,$48.92 , N/A , N/A ,$84.74 , N/A ,$59.41 ,$56.49 ,$84.74 , N/A , N/A , N/A , N/A ,$61.20 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98500012,93350,PC ECHO REST AND STRESS W/PF-26,985,1 ,$456.37 ,$296.64 ,$240.51 ,"$1,063.83 ",$340.00 ,$298.92 ,$456.37 ,$240.51 ,$456.37 ,$287.97 ,$287.97 ,$287.97 ,$287.97 ,$410.73 ,$342.28 ,$456.37 ,$401.61 ,$456.37 ,$342.28 ,$342.28 ,$387.91 ,$387.91 ,$456.37 ,$387.91 ,$456.37 ,$360.53 ,$360.53 ,$360.53 ,$410.73 ,$456.37 ,$410.73 ,$456.37 ,$456.37 ,$298.92 ,$456.37 ,$335.66 , N/A ,$456.37 ,$410.73 ,"$1,063.83 ",$287.97 ,$273.82 ,$410.73 ,$456.37 , N/A , N/A ,$456.37 ,$296.64 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98500013,93015,PC CARDIOVASCULAR STRESS TEST W/EKG MONITORING,985,1 ,$206.34 ,$134.12 ,$108.74 ,$206.34 ,$153.72 ,$135.15 , N/A ,$108.74 , N/A ,$130.20 ,$130.20 ,$130.20 ,$130.20 ,$185.71 ,$154.76 , N/A ,$181.58 , N/A ,$154.76 ,$154.76 ,$175.39 ,$175.39 , N/A ,$175.39 , N/A ,$163.01 ,$163.01 ,$163.01 ,$185.71 , N/A ,$185.71 , N/A ,$206.34 ,$135.15 , N/A ,$126.65 , N/A , N/A ,$185.71 , N/A ,$130.20 ,$123.80 ,$185.71 , N/A , N/A , N/A , N/A ,$134.12 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98600001,95806,PC SLEEP STUDY UNATTENDED-26,986,1 ,$138.12 ,$89.78 ,$72.79 ,$307.44 ,$102.90 ,$90.47 ,$138.12 ,$72.79 ,$138.12 ,$87.15 ,$87.15 ,$87.15 ,$87.15 ,$124.31 ,$103.59 ,$138.12 ,$121.55 ,$138.12 ,$103.59 ,$103.59 ,$117.40 ,$117.40 ,$138.12 ,$117.40 ,$138.12 ,$109.11 ,$109.11 ,$109.11 ,$124.31 ,$138.12 ,$124.31 ,$138.12 ,$138.12 ,$90.47 ,$138.12 ,$138.12 , N/A ,$138.12 ,$124.31 ,$307.44 ,$87.15 ,$82.87 ,$124.31 ,$138.12 , N/A , N/A ,$138.12 ,$89.78 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98600002,95810,PC SLEEP STUDY PSG 4+ PARAMETERS >6YRS-26,986,1 ,$373.02 ,$242.46 ,$196.58 ,"$2,026.41 ",$277.90 ,$244.33 ,$373.02 ,$196.58 ,$373.02 ,$235.38 ,$235.38 ,$235.38 ,$235.38 ,$335.72 ,$279.77 ,$373.02 ,$328.26 ,$373.02 ,$279.77 ,$279.77 ,$317.07 ,$317.07 ,$373.02 ,$317.07 ,$373.02 ,$294.69 ,$294.69 ,$294.69 ,$335.72 ,$373.02 ,$335.72 ,$373.02 ,$373.02 ,$244.33 ,$373.02 ,$373.02 , N/A ,$373.02 ,$335.72 ,"$2,026.41 ",$235.38 ,$223.81 ,$335.72 ,$373.02 , N/A , N/A ,$373.02 ,$242.46 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98600003,95811,PC SLEEP STUDY PSG 4+ PRMTRS W/CPAP>6YR-26,986,1 ,$386.82 ,$251.43 ,$203.85 ,"$2,026.41 ",$288.18 ,$253.37 ,$386.82 ,$203.85 ,$386.82 ,$244.08 ,$244.08 ,$244.08 ,$244.08 ,$348.14 ,$290.12 ,$386.82 ,$340.40 ,$386.82 ,$290.12 ,$290.12 ,$328.80 ,$328.80 ,$386.82 ,$328.80 ,$386.82 ,$305.59 ,$305.59 ,$305.59 ,$348.14 ,$386.82 ,$348.14 ,$386.82 ,$386.82 ,$253.37 ,$386.82 ,$386.82 , N/A ,$386.82 ,$348.14 ,"$2,026.41 ",$244.08 ,$232.09 ,$348.14 ,$386.82 , N/A , N/A ,$386.82 ,$251.43 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98600004,95805,PC MULTIPLE SLEEP LATENCY TEST-26,986,1 ,$182.07 ,$118.35 ,$95.95 ,"$1,074.60 ",$135.64 ,$119.26 ,$182.07 ,$95.95 ,$182.07 ,$114.89 ,$114.89 ,$114.89 ,$114.89 ,$163.86 ,$136.55 ,$182.07 ,$160.22 ,$182.07 ,$136.55 ,$136.55 ,$154.76 ,$154.76 ,$182.07 ,$154.76 ,$182.07 ,$143.84 ,$143.84 ,$143.84 ,$163.86 ,$182.07 ,$163.86 ,$182.07 ,$182.07 ,$119.26 ,$182.07 ,$182.07 , N/A ,$182.07 ,$163.86 ,"$1,074.60 ",$114.89 ,$109.24 ,$163.86 ,$182.07 , N/A , N/A ,$182.07 ,$118.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98600005,G0399,PC HOME SLEEP STUDY-26,986,1 ,$396.63 ,$257.81 ,$141.86 ,$396.63 ,$295.49 ,$259.79 ,$141.86 ,$209.02 ,$141.86 ,$250.27 ,$250.27 ,$250.27 ,$250.27 ,$356.97 ,$297.47 ,$141.86 ,$349.03 ,$141.86 ,$297.47 ,$297.47 ,$337.14 ,$337.14 ,$141.86 ,$337.14 ,$141.86 ,$313.34 ,$313.34 ,$313.34 ,$356.97 ,$340.55 ,$356.97 ,$141.86 ,$396.63 ,$259.79 ,$141.86 ,$277.64 , N/A ,$148.49 ,$356.97 ,$307.44 ,$250.27 ,$237.98 ,$356.97 ,$141.86 , N/A , N/A ,$141.86 ,$257.81 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98600006,95807,PC SLEEP STUDY ATTENDED NAP - 26,986,1 ,$186.69 ,$121.35 ,$98.39 ,"$1,074.60 ",$139.08 ,$122.28 ,$186.69 ,$98.39 ,$186.69 ,$117.80 ,$117.80 ,$117.80 ,$117.80 ,$168.02 ,$140.02 ,$186.69 ,$164.29 ,$186.69 ,$140.02 ,$140.02 ,$158.69 ,$158.69 ,$186.69 ,$158.69 ,$186.69 ,$147.49 ,$147.49 ,$147.49 ,$168.02 ,$186.69 ,$168.02 ,$186.69 ,$186.69 ,$122.28 ,$186.69 ,$186.69 , N/A ,$186.69 ,$168.02 ,"$1,074.60 ",$117.80 ,$112.01 ,$168.02 ,$186.69 , N/A , N/A ,$186.69 ,$121.35 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98600007,95811,PC SLEEP STUDY PSG 4+ PRMTRS W/CPAP>6YR,986,1 ,$386.82 ,$251.43 ,$203.85 ,"$2,026.41 ",$288.18 ,$253.37 ,$386.82 ,$203.85 ,$386.82 ,$244.08 ,$244.08 ,$244.08 ,$244.08 ,$348.14 ,$290.12 ,$386.82 ,$340.40 ,$386.82 ,$290.12 ,$290.12 ,$328.80 ,$328.80 ,$386.82 ,$328.80 ,$386.82 ,$305.59 ,$305.59 ,$305.59 ,$348.14 ,$386.82 ,$348.14 ,$386.82 ,$386.82 ,$253.37 ,$386.82 ,$386.82 , N/A ,$386.82 ,$348.14 ,"$2,026.41 ",$244.08 ,$232.09 ,$348.14 ,$386.82 , N/A , N/A ,$386.82 ,$251.43 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98600008,95810,PC SLEEP STUDY PSG 4+ PARAMETERS >6YRS,986,1 ,$373.02 ,$242.46 ,$196.58 ,"$2,026.41 ",$277.90 ,$244.33 ,$373.02 ,$196.58 ,$373.02 ,$235.38 ,$235.38 ,$235.38 ,$235.38 ,$335.72 ,$279.77 ,$373.02 ,$328.26 ,$373.02 ,$279.77 ,$279.77 ,$317.07 ,$317.07 ,$373.02 ,$317.07 ,$373.02 ,$294.69 ,$294.69 ,$294.69 ,$335.72 ,$373.02 ,$335.72 ,$373.02 ,$373.02 ,$244.33 ,$373.02 ,$373.02 , N/A ,$373.02 ,$335.72 ,"$2,026.41 ",$235.38 ,$223.81 ,$335.72 ,$373.02 , N/A , N/A ,$373.02 ,$242.46 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98780006,99238,PC HOSPITAL DISCHARGE DAY <31MIN,987,1 ,$654.00 ,$425.10 ,$93.29 ,$654.00 ,$487.23 ,$428.37 , N/A ,$344.66 , N/A ,$412.67 ,$412.67 ,$412.67 ,$412.67 ,$588.60 ,$490.50 , N/A ,$575.52 , N/A ,$490.50 ,$490.50 ,$555.90 ,$555.90 , N/A ,$555.90 , N/A ,$516.66 ,$516.66 ,$516.66 ,$588.60 , N/A ,$588.60 , N/A ,$654.00 ,$428.37 , N/A ,$93.29 , N/A , N/A ,$588.60 , N/A ,$412.67 ,$392.40 ,$588.60 , N/A , N/A , N/A , N/A ,$425.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98780007,99239,PC HOSPITAL DISCHARGE DAY >30MIN,987,1 ,$654.00 ,$425.10 ,$136.71 ,$654.00 ,$487.23 ,$428.37 , N/A ,$344.66 , N/A ,$412.67 ,$412.67 ,$412.67 ,$412.67 ,$588.60 ,$490.50 , N/A ,$575.52 , N/A ,$490.50 ,$490.50 ,$555.90 ,$555.90 , N/A ,$555.90 , N/A ,$516.66 ,$516.66 ,$516.66 ,$588.60 , N/A ,$588.60 , N/A ,$654.00 ,$428.37 , N/A ,$136.71 , N/A , N/A ,$588.60 , N/A ,$412.67 ,$392.40 ,$588.60 , N/A , N/A , N/A , N/A ,$425.10 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98780011,99460,PC INIT HOSP E AND M NEWBORN CARE PER DAY,987,1 ,$300.00 ,$195.00 ,$120.71 ,$300.00 ,$223.50 ,$196.50 ,$120.71 ,$158.10 ,$120.71 ,$189.30 ,$189.30 ,$189.30 ,$189.30 ,$270.00 ,$225.00 ,$120.71 ,$264.00 ,$120.71 ,$225.00 ,$225.00 ,$255.00 ,$255.00 ,$120.71 ,$255.00 ,$120.71 ,$237.00 ,$237.00 ,$237.00 ,$270.00 ,$289.77 ,$270.00 ,$120.71 ,$300.00 ,$196.50 ,$120.71 ,$123.25 , N/A ,$126.34 ,$270.00 ,$261.59 ,$189.30 ,$180.00 ,$270.00 ,$120.71 , N/A , N/A ,$120.71 ,$195.00 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98780012,99462,PC SUBSQ HOSP E AND M NEWBORN CARE PER DAY,987,1 ,$132.00 ,$85.80 ,$54.39 ,$132.00 ,$98.34 ,$86.46 , N/A ,$69.56 , N/A ,$83.29 ,$83.29 ,$83.29 ,$83.29 ,$118.80 ,$99.00 , N/A ,$116.16 , N/A ,$99.00 ,$99.00 ,$112.20 ,$112.20 , N/A ,$112.20 , N/A ,$104.28 ,$104.28 ,$104.28 ,$118.80 , N/A ,$118.80 , N/A ,$132.00 ,$86.46 , N/A ,$54.39 , N/A , N/A ,$118.80 , N/A ,$83.29 ,$79.20 ,$118.80 , N/A , N/A , N/A , N/A ,$85.80 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98780013,99463,PC INIT HOSP E AND M NEWBORN CARE SAME DAY ADMIT/DISCH,987,1 ,$357.00 ,$232.05 ,$120.71 ,$357.00 ,$265.97 ,$233.84 ,$120.71 ,$188.14 ,$120.71 ,$225.27 ,$225.27 ,$225.27 ,$225.27 ,$321.30 ,$267.75 ,$120.71 ,$314.16 ,$120.71 ,$267.75 ,$267.75 ,$303.45 ,$303.45 ,$120.71 ,$303.45 ,$120.71 ,$282.03 ,$282.03 ,$282.03 ,$321.30 ,$289.77 ,$321.30 ,$120.71 ,$357.00 ,$233.84 ,$120.71 ,$141.96 , N/A ,$126.34 ,$321.30 ,$261.59 ,$225.27 ,$214.20 ,$321.30 ,$120.71 , N/A , N/A ,$120.71 ,$232.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98780014,99468,PC INIT HOSP E AND M CRIT CARE NEONATE<28 DAYS,987,1 ,"$3,000.00 ","$1,950.00 ","$1,186.17 ","$3,000.00 ","$2,235.00 ","$1,965.00 ", N/A ,"$1,581.00 ", N/A ,"$1,893.00 ","$1,893.00 ","$1,893.00 ","$1,893.00 ","$2,700.00 ","$2,250.00 ", N/A ,"$2,640.00 ", N/A ,"$2,250.00 ","$2,250.00 ","$2,550.00 ","$2,550.00 ", N/A ,"$2,550.00 ", N/A ,"$2,370.00 ","$2,370.00 ","$2,370.00 ","$2,700.00 ", N/A ,"$2,700.00 ", N/A ,"$3,000.00 ","$1,965.00 ", N/A ,"$1,186.17 ", N/A , N/A ,"$2,700.00 ", N/A ,"$1,893.00 ","$1,800.00 ","$2,700.00 ", N/A , N/A , N/A , N/A ,"$1,950.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98780015,99469,PC SUBSQ HOSP E AND M CRIT CARE NEONATE<28 DAYS,987,1 ,"$1,203.00 ",$781.95 ,$513.61 ,"$1,203.00 ",$896.24 ,$787.97 , N/A ,$633.98 , N/A ,$759.09 ,$759.09 ,$759.09 ,$759.09 ,"$1,082.70 ",$902.25 , N/A ,"$1,058.64 ", N/A ,$902.25 ,$902.25 ,"$1,022.55 ","$1,022.55 ", N/A ,"$1,022.55 ", N/A ,$950.37 ,$950.37 ,$950.37 ,"$1,082.70 ", N/A ,"$1,082.70 ", N/A ,"$1,203.00 ",$787.97 , N/A ,$513.61 , N/A , N/A ,"$1,082.70 ", N/A ,$759.09 ,$721.80 ,"$1,082.70 ", N/A , N/A , N/A , N/A ,$781.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98780016,99475,PC INIT HOSP E AND M CRIT CARE PEDS>24 MOS,987,1 ,"$1,740.00 ","$1,131.00 ",$722.77 ,"$1,740.00 ","$1,296.30 ","$1,139.70 ", N/A ,$916.98 , N/A ,"$1,097.94 ","$1,097.94 ","$1,097.94 ","$1,097.94 ","$1,566.00 ","$1,305.00 ", N/A ,"$1,531.20 ", N/A ,"$1,305.00 ","$1,305.00 ","$1,479.00 ","$1,479.00 ", N/A ,"$1,479.00 ", N/A ,"$1,374.60 ","$1,374.60 ","$1,374.60 ","$1,566.00 ", N/A ,"$1,566.00 ", N/A ,"$1,740.00 ","$1,139.70 ", N/A ,$722.77 , N/A , N/A ,"$1,566.00 ", N/A ,"$1,097.94 ","$1,044.00 ","$1,566.00 ", N/A , N/A , N/A , N/A ,"$1,131.00 " ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98780017,99476,PC SUBSQ HOSP E AND M CRIT CARE PEDS>24 MOS,987,1 ,"$1,041.00 ",$676.65 ,$447.19 ,"$1,041.00 ",$775.55 ,$681.86 , N/A ,$548.61 , N/A ,$656.87 ,$656.87 ,$656.87 ,$656.87 ,$936.90 ,$780.75 , N/A ,$916.08 , N/A ,$780.75 ,$780.75 ,$884.85 ,$884.85 , N/A ,$884.85 , N/A ,$822.39 ,$822.39 ,$822.39 ,$936.90 , N/A ,$936.90 , N/A ,"$1,041.00 ",$681.86 , N/A ,$447.19 , N/A , N/A ,$936.90 , N/A ,$656.87 ,$624.60 ,$936.90 , N/A , N/A , N/A , N/A ,$676.65 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98780018,99477,PC INIT HOSP E AND M INTENSIVE CARE NEO<28 DAYS,987,1 ,"$1,065.00 ",$692.25 ,$450.73 ,"$1,065.00 ",$793.43 ,$697.58 , N/A ,$561.26 , N/A ,$672.02 ,$672.02 ,$672.02 ,$672.02 ,$958.50 ,$798.75 , N/A ,$937.20 , N/A ,$798.75 ,$798.75 ,$905.25 ,$905.25 , N/A ,$905.25 , N/A ,$841.35 ,$841.35 ,$841.35 ,$958.50 , N/A ,$958.50 , N/A ,"$1,065.00 ",$697.58 , N/A ,$450.73 , N/A , N/A ,$958.50 , N/A ,$672.02 ,$639.00 ,$958.50 , N/A , N/A , N/A , N/A ,$692.25 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98780019,99478,PC SUBSQ HOSP E AND M INTENSIVE CARE NEO WT<1500GM,987,1 ,$423.00 ,$274.95 ,$177.17 ,$423.00 ,$315.14 ,$277.07 , N/A ,$222.92 , N/A ,$266.91 ,$266.91 ,$266.91 ,$266.91 ,$380.70 ,$317.25 , N/A ,$372.24 , N/A ,$317.25 ,$317.25 ,$359.55 ,$359.55 , N/A ,$359.55 , N/A ,$334.17 ,$334.17 ,$334.17 ,$380.70 , N/A ,$380.70 , N/A ,$423.00 ,$277.07 , N/A ,$177.17 , N/A , N/A ,$380.70 , N/A ,$266.91 ,$253.80 ,$380.70 , N/A , N/A , N/A , N/A ,$274.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98780020,99479,PC SUBSQ HOSP E AND M INTENSIVE CARE NEO WT 1500-2500GM,987,1 ,$375.00 ,$243.75 ,$160.71 ,$375.00 ,$279.38 ,$245.63 , N/A ,$197.63 , N/A ,$236.63 ,$236.63 ,$236.63 ,$236.63 ,$337.50 ,$281.25 , N/A ,$330.00 , N/A ,$281.25 ,$281.25 ,$318.75 ,$318.75 , N/A ,$318.75 , N/A ,$296.25 ,$296.25 ,$296.25 ,$337.50 , N/A ,$337.50 , N/A ,$375.00 ,$245.63 , N/A ,$160.71 , N/A , N/A ,$337.50 , N/A ,$236.63 ,$225.00 ,$337.50 , N/A , N/A , N/A , N/A ,$243.75 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98780021,99480,PC SUBSQ HOSP E AND M INTENSIVE CARE NEO WT 2501-5000GM,987,1 ,$363.00 ,$235.95 ,$154.27 ,$363.00 ,$270.44 ,$237.77 , N/A ,$191.30 , N/A ,$229.05 ,$229.05 ,$229.05 ,$229.05 ,$326.70 ,$272.25 , N/A ,$319.44 , N/A ,$272.25 ,$272.25 ,$308.55 ,$308.55 , N/A ,$308.55 , N/A ,$286.77 ,$286.77 ,$286.77 ,$326.70 , N/A ,$326.70 , N/A ,$363.00 ,$237.77 , N/A ,$154.27 , N/A , N/A ,$326.70 , N/A ,$229.05 ,$217.80 ,$326.70 , N/A , N/A , N/A , N/A ,$235.95 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98800013,99221,PC INITIAL HOSPITAL CARE LVL 1 LOW 30MIN,987,1 ,$306.00 ,$198.90 ,$131.76 ,$306.00 ,$227.97 ,$200.43 , N/A ,$161.26 , N/A ,$193.09 ,$193.09 ,$193.09 ,$193.09 ,$275.40 ,$229.50 , N/A ,$269.28 , N/A ,$229.50 ,$229.50 ,$260.10 ,$260.10 , N/A ,$260.10 , N/A ,$241.74 ,$241.74 ,$241.74 ,$275.40 , N/A ,$275.40 , N/A ,$306.00 ,$200.43 , N/A ,$131.76 , N/A , N/A ,$275.40 , N/A ,$193.09 ,$183.60 ,$275.40 , N/A , N/A , N/A , N/A ,$198.90 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98800015,99222,PC INITIAL HOSPITAL CARE LVL 2 MOD 50MIN,987,1 ,$411.00 ,$267.15 ,$177.57 ,$411.00 ,$306.20 ,$269.21 , N/A ,$216.60 , N/A ,$259.34 ,$259.34 ,$259.34 ,$259.34 ,$369.90 ,$308.25 , N/A ,$361.68 , N/A ,$308.25 ,$308.25 ,$349.35 ,$349.35 , N/A ,$349.35 , N/A ,$324.69 ,$324.69 ,$324.69 ,$369.90 , N/A ,$369.90 , N/A ,$411.00 ,$269.21 , N/A ,$177.57 , N/A , N/A ,$369.90 , N/A ,$259.34 ,$246.60 ,$369.90 , N/A , N/A , N/A , N/A ,$267.15 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98800016,99223,PC INITIAL HOSPITAL CARE LVL 3 HIGH 70MIN,987,1 ,$609.00 ,$395.85 ,$260.20 ,$609.00 ,$453.71 ,$398.90 , N/A ,$320.94 , N/A ,$384.28 ,$384.28 ,$384.28 ,$384.28 ,$548.10 ,$456.75 , N/A ,$535.92 , N/A ,$456.75 ,$456.75 ,$517.65 ,$517.65 , N/A ,$517.65 , N/A ,$481.11 ,$481.11 ,$481.11 ,$548.10 , N/A ,$548.10 , N/A ,$609.00 ,$398.90 , N/A ,$260.20 , N/A , N/A ,$548.10 , N/A ,$384.28 ,$365.40 ,$548.10 , N/A , N/A , N/A , N/A ,$395.85 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98800017,99231,PC SUBSQ HOSPITAL CARE LVL 1 LOW 15MIN,987,1 ,$117.00 ,$76.05 ,$50.69 ,$117.00 ,$87.17 ,$76.64 , N/A ,$61.66 , N/A ,$73.83 ,$73.83 ,$73.83 ,$73.83 ,$105.30 ,$87.75 , N/A ,$102.96 , N/A ,$87.75 ,$87.75 ,$99.45 ,$99.45 , N/A ,$99.45 , N/A ,$92.43 ,$92.43 ,$92.43 ,$105.30 , N/A ,$105.30 , N/A ,$117.00 ,$76.64 , N/A ,$50.69 , N/A , N/A ,$105.30 , N/A ,$73.83 ,$70.20 ,$105.30 , N/A , N/A , N/A , N/A ,$76.05 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98800018,99232,PC SUBSQ HOSPITAL CARE LVL 2 MOD 25MIN,987,1 ,$216.00 ,$140.40 ,$92.87 ,$216.00 ,$160.92 ,$141.48 , N/A ,$113.83 , N/A ,$136.30 ,$136.30 ,$136.30 ,$136.30 ,$194.40 ,$162.00 , N/A ,$190.08 , N/A ,$162.00 ,$162.00 ,$183.60 ,$183.60 , N/A ,$183.60 , N/A ,$170.64 ,$170.64 ,$170.64 ,$194.40 , N/A ,$194.40 , N/A ,$216.00 ,$141.48 , N/A ,$92.87 , N/A , N/A ,$194.40 , N/A ,$136.30 ,$129.60 ,$194.40 , N/A , N/A , N/A , N/A ,$140.40 ST. ANTHONY'S MEMORIAL HOSPITAL (ACU),98800019,99233,PC SUBSQ HOSPITAL CARE LVL 3 HIGH 35MIN,987,1 ,$315.00 ,$204.75 ,$133.84 ,$315.00 ,$234.68 ,$206.33 , N/A ,$166.01 , N/A ,$198.77 ,$198.77 ,$198.77 ,$198.77 ,$283.50 ,$236.25 , N/A ,$277.20 , N/A ,$236.25 ,$236.25 ,$267.75 ,$267.75 , N/A ,$267.75 , N/A ,$248.85 ,$248.85 ,$248.85 ,$283.50 , N/A ,$283.50 , N/A ,$315.00 ,$206.33 , N/A ,$133.84 , N/A , N/A ,$283.50 , N/A ,$198.77 ,$189.00 ,$283.50 , N/A , N/A , N/A , N/A ,$204.75